JACR: EMR use virtually eliminates violations of portal image review policies

Using an EMR to review portal images during daily radiation treatments dramatically improves compliance with timeliness and record keeping, which, in turn, improves patient care and safety, according to a study in the July issue of the Journal of the American College of Radiology.

Verifying the positioning of patients using portal images improves the accuracy of the radiation field placement, reduces exposure to normal tissue and delivers an accurate dose to tumors, explained authors Andre Konski, MD, MBA, MA, of Wayne State University School of Medicine in Detroit, and colleagues.

“More timely review of portal images is critical because it allows for higher quality care in the treatment of patients with radiation,” Konski said in a release.

Most departments stipulate that portal images should be reviewed within one or two business days, according to the authors. At Barbara Ann Karmanos Cancer Center, where Konski serves as chief of radiation therapy, use of an EMR to review portal images was initiated in March 2010. Prior to using the EMR, portal images were reviewed either on radiographic film or on printouts from systems equipped with electronic portal imaging.

To compare compliance of reviewing portal images before and after implementing EMR access, Konski and colleagues randomly selected a group of patients who were treated by attending physicians during these time periods. Radiographic film portal images from 2009 and portal images in the EMR from March to June 2010 were reviewed for their compliance with proper verification per departmental policy.

A total of 411 portal images were reviewed—204 radiographic films and 207 portal images in the EMR, all signed by the same group of six attending physicians—with results showing a statistically significant improvement in compliance with the portal image review policy after implementation of the EMR. One-in-four portal images reviewed by hand on radiographic films had violations of departmental policy, while just 1 percent of portal images reviewed via the EMR incurred violations.

The most common departmental violations when reviewing by hand were images that did not document the film date when taken by therapists, lack of documentation of date signed, images signed after one business day and images that were never signed.

“The use of the EMR systematically eliminated three of the four potential violations by automatically dating all activity and not allowing images to disappear from the image work list until ultimately reviewed and signed by an attending physician,” wrote the authors.

Konski and colleagues chalked up the improved compliance numbers to the fact that EMR gives physicians expanded access and the convenience of reviewing portal images from remote locations.

“Given this study's findings, in accordance with a nationwide push for transitioning to EMRs, reviewing portal images via an EMR should be standard of care,” they wrote.