Radiologists' Perceptions of Computerized Decision Support

A Focus Group Study from the Medicare Imaging Demonstration Project

Published in: AJR, American Journal of Roentgenology, v. 205, no. 5, Nov. 2015, p. 947-955

Posted on RAND.org on November 06, 2015

by Christoph I. Lee, Dmitry Khodyakov, Beverly A. Weidmer, Neil S. Wenger, Justin W. Timbie, Brittain Brantley, Lane F. Burgette, Kristin J. Leuschner, Peter S. Hussey, Katherine L. Kahn

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Research Question

  1. What effect do radiologists perceive a computerized decision support (CDS) intervention had on their interactions with ordering clinicians, their radiology workflow, and the appropriateness of advanced imaging?

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. SUBJECTS AND 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. CONCLUSION: 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.

Key Findings

  • Most radiologists reported no substantial change in the frequency or nature of conversations with referring physicians after CDS was implemented as part of the Medicare Imaging Demonstration Project.
  • Most reported CDS having no effect on their workflow, including their processes, the time spent writing protocols for advanced imaging studies, and the time spent reviewing medical records.
  • Radiologists reported no effect on patient care and quality and no perceived increase in the appropriateness of imaging that clinicians ordered.
  • Radiologists, however, were still generally optimistic about the potential of CDS to increase the overall quality of their work and did not consider the likely decrease in volume to be a professional disadvantage.

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