EHR-Based Order Prioritization Could Streamline MRI Use

Posted on December 5, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

New research suggests that the overuse of STAT requests for MRIs could be trimmed down considerably if criteria for using such requests were integrated into healthcare organizations’ EHRs. The study also suggests, indirectly at least, that adding timing requests for various procedures into EHRs could help with overall workflow in many facilities.

Researchers from Emory University School of Medicine in Atlanta, who presented their findings at the RSNA 2017 show last month, found that the volume of STAT brain MRIs had increased to the point where 60% of all MRI orders were ordered as STAT between 2012 and 2015.

The increasing use of the STAT designation has ended up creating a bottleneck, researchers concluded. They found that the volume of STAT requests for brain MRIs was so high that it actually led to delays in turnarounds for those studies. In fact, they found that the mean turnaround time for STAT brain MRIs was roughly 50% longer than routine brain MRIs (23.43 hours versus 15.46 hours).

Among the sources of this problem, it seems, is that few clinicians were aware of the hospital’s policy for STAT MRIs. In an online survey of 97 providers, only 4% were aware that a STAT imaging study should be initiated within 30 minutes of the order. Instead, many expected that a stat MRI would be completed within the same day for inpatients within 2 to 3 days for outpatients, according to a story appearing in Radiology Business.

To address this problem, the researchers are proposing that hospitals add order prioritization criteria to their EHR.  These criteria will include definitions and clinical examples to help clinicians sort out which category to use when ordering a brain MRI.

This approach would also help clinicians better understand how the institution defines normal versus STAT priority for imaging orders. The researchers are recommending that hospitals include EMR documentation defining both STAT and routine categories, as well as a statement of when they can expect imaging to be completed under each category.

Adding categories and definitions of when imaging orders should be categorized as STAT would actually appeal to clinicians, the study suggests. Researchers found that more than 70% of clinicians said they would find clinical examples of an order prioritization scheme useful. What’s more, 84% of clinicians responding to the study said they would order routine MRIs if they were assured the studies would be completed within 24 hours.

The authors admitted that integrating order prioritization schemes for imaging could be time-consuming for IT departments, which suggests that finding other ways to set these priorities over the short term is probably a good idea. But given how supportive clinicians seem to be the idea of improving order turnaround, it seems likely that the EHR integration work should get done before too long.