The effect of incorporating guidelines into a computerized order entry system for diagnostic imaging

Area of Science:

• Health Informatics
• Medical Imaging
• Health Services Research

Background:

• The Manitoba Demonstration Project aimed to improve diagnostic imaging by implementing computerized provider order entry (CPOE) and clinical decision support (CDS).
• Evaluating the impact and implementation of these technologies is crucial for optimizing healthcare delivery.

Purpose of the Study:

• To assess the impact of CPOE and CDS on diagnostic imaging orders.
• To identify barriers to the implementation of these systems.
• To provide insights into quantitative findings related to imaging order appropriateness.

Main Methods:

• A mixed-methods approach combining quantitative order analysis with qualitative data from interviews, focus groups, and observations.
• Data collection occurred at multiple time points: pre-implementation, post-CPOE, post-CDS, and project completion.
• Stakeholder committee involvement guided implementation and interpretation of findings.

Main Results:

• Computerized provider order entry (CPOE) showed good process acceptance, but clinical decision support (CDS) faced low practice acceptance.
• Of 8,757 orders, 10.9% were deemed inappropriate based on guidelines, with only 2% of physicians adhering to CDS advice.
• Barriers included implementation issues, physician perspectives, timing of advice, lack of system integration, and software limitations.

Conclusions:

• Effective decision support requires appropriate timing and seamless integration with patient information systems.
• Implementation and impact evaluations are essential for assessing new system adoption, with early user engagement being key.
• Further research is necessary to quantify the extent of inappropriate diagnostic imaging ordering.