JOURNAL CLUB: Radiologists' Perceptions of Computerized Decision Support: A Focus Group Study From the Medicare Imaging Demonstration Project.
OBJECTIVE
The purpose of this study was to discern radiologists' perceptions regarding the implementation of a decision support system intervention as part of the Medicare Imaging Demonstration project and the effect of decision support on radiologists' interactions with ordering clinicians, their radiology work flow, and appropriateness of advanced imaging.


METHODS
A focus group study was conducted with a diverse sample of radiologists involved in interpreting advanced imaging studies at Medicare Imaging Demonstration project sites. A semistructured moderator guide was used, and all focus group discussions were recorded and transcribed verbatim. Qualitative data analysis software was used to code thematic content and identify representative segments of text. Participating radiologists also completed an accompanying survey designed to supplement focus group discussions.


RESULTS
Twenty-six radiologists participated in four focus group discussions. The following major themes related to the radiologists' perceptions after decision support implementation were identified: no substantial change in radiologists' interactions with referring clinicians; no substantial change in radiologist work flow, including protocol-writing time; and no perceived increase in imaging appropriateness. Radiologists provided suggestions for improvements in the decision support system, including increasing the usability of clinical data captured, and expressed a desire to have greater involvement in future development and implementation efforts.


CONCLUSIONS
Overall, radiologists from health care systems involved in the Medicare Imaging Demonstration did not perceive that decision support had a substantial effect, either positive or negative, on their professional roles and responsibilities. Radiologists expressed a desire to improve efficiencies and quality of care by having greater involvement in future efforts.
1 Department of Radiology, University of Washington School of Medicine, Department of Health Services, University of Washington School of Public Health; 825 Eastlake Ave E, G3-200, Seattle, WA 98109-1023.|2 RAND Corporation, Santa Monica, CA.
Christoph I
CI
Lee
2 RAND Corporation, Santa Monica, CA.
Dmitry
D
Khodyakov
2 RAND Corporation, Santa Monica, CA.
Beverly A
BA
Weidmer
2 RAND Corporation, Santa Monica, CA.|3 Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Neil S
NS
Wenger
2 RAND Corporation, Santa Monica, CA.
Justin W
JW
Timbie
2 RAND Corporation, Santa Monica, CA.
Brittain
B
Brantley
2 RAND Corporation, Santa Monica, CA.
Lane F
LF
Burgette
2 RAND Corporation, Santa Monica, CA.
Kristin J
KJ
Leuschner
2 RAND Corporation, Santa Monica, CA.
Peter S
PS
Hussey
2 RAND Corporation, Santa Monica, CA.|3 Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Katherine L
KL
Kahn
D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D020000:Decision Support Systems, Clinical; D017144:Focus Groups; D006801:Humans; D006278:Medicare; D011871:Radiology; D014481:United States
advanced imaging; appropriateness criteria; computerized physician order entry; decision support