Excerpt

There are widespread concerns within Veterans Affairs (VA) healthcare and in non-VA US healthcare that the costs of healthcare are rising at unsustainable rates. One driver of cost is the increasing use of radiology imaging procedures, particularly advanced imaging techniques such as computed tomography (CT) scanning, magnetic resonance imaging (MRI), and CT angiography. Most authorities agree that more appropriate use of certain imaging tests could both improve quality and save costs.

The recognition that more appropriate use of imaging could improve quality and reduce costs has led to the development of interventions to encourage more appropriate radiology utilization. Some of these interventions have made use of the clinical decision support capabilities of electronic health records (EHR). VA has been a leader in the use of electronic health records and clinical decision support.

In recognition of the risks and costs associated with inappropriate imaging, VA leadership has requested an evidence synthesis which evaluates studied methods for reducing inappropriate imaging that center around the electronic health record (EHR).

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • INTRODUCTION
  • METHODS
  • RESULTS
  • DISCUSSION
  • Abbreviations Table
• INTRODUCTION
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION 1 What is the effectiveness of EHR-based interventions in reducing unnecessary or inappropriate imaging?
  • KEY QUESTION 2 Do EHR-based interventions vary in results by system?
  • KEY QUESTION 3 What are the harms or potential harms associated with EHR-based interventions used to reduce inappropriate imaging?
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE BY KEY QUESTION
  • LIMITATIONS
  • RESEARCH GAPS/FUTURE RESEARCH
  • CONCLUSIONS
• REFERENCES
• APPENDIX A Evidence Tables
• APPENDIX B Search Strategies
• APPENDIX C Description of Outcomes Used as Measures of Appropriate or Inappropriate Use
• APPENDIX D Data Abstraction
• APPENDIX E Peer Review Comments/Author Responses

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, West Los Angeles VA Medical Center, Los Angeles, CA, Paul G. Shekelle, MD, PhD, Director

Suggested citation:

Goldzweig C L, Orshansky G, Paige N M, Ewing B A, Miake-Lye I M, Beroes J M, Shekelle P G. Electronic Health Record-Based Interventions for Reducing Inappropriate Imaging in the Clinical Setting: A Systematic Review of the Evidence. VA ESP Project #05-226; 2014.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the West Los Angeles VA Medical Center, Los Angeles, CA, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.