CAR: Canadian radiologists should champion appropriate imaging

CAR: Canadian radiologists should champion appropriate imaging

By Louise Gagnon, AuntMinnie.com contributing writer

April 29, 2014 — MONTREAL – Championing a cause such as appropriateness in imaging is a way for Canadian radiologists to improve their visibility as a profession, as well as protect their turf, said the immediate past president of the Canadian Association of Radiologists (CAR) at the society’s annual meeting last week.

“The bottom line is that there is room for improvement [in imaging appropriateness],” said Dr. James Fraser, professor of radiology at Dalhousie University and a specialist in cardiac radiology at the QEII Health Sciences Centre in Halifax, Nova Scotia. “It provides an opportunity for us to be physician leaders, to increase the visibility of radiology as a profession, to prove our value to government, and to be patient advocates.”

Making appropriate imaging a priority can include efforts such as CAR’s involvement in Choosing Wisely Canada, an initiative modeled after the U.S. campaign that assists physicians and patients in engaging in discussions about unnecessary tests, treatments, and procedures, he said.

Room for progress

A guest editorial that appeared in a journal about a decade ago sparked investigation and debate about imaging appropriateness in Canada. The article claimed that up to 30% of imaging in Canada was inappropriate (Picano, BMJ, 2004, Vol. 328, pp. 578).

“This figure got tagged to CAR and our members,” Fraser said. “Our members were worried about the perception [of radiology].”

The issue of appropriateness differs north and south of the U.S.-Canada border, Fraser noted. “People are not competing for imaging in Canada,” he said. “We generally have wait lists.”

Another key difference in Canada is its less litigious nature, which means that radiologists do not need to practice defensive medicine and overimage to the same extent as their U.S. colleagues, Fraser said.

Despite the differences, numerous published studies validate that there is room for progress in imaging appropriateness in Canada. A study published last year found that just 44.3% of lumbar spine MRIs ordered to investigate back pain were appropriate, with the remainder being inappropriate or of uncertain value (Emery et al, JAMA Internal Medicine, 2013, Vol. 173:9, pp. 823-825).

The role of CPOE

Incorporating computerized physician order-entry (CPOE) decision support is one way to identify and potentially reduce inappropriate imaging in Canada. In a 2011 study, 10.9% of imaging orders were deemed inappropriate after CPOE implementation, based on CAR guidelines (Bowen et al, Journal of the American College of Radiology, 2011, Vol. 8:4, pp. 251-258).

The findings were surprising given the study’s setting, Fraser said.

“It was within a tertiary care, pediatric academic hospital, a population where you would expect physicians to be well-informed of what’s appropriate,” he said. “Despite that, there were 11% [of orders] that were deemed inappropriate.”

CPOE decision support allows evidence-based data collection, which could improve the appropriateness of imaging studies.

“If you don’t have the metrics, you don’t know what the problem is,” Fraser said. “You also don’t know if you are making a difference with the use of guidelines and decision support.”

Citing data from the Canadian Institute for Health Information, a not-for-profit, nongovernmental organization that tracks data on healthcare utilization and delivery in Canada, Fraser noted that more than $2.2 billion was spent on imaging in Canada in a recent two-year period.

“Even small percentages of improvement by addressing inappropriate imaging can have a significant impact on the cost of healthcare that we deliver,” he said.

Imaging exams can be judged inappropriate for several reasons, including the inability of the scan to contribute to patient management, performance of an exam at the wrong time, and failure to obtain imaging when indicated, Fraser explained. Inappropriate imaging unnecessarily exposes patients to radiation and can lead to overinvestigation of incidental findings that ultimately prove benign, he added.

One typical example of inappropriate imaging is a referring physician failing to order a coronary CT angiogram and instead ordering cardiac catheterization for a patient who is symptomatic and presenting with low to intermediate risk of coronary artery disease.

“A less appropriate exam is ordered,” Fraser said, noting that referring physicians have to be provided with guidance on appropriate examinations that reflects changes in technology.

 

“We are a technology-based profession, and technology changes very quickly,” he said in a follow-up interview with AuntMinnie.com. “The appropriate examination for any particular clinical presentation may change quickly enough so referring physicians can’t stay on top of the changes. One of the important things is to have up-to-date guidelines that are useable for [referring physicians].”

For Medicare Reform, 11th-Hour Decision Support | Imaging Economics

For Medicare Reform, 11th-Hour Decision Support

By Jenny Lower

Congress doesn’t always succeed in implementing forward-thinking policy changes. But the recent passage of the Protecting Access to Medicare Act of 2014 not only addresses overutilization and rising costs with careful, evidence-based reform, it puts power back in the hands of radiologists.

