Report Cards Reduce MRI Orders

Leesburg, VA, February 15, 2019—Clinical decision support (CDS)-generated evidence-based report cards can significantly reduce the number of primary care provider (PCP) orders for lumbar spine MRI after an adult outpatient visit for low back pain, according to a study published in the February 2019 issue of the American Journal of Roentgenology (AJR).

In their study, “Effect of Clinical Decision Support–Generated Report Cards Versus Real-Time Alerts on Primary Care Provider Guideline Adherence for Low Back Pain Outpatient Lumbar Spine MRI Orders,” Hanna M. Zafar and colleagues sought to determine whether the specific type of guideline adherence feedback can influence the likelihood of lumbar spine MRI orders placed the day of and 1–30 days after an adult outpatient PCP visit for low back pain.

The study was performed in a tertiary academic health system with eight PCP practices. The authors tested four types of PCP feedback entered for lumbar spine MRI orders on the day of adult outpatient visits: no feedback, periodic provider report cards, real-time CDS alerts at the time of order, and both report cards and real-time alerts.

The study was conducted over three different time periods: baseline, CDS categorized orders with no feedback; intervention period 1, one group of PCPs received only periodic report cards on guideline adherence and the other group received only real-time CDS alerts on adherence at computerized physician order entry; and intervention period 2, both PCP groups received both periodic report cards and real-time CDS alerts.

The use of CDS-generated report cards correlated with a lower likelihood of lumbar spine MRI orders made the day of and 1–30 days after the visit, versus the periods for baseline and report cards alone. Real-time CDS alerts alone did not affect MRI orders made the day of or 1–30 days after the visit.

Results suggest that health information technology tools can encourage effective and resource-efficient health care through the use of high-quality provider report cards. The effect of the report cards was likely optimized by report card content, frequency, and the trustworthiness of the evidence source. For more information, visit

Founded in 1900, ARRS is the first and oldest radiology society in the United States, and is an international forum for progress in radiology. The Society's mission is to improve health through a community committed to advancing knowledge and skills in radiology. ARRS achieves its mission through an annual scientific and educational meeting, publication of the American Journal of Roentgenology (AJR) and InPractice magazine, topical symposia and webinars, and print and online educational materials. ARRS is located in Leesburg, VA.