EHR intervention cuts unnecessary MRI orders by 35%
Integrating informative alerts into a practice’s electronic health record can significantly reduce the amount of unnecessary imaging referrals for patients struggling with chronic headaches.
A substantial portion of neurology referrals are for headache-related reasons, and it is common to send patients for imaging during the diagnostic process. Many of these exams are ultimately deemed normal, and their results often do not affect how patients’ headaches are managed. This can create an added burden on both radiology and neurology providers.
To address this, a team of multidisciplinary experts recently analyzed one institution’s referral processes to determine if certain interventions could help streamline the path patients must take to acquire an appropriate diagnosis.
“The demand for neurology services exceeds the current supply. We convened multiple stakeholders to learn what drives our primary care providers to refer patients with headache to our neurology practice,” senior author Scott Friedenberg, MD, a neurologist at Geisinger Health, and co-authors explained. "This information guided a collaborative effort to evaluate the impact of an electronic health record headache tool on care delivery in our PCP clinics.”
The group created an aid intended to make the entire diagnostic process, including referrals to neurology and for imaging, more efficient. After it was integrated into the institution’s EHR, an alert would appear when providers entered headache as a patient’s primary complaint. The alert included information related to headache disorders, specific red flags that could warrant greater concern, quick access links to imaging indications and orders and medications commonly used to treat headaches, in addition to a request for provider-to-provider consultation. Physicians had the option to accept or decline the alert when it appeared.
The tool’s use resulted in a 77% reduction in neurology referrals and a 35% drop in MRI orders for headaches. Over a period of three months, the group estimated that the decision aid's use saved the institution just over $200,000.
The prescribing habits of primary care providers, however, were minimally impacted by the alert—a finding the authors suggested should be further analyzed when adjusting the intervention in the future.
“Electronically embedding a neurologist's knowledge in our PCP office was an effective way to shape the demand for headache consultation,” the group noted. “By further leveraging stakeholder collaboration, we plan to improve the tool and disseminate it across our health system to reduce headache burden and healthcare costs.”
The study abstract is available in Neurology.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.