Passed by the Senate on March 31 and signed into law on April 1, the bill—also known as the latest Sustainable Growth Rate (SGR) “patch”—requires referring physicians to consult appropriateness criteria before prescribing advanced imaging procedures for Medicare patients. The requirements apply to CT, MRI, nuclear medicine, and PET; ultrasound and x-ray are not affected.

Cindy Moran, American College of Radiology

The bill offers a 12-month reprieve from the 24% payment cuts originally scheduled to go into effect on January 1 of this year. Congress has passed similar payment patches more than a dozen times in the last 12 years, typically without introducing new policies. This version marks a distinct shift.

By requiring physicians to consult appropriateness criteria such as ACR Select, the legislation reverses the trend toward marginalization many radiologists have experienced as a result of the current volume-driven, fee-for-service model, said Cindy Moran, executive vice president for government relations, economics, and health policy at the American College of Radiology (ACR). “It reinserts radiologists as the managers of diagnostic imaging studies and reinserts them as consultants to the ordering physician.”

The unusual departure is due to Congress’ failure to pass a more comprehensive SGR reform bill in 2013. Despite widespread support in the House and Senate among both Republicans and Democrats, policy makers failed to agree on how to manage the package’s $180 billion price tag. Sensing an opportunity for incremental reform, the ACR convinced Congress to incorporate the appropriateness criteria into the patch as a “downpayment” on broader changes down the road.

Embracing decision support also largely precludes radiology benefits managers (RBMs) from becoming entrenched in the fee-for-service model, and instead enables appropriateness criteria to serve as an educational tool, Moran said. “It allows for a discussion between the ordering physician and the rendering physician—unlike the black box of an RBM, which just makes a payment decision. When it’s part of a larger communication tool, the appropriateness criteria process allows more interaction.”

Policy makers hope those discussions will help rein in rising healthcare costs due to overutilization, which may arise from ignorance on the part of the referring physician. But there are other legitimate concerns that lead to overimaging, such as the threat of malpractice suits and pressure from patients themselves. Appropriateness criteria can provide a framework to help combat those issues.

The appropriateness criteria portion of the bill rolls out January 1, 2017, but some benchmarks take effect before then. The Secretary of Health and Human Services will have to determine by April 2015 which sets of appropriateness criteria to sanction. The Secretary then has until April 2016 to designate a clinical decision support system to manage the criteria. The ACR is hopeful that ACR Select will pass muster. The criteria have been continually updated over the past two decades and the organization believes it offers the most comprehensive, evidence-based solution available.

“The bill is a fundamental reorientation of how Medicare has been run and how Medicare has been paying for services,” Moran said. “We think it’s a very positive change. But it needs to be correctly built, so we’re going to have to work with the system to make sure that it meets those criteria.”

Jenny Lower is the associate editor for Imaging Economics. 

– See more at: http://www.imagingeconomics.com/2014/04/medicare-reform-11th-hour-decision-support/#sthash.66hGhxdy.dpuf

ACR wants CPOE to incorporate appropriateness-guided CDS – FierceMedicalImaging

ACR wants CPOE to incorporate appropriateness-guided CDS

The American College of Radiology on April 24 submitted comments on the Office of the National Coordinator for Health IT’s proposed rule containing voluntary electronic health record technology certification criteria for 2015.

In it’s comments, ACR said it supports ONC’s proposal to separate the order types in previous computerized physician order entry (CPOE) certification criteria into three distinct criteria encompassing medications, lab-tests and radiology/imaging.

“A standardized certification criteria from CPOE of radiology/imaging will allow more specialized, robust order entry software to achieve modular certification for use in the EHR Incentive Program without having to add unrelated medication and lab-test functionality,” said Paul Ellenbogen, chair of ACR’s board of chancellors, and Keith Dreyer, chair of ACR’s IT and informatics committee.

ACR also recommended that ONC require radiology/imaging order functionality to integrate appropriateness-guided clinical decision support, pointing out that such systems reduce inappropriate ordering and reduce costs, eliminate waste and improve patient care and safety. The recently passed SGR fix, ACR pointed out, will require healthcare providers to use clinical decision support to get reimbursement for imaging services.

The comments went on to suggest that it would be “helpful to ordering providers if ONC’s related certification criteria … explicitly require CPOE/CDS to include/enable this functionality.”

While ACR said it understands that radiology/imaging CPOE in the EHR incentive program now focuses on documentation within certified EHR technology, and not transmission of orders to “referring providers,” it suggested that in the future, CPOE systems should be able to provide those providers with structured reasons or indications for orders.

