At a conference held at the Society for Imaging Informatics in Medicine (SIIM) it was pointed out that computerized physician order-entry (CPOE) technology is not only limited to physicians. CPOE software can be utilized by radiologists to properly call-for the scanner protocols that perform imaging studies.
At the MD Anderson Cancer Center, a scanner protocol order-entry process for radiologists that is fixed in the establishment's electronic medical record (EMR) has significantly diminished paper-driven protocol calling for MR and CT studies at five different locations. Presenter, Dr. Kevin McEnery also notes the order-entry system expands a radiologist's position in clinical management.
"CPOE provides radiologists with the opportunity for an integral role in the imaging process. In my opinion, radiologist CPOE systems will contribute to redefining the radiologist value proposition,” he said.
McEnery went on to add that imaging procedure protocols is a crucial step in decoding the requested imaging study into directions for technologists to use and follow. Traditionally, most radiology departments send-out for imaging protocols through a paper-driven procedure. This strategy however, depends on manual-labor, by going and retrieving clinical information and provides no room for decision support.
Additionally, paper-driven methods often involve obscure logistics like faxing and delivery with the slight chance for lost protocols. Moreover, they are not implemented in the digital workflow and offer no data for process re-structuring and overall improvement.
By implementing clinical order sets in EMRs gives-way to the regularity care of delivery systems.
“These order sets enable efficient clinician ordering of numerous care events. They can also contain multiple instructions for care, covering medications, required tests, nursing instructions, imaging procedures, and consults,” said McEnery.
For CT and MRI, order sets would consist of descriptions and specific instructions of medications covering oral contrast, intravenous contrast, allergy mitigation, and anxiety relief.
Radiologists using the system can choose from a number of CT protocols with designated presets. They themselves can add options and medications. For MRIs, radiologists can select and highlight areas of interest and the scanning sequences required. The system also has the ability to predict how long a protocol will take to be carried-out.
Research studies that focus on the use of CPOE software in radiology are usually assessed EMR order formation by clinicians, with decision-support studies observing clinicians order the proper exam. However, current software doesn’t necessarily identify radiologists as clinicians.
The EMR is essentially an order system, while the RIS is a protocol entry system. Protocols determine the technical facets of an examination, while medication order entry and incorporated oversight of historical information focus on the clinical elements of a radiologist's job; since radiologists make sure a patient's scan will be optimized for radiation, medication, and clinical outcome, he/she must be present in both the technical and clinical imaging areas.
For now McEnery believes a concept of radiologist CPOE: a system that allows radiologists to perform order entry in regards of patient information will lead to vast improvement.
"It will elevate the role of the radiologist in the clinical management process. Radiologists filling out protocols and order sets exactly like clinicians gives the perception and, actually, the reality that the radiologists are participating in the same care-giving process that the clinicians are,” he said.
