Harnessing Technology to Make Better Decisions at MGH

By Scott Harris

Health IT holds plenty of promise for improving outcomes and quality. But as new data illustrate, it is not an end in itself. Electronic records systems can be useful in the battle for better quality and lower costs. But like any other tool, health IT is only as effective as the person wielding it.

A recent study in Health Affairs showed that having computer-based access to imaging test results — a tool intended to help doctors and care teams work smarter — resulted in a 40 to 70 percent greater chance of tests being ordered. The added convenience of ordering through a computer-based entry system may be one underlying factor.

“These findings raise the possibility that, as currently implemented, electronic access does not decrease test ordering in the office setting and may even increase it, possibly because of system features that are enticements to ordering,” the study co-authors wrote. “We conclude that use of these health information technologies, whatever their other benefits, remains unproven as an effective cost-control strategy.”

The key words in that quote may be “as currently implemented.” Many hospitals, not to mention office practices, are still figuring out how to set up and optimize their health IT systems.

If current systems can indeed lead to increased ordering, at least in the world of radiological testing, can they lead to a solution as well? Massachusetts General Hospital (MGH), for one, has found that they can. MGH’s Radiology Order Entry (ROE) system, first implemented in 2001, provides more than just an easy way to order tests and view results. An easy-to-understand scoring component harnesses data to help caregivers make better decisions in real time.

“ROE uses a set of standard criteria from the American College of Radiology to provide a decision-support score,” said Jeffrey Weilburg, MD, associate medical director of the Mass General Physicians Organization. “It seems to moderate the growth of utilization and may even reduce variation in ordering among primary care physicians.”

When a doctor or other provider attempts to order a test through the ROE, the system automatically provides a score of 1 to 9. A number between 1 and 3 is a “red” score, and indicates that the requested test is unlikely to help. “Yellow” scores between 4 and 6 mean the test might help, and a “green” score of 7 to 9 means the requested procedure is appropriate. In addition, the ROE system also offers test alternatives — for example, an MRI instead of a CT — and warnings about duplicate exams and radiation.

A study published in 2009 in Radiology found that the annual growth of MGH’s outpatient imaging orders decreased significantly before and after ROE’s implementation. Annual CT growth decreased from 12 percent to 1 percent, MR growth went down from 12 percent to 7 percent, and ultrasonography growth went from 9 percent to 4 percent.

“This is computer-based order entry combined with decision support and feedback to users for the sake of quality improvement,” Weilburg said.