title: Compliance of reviewing portal images on radiographic film vs an electronic medical record.
abstract: OBJECTIVE
  Timely approval of weekly portal images is essential for quality patient care. Most departments stipulate that portal images should be reviewed within 1 to 2 business days after imaging. The purpose of this study was to compare compliance of reviewing portal images per departmental policy before and after implementing an electronic medical record (EMR).
  
  
  METHODS
  The use of an EMR to review portal images was initiated at the investigators' institution in March 2010. Before this, portal images were reviewed on either radiographic film or printouts from machines equipped with electronic portal imaging. The EMR could be accessed remotely by any computer with direct access to the institution's network. Patients selected were those treated by attending physicians present before and after the switch to the EMR. Patients were randomly selected for review of their portal images from 2009 for radiographic film and March to June 2010 for portal images in the EMR. Violations of department policy included unsigned portal images, undated portal images, no date documented when signed by the attending physician, and portal images signed after >1 business day. Violations for each portal image counted only once, even if the portal image had multiple types of violations.
  
  
  RESULTS
  A total of 411 portal images were evaluated. Two hundred four radiographic films taken on 22 different patients were hand signed by 6 different attending physicians. Two hundred seven portal images taken on 16 different patients were reviewed via the EMR by the same 6 attending physicians. Twenty-five percent (51 of 204) of portal images reviewed by hand on radiographic films incurred violations, while 1% (2 of 207) of portal images reviewed via the EMR incurred violations. When portal images were reviewed by hand, 16 (8%) did not have the film date documented when taken by the therapists, 2 (1%) did not have documentation of date signed, 16 (8%) were never signed, and 17 (8%) were signed after 1 business day. All violations incurred with the EMR were for films signed after >1 business day. Chi-square analysis showed a significant improvement in compliance with reviewing portal films with the EMR (P < .001).
  
  
  CONCLUSIONS
  The use of an EMR for reviewing portal images dramatically improved compliance with timeliness and record keeping. Timeliness of reviewing portal images improves patient care and safety.
authors: Department of Radiation Oncology, Wayne State University School of Medicine and Barbara Ann Karmanos Cancer Center, Detroit, Michigan 48201, USA.
authors: George G
authors: GG
authors: Chen
authors: Ahmad
authors: A
authors: Hammoud
authors: Melanie
authors: M
authors: Komajda
authors: Andre
authors: A
authors: Konski
mesh_terms: D004282:Documentation / Q000592:standards*; D057286:Electronic Health Records / Q000592:standards*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D008824:Michigan; D017410:Practice Guidelines as Topic; D011871:Radiology / Q000592:standards*; D014962:X-Ray Film / Q000592:standards*; D014963:X-Ray Intensifying Screens / Q000592:standards*