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ESP Report: Electronic Health Record-based Interventions for Reducing Inappropriate Imaging in the Clinical Setting

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Electronic Health Record-based Interventions for Reducing Inappropriate Imaging in the Clinical Setting

Investigator: Paul G. Shekelle, MD, PhD
Contributing Investigators: Caroline Lubick Goldzweig, MD, MS; Greg Orshansky, MD; Neil M. Paige, MD, MSHS; Brett A. Ewing, MS

Evidence-based Synthesis Program (ESP) Center, West Los Angeles VA Medical Center, Los Angeles, CA

Washington (DC): Department of Veterans Affairs; January 2015

Download PDF: Complete Report, Executive Summary, Report, Appendices


There are widespread concerns within Veterans Affairs (VA) healthcare and in non-VA US healthcare that the costs of healthcare are rising at unsustainable rates. One driver of cost is the increasing use of radiology imaging procedures, particularly advanced imaging techniques such as computed tomography (CT) scanning, magnetic resonance imaging (MRI), and CT angiography. Most authorities agree that more appropriate use of certain imaging tests could both improve quality and save costs.

The recognition that more appropriate use of imaging could improve quality and reduce costs has led to the development of interventions to encourage more appropriate radiology utilization. Some of these interventions have made use of the clinical decision support capabilities of electronic health records (EHR). VA has been a leader in the use of electronic health records and clinical decision support.

In recognition of the risks and costs associated with inappropriate imaging, VA leadership has requested an evidence synthesis which evaluates studied methods for reducing inappropriate imaging that center around the electronic health record (EHR).

Key questions:

Key Question 1: What is the effectiveness of EHR-based interventions in reducing unnecessary or inappropriate imaging? Key Question 2: Do EHR-based interventions vary in results by system (type of EHR intervention)? Key Question 3: What are the harms or potential harms associated with EHR-based interventions used to reduce inappropriate imaging?

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