Impact of a Real-Time Computerized Duplicate Alert System on the Utilization of Computed Tomography

Abstract

The use of high-cost imaging modalities is rising rapidly. From 1995 through 2007, use of computed tomographic (CT) scans in the United States increased more than 4-fold1,2; by 2006, CT and magnetic resonance imaging examinations were the fastest-growing physician-directed Medicare expenditure.3,4 An uncertain proportion of these examinations represent overuse.5 There are little published data on the frequency of duplicated high-cost imaging examinations,6 but economic modeling suggests that cost savings from reducing redundant radiologic testing would be substantial.7 Because unnecessary duplication of CT examinations contributes to an increasingly strained medical payment system and exposes patients to unnecessary potential risks of radiation and intravenous contrast,2,8,9 we sought to determine whether alerting an ordering health care provider to the presence of a potentially redundant recent CT examination via decision support in a computerized physician order entry system (CPOE) can reduce repeated testing.

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