ACR also responded to questions for the 2017 Edition EHR certification criteria related to imaging.

For example, as to whether medical images being supplied to patients need to be of diagnostic quality, ACR replied that while those images don’t need diagnostic quality if they are for a patient’s personal use, they should be of diagnostic quality if they are being transmitted to a physician or provider third party.

ACR also suggested that ONC should examine the recent recommendations of the HIT Standards Committee clinical operations workgroup to get a look at standards and methods relating to enabling imagine sharing in various use cases.

To learn more:
– read the ACR’s comments (.pdf)

Related Articles:
ONC releases proposed 2015 EHR technology certification criteria
H.R. 4302: Duct tape, delays and decision support
Has the Meaningful Use program run its course?
Congress may add MU interoperability requirements to permanent SGR fix
Penn turns to EHR technology to cut unnecessary imaging

DOTmed.com – Doc fix bill puts clinical decision support in the spotlight

Doc fix bill puts clinical decision support in the spotlight

by Lisa Chamoff, Freelance Reporter
For the past several years, the radiology division of Partners HealthCare atMassachusetts General Hospital has been using the American College of Radiology’s appropriateness criteria to provide clinical decision support for an in-house physician order entry and scheduling program.

The program is similar to the ACR Select product that Massachusetts General Hospital is planning to adopt once it completes integration of a new electronic medical records system, and that is likely to soon become a key part of radiology practices’ information systems nationwide.

The latest “doc fix” law, or SGR patch as it sometimes referred to, that was recently passed to stave off cuts in Medicare reimbursement rates, also created a new mandate for the use of clinical decision support in diagnostic imaging exam ordering, which is aimed at cutting down on duplicate or unnecessary scanning and its associated costs.

Dr. Keith Dreyer, vice chairman and associate professor of radiology at Mass General, associate professor of radiology at Harvard and corporate director of medical imaging for Partners HealthCare, called the Radiology Order Entry system a precursor to the ACR Select product.

Over the past 20 years, the ACR has been developing appropriateness criteria, recommending the appropriate imaging procedures based on a patient’s condition. As electronic medical records programs began to proliferate, the ACR decided to make these criteria more actionable in the marketplace. They contracted with the National Decision Support Company, which took the ACR’s appropriate use criteria and built the platform. The company also provides technical support and sales, so that that the criteria can be integrated into physician order entry applications. The product was released early last year.

The National Decision Support Company has set to integrate ACR Select product into a number of EMR platforms, including those from Epic and Cerner.

Bob Cooke, vice president of marketing and strategy for the National Decision Support Company, explained that the ACR Select criteria applies to high-tech imaging orders, such as CT and MRI. For example, if a doctor is trying to order an MRI of a patient’s knee, because the patient has pain and can’t bear weight, but they haven’t had an X-ray, the program would recommend an X-ray instead.

The Partners product worked in a similar way, though it went a step further and required trainees to get approval from a staff physician when ordering a low-yield exam instead of one that’s considered more appropriate. A staff physician’s adherence to the criteria becomes part of their annual review.

The ACR’s appropriateness criteria are based on evidence from several thousand peer-reviewed articles.

“There’s a lot that changes in imaging,” Dreyer, who is also chair of the ACR Informatics Committee, told DOTmed News. “There are a lot of new studies and information that comes out and changes the decision-making process and makes some exams more appropriate in certain clinical circumstances. It’s hard for general practitioners and specialists to keep track.”

With the guidelines updated twice a year, and reviewed at least every two years, the ACR Select program is updated with a few clicks.

Dreyer said the in-house program ended up making financial sense. While the practice was decreasing the cost of what insurance companies had to pay for high-cost imaging by 12 percent, it was able to make that up by keeping the same patient volume.

The government has also taken notice. Systems using federally approved clinical decision support tools will be required by 2017. While the new law is not connected to the federal government’s Meaningful Use incentive program, Cooke said the new law will likely lead to clinical decision support for radiology being integrated into the Meaningful Use program.

MU’s push for CDS: How will it impact Radiology? | Imagingbiz

MU’s push for CDS: How will it impact Radiology?

 - Safwan Halabi, MD

Safwan Halabi, MD

As the federal meaningful use incentive program has progressed, its direct impact on the practice of radiology has intensified through the addition of provisions specific to the utilization and sharing of medical images. Meaningful use also stands to impact the field indirectly through changes in incentivizes across the healthcare continuum. Most significant among these may be the use of clinical decision support to encourage appropriate, outcomes-based ordering of imaging studies.

