EHRs influence emergency radiological interpretations, improve quality of care

Use of electronic health records (EHRs) in the emergency department influences radiological interpretations and improves the overall quality of health care, according to a study published in the May issue of Health Affairs.

While previous research has illustrated the detrimental effects of incomplete clinical information on radiologic interpretations, knowledge regarding the interpretive value of EHRs in delivering radiologic services is limited.

“Radiology is a field particularly suited to remote health care access and delivery, but at the same time it is vulnerable to informational risks, including lack of or inaccurate clinical data, that may influence the interpretation,” wrote John L. Ulmer, MD, of the Medical College of Wisconsin in Milwaukee, the study’s senior author, and colleagues. “For remote image viewing scenarios, whether within the same institution or between institutions, the integration of EHR data into existing information technology has the potential to improve the quality and safety of radiologic practice.”

The researchers looked to determine how often the EHRs that were accessed by interpreting radiologists were thought to offer relevant supplementary information and to estimate the importance of the additional data in interpreting imaging studies.

Ulmer et al compared medical information relevant to 2,000 emergent head CT exams as entered by referring emergency department physicians to additional EHR-derived information obtained by interpreting radiologists. Of the exams reviewed, 49.2 percent were males and 50.8 percent were females, with a mean patient age of 54. Three neuroradiologists independently compared the exams with that of any additional EHR information and then rated any discrepancies between the two.

The neuroradiologist raters found that additional clinical data were present in 49.3 percent of the head CT examinations. A strong agreement among the raters on the presence of additional medical content was observed. The raters predicted that in 179 of the 2,000 patients in the study group, interpretations would “very likely” have been adversely affected by the lack of clinical information that otherwise would have been available through use of the EHR. Additional clinical information was rated as “possibly” having a clinically significant impact on interpretations in 22.3 percent of the cases.

“Our data are the first to show the potential positive benefit of accessing the EHR in optimizing radiological interpretations. Our results support the notion that EHR access is critical for accurate neuroradiology interpretations of ED head CTs,” wrote the study’s authors.

“Health care providers must recognize the value of implementing EHRs and the potential harm that may come from their absence, while policy makers need to continue to work toward nationwide exchange of health information” they concluded.