title: Using informatics-enabled quality improvement techniques to meet health record documentation requirements in radiology reports.
abstract: OBJECTIVE
  Medicare requires documented teaching physician involvement (attestation) in trainee-generated radiology reports. Automated attestation statement insertion in reports expedites the process but does not comply with requirements for active attestation. We evaluated an informatics-enabled quality improvement (QI) intervention to improve health record documentation requirements for active attestation.
  
  
  METHODS
  Institutional review board approval was not needed for this QI project performed in a 776-bed tertiary/quaternary teaching hospital. The intervention consisted of (1) policy requiring staff radiologists to actively attest to trainee-generated reports by personally activating a "macro" in the reporting system and (2) a semiautomated process to detect reports missing attestation; radiologists received daily e-mail reminders until the attestation statement was inserted. A random sample of 600 of 123,561 trainee-generated radiology reports created 17 months after the intervention (May 2011) was manually reviewed to determine attestation policy adherence. The number of attestation statements added in response to reminders throughout the entire study period was also evaluated. Trend analysis of the number of report addenda containing solely the attestation statement (proxy for missing initial attestation) was performed.
  
  
  RESULTS
  Of 600 reports, 594 (99%) contained the attestation statement. Monthly attestations in response to email notifications decreased from 585 to 227 by the sixth month, a 2.6-fold reduction (P < .01). No significant trend was observed the following year, indicating a sustained effect.
  
  
  CONCLUSIONS
  Informatics-enabled QI techniques resulted in 99% adherence to our teaching physician attestation policy with sustained results. Similar approaches may help improve adherence to other mandated performance measures in radiology reports.
authors.affiliation: Center for Evidence-Based Imaging, Boston, MA, USA. lprevedello@post.harvard.edu
authors.forename: Luciano M
authors.initials: LM
authors.lastname: Prevedello
authors.forename: Cameron
authors.initials: C
authors.lastname: Farkas
authors.forename: Allen
authors.initials: A
authors.lastname: Dufault
authors.forename: Maria
authors.initials: M
authors.lastname: Damiano
authors.forename: Peter
authors.initials: P
authors.lastname: Doubilet
authors.forename: Ramin
authors.initials: R
authors.lastname: Khorasani
mesh_terms: D001900:Boston; D005568:Forms and Records Control / Q000592:standards* / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D008491:Medical Informatics Applications; D016347:Medical Records Systems, Computerized / Q000592:standards* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000592:standards*; D011871:Radiology / Q000592:standards* / Q000706:statistics & numerical data
keywords: Attestation; health record documentation; quality improvement