JACR: 5 strategies to tap into IT & optimize protocols

Optimizing radiology protocols is essential for ensuring that imaging procedures answer the relevant clinical questions without running into inefficient delays, and IT can lend a much-needed helping hand in improving protocol performance, according to an article published in the October issue of the Journal of the American College of Radiology.

Ramin Khorasani, MD, MPH, of the department of radiology at Brigham and Women’s Hospital in Boston, explained that optimal imaging protocols allow radiologists the best chance to make an accurate diagnosis and reduce unnecessary follow-up examinations. If protocols are not well thought out and up-to-date, they could expose patients to the risks of additional imaging, such as additional contrast agents or radiation, depending on the procedure.

“The impact of suboptimal protocolling on reducing the quality, safety and efficiency of care in the radiology department is perhaps underappreciated even by most radiologists,” wrote Khorasani.

Khorasani said that it is not uncommon for important clinical information to be discovered at the time a patient arrives for a scheduled procedure. These late discoveries result in much inefficiency if the protocols then have to change based on the needs of the patient.

The article provided five ways IT can be used to optimize imaging study protocols:

1. Create protocolling worklists – Similar to interpretation worklists, protocolling worklists should be integrated into workflow, dynamically updated throughout the day and available on PACS workstations. These worklists should be generated using the imaging request time rather than the scheduled procedure time.
2. Present a synopsis of the relevant EMR data – Physician notes, history of the present illness, current medications, allergies and prior images are just some examples of data that should be available to radiologists at the time of protocolling to improve quality, safety and efficiency.
3. Provide decision support to the radiologist – Evidence-based clinical decision support has been shown to reduce the inappropriate use of imaging when used by ordering physicians. Likewise, decision support tools for radiologists during protocolling could provide additional help in reducing unnecessary exams.
4. Enable medication order entry – When ordering any medication, including contrast agents, the use of a medication order entry and decision support module integrated with EMR data can reduce medication errors.
5. Create a radiologist-centric user interface – The user interfaces used during protocolling should combine only the relevant data from the RIS and EMR to enable a more efficient process.

Khorasani noted that future studies could identify performance gaps in protocolling that could be improved.