Use of Imaging Appropriateness Criteria for Decision Support During Radiology Order Entry: The MGH Experience

Abstract

This chapter will focus on the institutional perspective of The Massachusetts General Hospital (MGH) in Boston during the first decade of the twenty-first century. We will describe the MGH experience with design, implementation, adoption and current use of a computerized radiology order entry system that displays explicit normative “appropriateness scores” for outpatient CT, MR, and nuclear cardiology procedures and is embedded in routine clinical workflow. The radiology order entry (ROE) and decision support (DS) system has come to be known as ROE-DS within MGH and among a broader community of US radiologists, various industry stakeholders, and policy makers working in the field. One key point that will be emphasized is that a system like ROE-DS in wide use is a necessary, though by no means sufficient, first step in executing comprehensive institutional programs of imaging utilization management, quality improvement, and radiation dose mitigation.