EHR Interventions Reduce Contrast-Enhanced CT Utilization

Using an electronic health record (EHR) order entry-based interventions implemented in response to the global iodinated contrast media shortage significantly reduced contrast-enhanced CT utilization within a large health system. The findings, published in the American Journal of Roentgenology, “indicate the ability to rapidly achieve changes in ordering clinician behavior and subsequent clinical practice using system-wide EHR changes,” wrote first author Daniel I. Glazer of the Center for Evidence-Based Imaging at Brigham and Women’s Hospital in Boston, MA.

Glazer and colleagues’ retrospective study included 78,792 patients who underwent at least one CT examination (outpatient, inpatient, or emergency department setting) from April 1–July 3, 2022. On May 10, an initial EHR intervention created a sidebar alert after any contrast-enhanced body CT orders, noting the present iohexol shortage and recommending alternate imaging modalities. A second EHR-based intervention on May 16, 2022, required referrers to enter detailed clinical information for all contrast-enhanced body CT orders, which radiologists used when protocoling examinations.

Ultimately, the mean number of patients undergoing contrast-enhanced CT per weekday during pre-intervention, first post-intervention, and second post-intervention periods was 726, 689, and 639; the mean number of contrast-enhanced CT orders was 154, 143, and 131.

Noting that their health system encompassed two large academic medical centers, seven community hospitals, three specialty hospitals, and multiple affiliated ambulatory care centers—all using a single EHR (Hyperspace, Epic Systems, Verona, WI)—“the number of patients undergoing contrast-enhanced CT examinations per day decreased by 12.0%, and the number of orders for CT with contrast media decreased by 15.2% per day,” the authors of this AJR article concluded.