title: Effect of computerized physician order entry on imaging study indication.
abstract: OBJECTIVE
  The effect of computerized physician order entry (CPOE) on imaging indication quality had only been measured in one institution's emergency department using a homegrown electronic health record with faculty physicians, and only with one instrument. To better understand how many US hospitals' recent CPOE implementations had affected indication quality, we measured its effect in a generalizable inpatient setting, using one existing and one novel instrument.
  
  
  METHODS
  We retrospectively analyzed the indications for 100 randomly selected inpatient abdominal CT studies during 2 calendar months immediately prior to a 3/3/2012 CPOE implementation (1/1/2012-2/29/2012) and during 2 subsequent calendar months (5/1/2012-6/30/2012). We excluded 2 intervening months to avoid behaviors associated with adoption. We measured indication quality using a published 8-point explicit scoring scale and our own, novel, implicit 7-point Likert scale.
  
  
  RESULTS
  Explicit scores increased 93% from a pre-CPOE mean ± 95% confidence interval of 1.4 ± 0.2 to a CPOE mean of 2.7 ± 0.3 (P < .01). Implicit scores increased 26% from a pre-CPOE mean of 4.3 ± 0.3 to a CPOE mean of 5.4 ± 0.2 (P < .05). When presented with a statement that an indication was "extremely helpful," and choices ranging from "strongly disagree" = 1 to "strongly agree" = 7, implicit scores of 4 and 5 signified "undecided" and "somewhat agree," respectively.
  
  
  CONCLUSIONS
  In an inpatient setting with strong external validity to other US hospitals, CPOE implementation increased indication quality, as measured by 2 independent scoring systems (one pre-existing explicit system and one novel, intuitive implicit system). CPOE thus appears to enhance communication from ordering clinicians to radiologists.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, California. Electronic address: jpevnick@gmail.com.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Pevnick
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Herzik
authors.affiliation: Enterprise Information Services, Cedars-Sinai Health System, Los Angeles, California.
authors.forename: Ximin
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Imaging, Cedars-Sinai Health System, Los Angeles, California.
authors.forename: Irene
authors.initials: I
authors.lastname: Chen
authors.affiliation: Department of Physical Medicine and Rehabilitation, Veteran Affairs Greater Los Angeles Health System, Los Angeles, California.
authors.forename: Mamata
authors.initials: M
authors.lastname: Chithriki
authors.affiliation: Department of Physical Medicine and Rehabilitation, Veteran Affairs Greater Los Angeles Health System, Los Angeles, California.
authors.forename: Lysander
authors.initials: L
authors.lastname: Jim
authors.affiliation: Department of Emergency Medicine, Cedars-Sinai Health System, Los Angeles, California.
authors.forename: Paul
authors.initials: P
authors.lastname: Silka
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D009518:New York; D011785:Quality Assurance, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011860:Radiography, Abdominal / Q000592:standards / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000592:standards / Q000706:statistics & numerical data*
keywords: Computerized physician order entry; diagnostic imaging; medical informatics; referral and consultation