Opportunities for Innovation to Enhance the Image Ordering Process

Abstract

Objectives: To quantify clinical concepts relevant to radiology consultation requests and assess rates of clinical decision support (CDS) attributes documented in Emergency Department provider notes at the time of image order entry. Methods: We reviewed data from encounters for patients with headaches during which head CT was performed. We compared relevant concepts extracted via natural language processing of notes to image order requisitions. We reviewed data from encounters for patients with falls, trauma, or bicycle accidents during which cervical spine imaging was performed and reviewed rates of CDS attributes and agreement with concepts in CDS module. Results: We identified a significant number of encounters where provider EHR documentation was available at the time of image order entry applicable to order requisitions as well as CDS rules and exclusion criteria. Significantly more concepts relevant to headache were extracted from notes compared to order requisitions. Discussion: EHR Clinical documentation provides a source of valuable information that could be used in an automated fashion to improve communication between ordering providers and radiologists and enhance the order entry process. Conclusion: Future work is needed to integrate and automate within the EHR to optimize documentation and communication of clinically useful information in the ordering process.