“Radiology is going to be affected by what meaningful use does to everyone else as well,” says Safwan Halabi, MD, radiologist at Henry Ford Hospital, Detroit, Mich. Along with Joshua S. Broder, MD, Halabi co-authored a March 2014 article in Journal of the American College of Radiology titled “Improving the Application of Imaging Clinical Decision Support Tools: Making the Complex Simple.” As he notes, “Radiology touches almost every single patient at some point or other during their lives. We have a lot of information that’s not really being used—yet.”

Weaknesses in CDS tools

Halabi and Broder point out that the promotion and incentivization of EHRs and CPOE on the part of CMS have created “a unique opportunity to catalyze the use of evidence-based guidelines with the inclusion of clinical decision support tools.” Halabi says, however, that these tools will require improvement if they are to become part of clinicians’ daily workflows. “The onus will be on future-looking physicians to help develop tools that will give ordering clinicians guidance while not hindering them in seeing as many patients as they can.”

Halabi also points out that while current CDS tools include guidance for thousands of indications, even that level of granularity comes with significant gaps. “If you look at the guidance, it doesn’t really cover the entire spectrum, and it’s not one-size-fits-all,” he says. “It’s rare to see a patient with just one problem. Further, a lot of the existing guidance doesn’t include prior imaging or prior treatments—it’s just looking at the here and now. Patients are very nuanced, and it’s hard to build an algorithm that covers every scenario.”

Finally, he offers that at this point, delivering an evidence-based justification for every one of the guidelines just isn’t possible. “A lot of different groups got together to decide on what they believe are the most appropriate tests for certain diseases based on what we know now,” Halabi says. “But we must do a better job at basing the guidelines on outcomes and clinical evidence. We have yet to see whether a lot of this will help patients in the long run.”

Halabi envisions a future in which CDS is robust enough to accommodate the nuances of a patient’s comorbidities and medical history to offer both short- and long-term recommendations regarding that patient’s care. “Thedata need to be utilized in CDS so that you don’t have to go through a whole process to get the guidance you need—it should be teed up based on the patient’s age, gender and problem lists,” he says. “It should be like on Amazon.com, when it tells you ‘people who ordered this also ordered this’—in this case, it would say ‘patients like this one saw their health improve from these steps.’”

MU and adoption

By incentivizing the use of CDS as part of CPOE, the meaningful use program has the potential to drive the widespread adoption of the technology necessary to create this robust feedback loop, Halabi says. “In this version of MU, CMS is laying the groundwork for healthcare organizations,” he observes. “With this whole push toward using health IT, more and more practices and health systems are collecting a lot of data on patients. Now what we need is feedback on outcomes to improve future practice.”

Halabi describes the continuous integration and utilization of that feedback as “the holy grail,” but acknowledges it raises philosophical questions about the role of the physician in general, as well as the role of the radiologist. “I have this discussion with my residents all the time. They feel like they’re artisans honing a skill—they don’t want to be pushed into just following checklists. And that’s the real struggle: How do you maintain physician and patient autonomy while still putting people into best practice sequences? The person who has examined thousands of patients could know better than a piece of software.”

With so much guidance automated, where will the radiologist fit in the care continuum? “Medical imaging will always be here, but it’s really up to radiologists to decide whether they are willing to change according to how medicine is practiced and how patients perceive their care,” Halabi says. “CDS is a hard sell for some places—they know it will reduce the amount of imaging they do, and that’s a hard transition to make.”

Halabi is hopeful, however, that this transition will actually enable radiologists to get back to their roots. “Historically, the role of the radiologist was to be a consultant,” he says. “As we get away from the churn-and-burn model of practice that we’ve had under fee-for-service, I think we will see a paradigm shift in how radiologists practice, and that’s where the origins of the profession will come into play. If you have a limited pool of money to work with, you need to be able to tell your clinicians exactly what an exam will do for a patient. Could it add five minutes to his lifespan, or five years?”

Thanks to the push provided by meaningful use, Halabi believes this change could be coming sooner than later. “I’d love to be able to tell my trainees that they shouldn’t be focused on just churning out reports, that they need to get their doctor hats on,” he says. “The driver of that change will be MU’s emphasis on proving what the outcome of a study will be.”

Bill Pushes CDS Forward with Potentially Positive Impact on Radiology | Diagnostic Imaging

Aunt Minnie: Is there a silver lining to the 2014 SGR patch?

Is there a silver lining to the 2014 SGR patch?

