Quality of indications improve with computerized physician order entry

The use of computerized physician order entry (CPOE) in typical inpatient settings increases the quality of imaging indications and improves overall communication among clinicians and radiologists, according to a study published in the January issue of the Journal of the American College of Radiology.

Many prominent studies have been conducted showing both the benefits and disadvantages of CPOE implementation. Until recently, however, only one study had been conducted (in one emergency department using a single scoring instrument) to evaluate CPOE’s effectiveness in improving overall imaging indication quality.

The team of researchers from the Cedar Sinai Health System in Los Angeles set out to measure the effects of CPOE using one novel and one existing instrument in a generalized inpatient setting. “When our large hospital implemented inpatient CPOE, it provided an excellent setting, from the standpoint of external validity to other U.S. hospitals, to further test the effect of CPOE on indication quality,” wrote lead author Joshua M. Pevnick, MD, MHSA, and colleagues.

To do so, the team utilized an already published eight-point explicit scoring scale and an implicit seven-point Likert scale of their own creation to retrospectively analyze the imaging indications of 100 inpatient abdominal CT studies. The randomly selected studies took place during the two months immediately preceding CPOE implementation as well as a subsequent two-month period under the new CPOE system.

Their results showed that explicit scores on imaging indications increased by 93 percent during the two months following implementation of CPOE, rising from a mean of 1.4 under the paper ordering system to 2.7 with CPOE. Implicit scores registered a 26 percent increase from 4.3 with paper to 5.4 using CPOE over the same time period. “Thus CPOE appears to enhance communication from ordering clinicians to radiologists,” the authors wrote.

The team noted that several potential limitations existed in the way the study was conducted, including the possibility of outside variables influencing scoring and resource restrictions that may have limited their ability to conduct a more wide-ranging study. They believe their results to be meaningful, however, and could prove valuable in future research into the effectiveness of CPOE in inpatient settings.

“It is important to know that these methods, which are the best currently available, showed no decrement in indication quality associated with CPOE implementation,” concluded Pevnick et al. “Further study would be helpful to learn whether CPOE-mediated increases in indication quality improve image interpretations, and ultimately patient outcomes.”