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EHR Decision Support Ups Radiologic Test Appropriateness

Harms of computerized clinical decision-support capabilities of EHR rarely assessed

TUESDAY, April 21, 2015 (HealthDay News) -- Computerized clinical decision-support (CCDS) capabilities of electronic health records may improve appropriate use of diagnostic radiologic test ordering and reduce test use, according to a review published in the April 21 issue of the Annals of Internal Medicine.

Caroline Lubick Goldzweig, M.D., from the West Los Angeles Veterans Affairs Medical Center and University of California, Los Angeles, and colleagues reviewed interventions that use the CCDS capabilities of the electronic health record to improve appropriate use of diagnostic radiologic test ordering. Data were included for 23 studies that assessed the impact of CCDS on diagnostic radiologic test ordering in adults.

The researchers found that moderate-level evidence that CCDS improves appropriateness (effect size, −0.49) and reduces use of diagnostic tests (effect size, −0.13) was provided by 13 studies. Interventions that prevent a clinician from overriding the CCDS without outside consultation ("hard stop") and interventions in integrated care delivery systems were suggested to be more effective. Harms were rarely assessed, but included reduction in appropriate test ordering and physician dissatisfaction.

"Computerized clinical decision support integrated with the electronic health record can improve appropriate use of diagnostic radiology by a moderate amount and decrease use by a small amount," the authors write. "Before widespread adoption can be recommended, more data are needed on potential harms."

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