title: Structured physician order entry for trauma CT: value in improving clinical information transfer and billing efficiency.
abstract: OBJECTIVE
  The purpose of this study was to measure the effects of use of a structured physician order entry system for trauma CT on the communication of clinical information and on coding practices and reimbursement efficiency.
  
  
  METHODS
  This study was conducted between April 1, 2011, and January 14, 2013, at a level I trauma center with 59,000 annual emergency department visits. On March 29, 2012, a structured order entry system was implemented for head through pelvis trauma CT, so-called pan-scan CT. This study compared the following factors before and after implementation: communication of clinical signs and symptoms and mechanism of injury, primary International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) code category, success of reimbursement, and time required for successful reimbursement for the examination. Chi-square statistics were used to compare all categoric variables before and after the intervention, and the Wilcoxon rank sum test was used to compare billing cycle times.
  
  
  RESULTS
  A total of 457 patients underwent pan-scan CT in 2734 distinct examinations. After the intervention, there was a 62% absolute increase in requisitions containing clinical signs or symptoms (from 0.4% to 63%, p<0.0001) and a 99% absolute increase in requisitions providing mechanism of injury (from 0.4% to 99%, p<0.0001). There was a 19% absolute increase in primary ICD-9-CM codes representing clinical signs or symptoms (from 2.9% to 21.8%, p<0.0001), and a 7% absolute increase in reimbursement success for examinations submitted to insurance carriers (from 83.0% to 89.7%, p<0.0001). For reimbursed studies, there was a 14.7-day reduction in mean billing cycle time (from 68.4 days to 53.7 days, p=0.008).
  
  
  CONCLUSIONS
  Implementation of structured physician order entry for trauma CT was associated with significant improvement in the communication of clinical history to radiologists. The improvement was also associated with changes in coding practices, greater billing efficiency, and an increase in reimbursement success.
authors.affiliation: 1 Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Wortman
authors.forename: Asha
authors.initials: A
authors.lastname: Goud
authors.forename: Ali S
authors.initials: AS
authors.lastname: Raja
authors.forename: Dana
authors.initials: D
authors.lastname: Marchello
authors.forename: Aaron
authors.initials: A
authors.lastname: Sodickson
mesh_terms: D001900:Boston / Q000453:epidemiology; D017598:Efficiency, Organizational / Q000191:economics* / Q000706:statistics & numerical data; D005249:Fees and Charges / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006747:Hospital Communication Systems / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000706:statistics & numerical data; D038801:International Classification of Diseases / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D050316:Medical Order Entry Systems / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D010350:Patient Credit and Collection / Q000191:economics* / Q000706:statistics & numerical data; D015995:Prevalence; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000191:economics* / Q000453:epidemiology
keywords: CT; clinical history; emergency radiology; trauma