E-prescribing could help control medical radiation exposure

There has been considerable discussion on the federal stimulus program and the impact it will have in bringing about an improved patient care model through the use of technology. This anticipates care providers having access to electronic health records (EHRs) that can communicate, or “interoperate,” with other health providers and health systems so a complete record of all a patient’s episodes of care, including pharmaceutical records, are available in real-time for physician review. As I explain below, these mechanisms could be used to help monitor and control medical radiation exposure.

This EHR model also anticipates practitioners electronically prescribing medications and having the system advise them of any interactions or allergies to the medications being requested. Such a system could enhance the quality of care, improve outcomes, minimize adverse results, and lower the overall cost of providing healthcare. The model is reminiscent of other industries where the introduction of information technology has had a major positive impact.

To qualify for stimulus funding, healthcare providers need to demonstrate that they actually use the technology in the application of care through a process called “meaningful use,” a guideline published by the Office of the National Coordinator for Health Information Technology. This guideline actually details what type of transactional information must be recorded and used via an EHR product during the care process and at what level of activity (for example, 60% of all prescriptions must be ordered electronically by 2011). The requirements are very rigid and have provoked considerable pushback from the physician community.

Surprisingly, one major component of healthcare, radiology, has been conspicuously omitted from this model. Radiology as a discipline has been at the forefront of IT adoption for more than a decade and the diagnostic equipment used in procedures interoperates extremely well with systems for order management and results reporting.

To demonstrate this in a practical fashion, let’s examine the e-prescribing model with radiation dosage as a substitute for pharmaceuticals. In this example, the EHR system of the radiologist’s practice will have as discrete data elements the levels of exposure and dose a patient has experienced over a period of time. These discrete elements are easily captured in the EHR system, since it is fed electronically from the diagnostic device itself. So the exact dose and duration that the patient received is stored in the permanent record.

This is actually an improvement over the pharmaceutical model, in that typically what is captured is which pharmaceuticals were ordered, not necessarily what was taken by the patient. (How many times has a patient admitted forgetting to take their required mediation or taking it at the wrong time of day)?

If we proceed on the assumption that EHRs are interoperative, then every patient who has a diagnostic exam can have those radiation doses recorded in the radiologists’ EHR system and know that the information is available to other caregivers when needed. So if an ordering physician has an EHR in the office and writes a scrip for a CT, that physician’s EHR system, if performing under the guidelines of interoperability, can query the radiologist’s EHR system and determine, based on the accumulated radiation dose, whether the patient is within acceptable guidelines or whether an alternative approach is warranted. If the ordering physician does not have an EHR and issues a manual scrip to the radiologist, the radiologist with an EHR system would still get an alert that the recommended levels of radiation were questionable and communicate back to the ordering physician for potential alternative approaches. This is just one of several examples that already exist in the radiology IT space.

With the rise of healthcare IT in this country, practical examples and role models are beneficial-and necessary if we are to change the operating culture of physicians. Examples already exist in radiology and should be leveraged whenever possible.


Mr. Christiano Jr. is chief administrative officer for Advanced Radiology Consultants in Trumbull, CT.