Latest Updates

July 23rd, 2007       July 6th, 2007

According to research from around the world, 10%-20% of diagnostic imaging exams that physicians order are not the most appropriate ones given the patient’s clinical symptoms. Either the one that is selected is not the most effective or no imaging study needs to be performed to determine a diagnosis and treatment.

A committee of the Canadian Association of Radiologists (CAR) chaired by Dr. Martin Reed adapted a set of appropriateness guidelines that were developed by the Royal College of Radiologists in Britain. The guidelines were developed using scientific evidence to establish the best possible diagnostic imaging exam given a particular set of clinical symptoms. The CAR guidelines were released in print and online in September and are also available on the Web sites of the Canadian Medical Association and the College of Family Physicians of Canada.

The Federal Department of Health agreed to fund projects designed to assess the impact of imbedding these guidelines in an electronic order entry system on physicians’ patterns of ordering diagnostic imaging studies.  Manitoba was the first province to commit funding to such a project, and Dr. Blake McClarty, Head of Diagnostic Imaging for the WRHA,  chose the Children’s Hospital as the site.  The CAR has received $750,000 from the Federal Department of Health and $250,000 from Manitoba Health to fund this project.  For the project we will be using Percipio™, an electronic diagnostic imaging order-entry software developed by Medicalis Inc., a Canadian company based in Waterloo, Ontario

The study will collect both qualitative and quantitative data. It will examine how to gain physician acceptance of the guidelines and software, some of the issues they face with using the software, and the impact of the software on physicians’ ordering patterns. That is, how often referring physicians follow the CAR guidelines by changing or cancelling their initial order whenever the software recommends that a different type of imaging test be ordered, and how often they override the guidelines’ recommendation in ordering.

1. As of mid July there were 8386 DI orders through Percipio.  The majority of those (82%) were entered by residents or staff physicians.  There was no improvement in response to prompts from the CAR Guidelines on appropriate use of DI resources.

• 386 (5%) orders triggered a decision prompt indicating that there was a duplicate order for the same child within the past month.  26% of these duplicate orders were abandoned.

• 839 (12%) orders triggered a decision prompt that the test order was not supported by the appropriate pediatric DI use guidelines created by the Canadian Association of Radiologists.  Only 5% of these inappropriate DI orders were abandoned.

2. Current funding for the project will end at the end of August 2007.  Efforts are being made to extend the project for further evaluation.  Interested individuals should contact Martin Reed, MD, Project Site Leader (mreed@hsc.mb.ca).
3. On Tuesday September 18^th an Invitational Workshop on the project will take place at the Caboto Centre (Italian Canadian Cultural Centre) on Wilkes Ave. The purpose of the session is to discuss and disseminate what we have learned through this project.  There will be two simultaneous streams to the Workshop: one focussed on the concerns of policy makers and the second addressed to clinicians.  Anyone with an interest in clinical guidelines and wait times management will benefit from attending the Workshop.  If you are interested in attending, please be in touch with anyone associated with the project.
4. REMINDER on the purpose of this project:  The prompts that you encounter in the process of creating a DI requisition through Percipio are designed to help you make the most appropriate use of DI resources.  The prompts are not intended as a hindrance, but as an opportunity to think about conserving a limited resource so that it can be put to better use.
5. All assistance calls should go through the WRHA e-health HELP Desk: 940-8500.
6. Keir Johnson, of the WRHA Research and Evaluation Unit, will be organizing interviews over the next month as part of closing data collection.
7. We want to hear from you.  If you have any comments, suggestions or concerns about the project, please contact the Project Evaluator, Keir Johnson at 926-8065 or kjohnson@wrha.mb.ca  Discussions with the project evaluator will be shared with the project team anonymously (your name will be kept confidential).

Top

1. At the end of June there were 7444 DI orders through Percipio.  The majority of those (81%) were entered by residents or staff physicians. 

339 (5%) orders triggered a decision prompt indicating that there was a duplicate order for the same child within the past month.  26% of these duplicate orders were abandoned.

739 (12%) orders triggered a decision prompt that the test order was not supported by the appropriate pediatric DI use guidelines created by the Canadian Association of Radiologists.  Only 4% of these inappropriate DI orders were abandoned.

2. As of the end of June the Project Software Application Administrator, Hossein Pourreza, left the project.  All assistance calls should go through the WRHA e-health HELP Desk: 940-8500.
3. Current funding for the project will end at the end of August 2007.  Efforts are being made to extend the project for further evaluation.  Interested individuals should contact Martin Reed, MD, Project Site Leader (mreed@hsc.mb.ca).
4. On Tuesday September 18^th an Invitational Workshop on the project will take place at the Caboto Centre (Italian Canadian Cultural Centre) on Wilkes Ave. The purpose of the session is to discuss and disseminate what we have learned through this project.  There will be two simultaneous streams to the Workshop: one focussed on the concerns of policy makers and the second addressed to clinicians.  Anyone with an interest in clinical guidelines and wait times management will benefit from attending the Workshop.  If you are interested in attending, please be in touch with anyone associated with the project.
5. REMINDER on the purpose of this project:  The prompts that you encounter in the process of creating a DI requisition through Percipio are designed to help you make the most appropriate use of DI resources.  The prompts are not intended as a hindrance, but as an opportunity to think about conserving a limited resource so that it can be put to better use.
6. Keir Johnson, of the WRHA Research and Evaluation Unit, will be organizing interviews over the next month as part of closing data collection.
7. We want to hear from you.  If you have any comments, suggestions or concerns about the project, please contact the Project Evaluator, Keir Johnson at 926-8065 or kjohnson@wrha.mb.ca  Discussions with the project evaluator will be shared with the project team anonymously (your name will be kept confidential).

Top