By Kate Madden Yee, AuntMinnie.com staff writer

April 10, 2014 — The latest effort to avert cuts to Medicare physician payments mandated by the sustainable growth rate (SGR) formula may be another in a long line of temporary fixes, but it also represents a victory for radiology, with language mandating the use of appropriateness criteria, transparency around payment policy, and radiation dose management.

On April 1, President Barack Obama signed into law a 13-month patch for the SGR: HR 4302, the Protecting Access to Medicare Act of 2014. The bill again delays a payment reduction for physicians and other practitioners who treat Medicare patients, replacing a 24% cut with a 0.5% increase in payments through December of this year and a 0% update from January 1 to April 1, 2015.

Although medical associations criticized Congress for failing to follow through on a permanent SGR repeal — this bill is the 17th short-term Medicare SGR patch over the past 11 years — the American College of Radiology (ACR) praised parts of the measure. ACR noted that the legislation requires ordering physicians to consult appropriateness criteria when ordering advanced imaging procedures for Medicare patients, and it directs the secretary of the U.S.Department of Health and Human Services (HHS) to identify clinical decision-support tools to help physicians do so.

“For the first time, appropriateness criteria language has been included in legislation like this,” Cynthia Moran, ACR executive vice president for government relations, told AuntMinnie.com. “This issue has been our highest legislative priority.”

Other wins include the U.S. Centers for Medicare and Medicaid Services (CMS) having to release the data it used to establish its controversial 2012 multiple procedure payment reduction (MPPR) policy for the professional component of imaging services, as well as a provision mandating that any cuts to particular codes greater than 20% will have to be phased in over two years, Moran said.

“We’re fairly certain CMS didn’t use a lot of data when it developed the MPPR policy, and now we’ll be able to go back to Congress — or the courts — to push back,” she told AuntMinnie.com.

Coming to a hospital near you: Clinical decision support

By November 2015, the HHS secretary must, through rule making, specify applicable appropriate use criteria for imaging services, using guidance from national professional medical specialty societies or other provider-led groups.

“Appropriate use criteria” means criteria developed to assist ordering professionals make the most appropriate treatment decision for a specific clinical condition for an individual. Such criteria must be evidence-based to the extent feasible, according to the bill.

By April 2016, the secretary must designate a clinical decision-support mechanism that will allow appropriateness criteria to be implemented. The clinical decision-support tool must meet the following requirements:

  • Make clear to clinicians the appropriate use criteria for advanced imaging
  • Determine the extent to which the ordered imaging service is consistent with the appropriate use criteria
  • Be updated regularly to reflect revisions to appropriateness criteria
  • Provide feedback to the ordering doctor

ACR will urge HHS to incorporate its ACR Select tool, which was developed in 2012 as a joint project between the organization and healthcare informatics software developer National Decision Support Company. Physicians ordering imaging exams through their computerized physician order-entry (CPOE) software encounter ACR Select whenever they are choosing an imaging exam for a patient. ACR Select applies a numerical score and color code to the exam based on appropriateness criteria, with questionable exams coded in red, appropriate exams in green, and yellow for those in between.

“We will make the argument that ACR Select should be included,” Moran said. “We’ve been developing appropriateness criteria for more than 20 years, and ACR Select is by far the most comprehensive and evidence-based tool.”

HR 4302’s appropriateness criteria rule will go into effect on January 1, 2017. Physicians will only be paid for advanced imaging exams if claims include information about which clinical decision-support mechanism was consulted and whether the service ordered adheres to the criteria — or if the criteria are not applicable, according to the bill’s text.

Those who have trouble complying with appropriateness criteria will be subject to a preauthorization process. Beginning January 2020, the secretary will apply prior authorization for applicable imaging services that are ordered by an outlier ordering professional.

“The threat of preauthorization should be a huge incentive for physicians to use decision support,” Moran said.

Radiation dose language

Language on radiation dose also crept into the SGR legislation. The law states that for all imaging studies performed on CT equipment out of compliance with the National Electrical Manufacturers Association (NEMA) 2013 dose management standards, payments will be cut by 5% in 2016 and by 15% in 2017 and subsequent years.

“The ACR worked closely with the manufacturers to impose a more gradual penalty into this policy,” Moran said. “And we’re encouraged that most CT equipment will be able to meet these compliance standards, certainly by 2017.”

HR 4302 is another temporary fix to the ongoing problem of reconciling the SGR with Medicare physician payment rates, but it does bring a bit of good news after years of challenges to radiology, according to Moran.

 

“Radiology has been on the receiving end of every bad public policy initiated by Congress and CMS for the last several years,” she said. “It’s nice to finally see some positive results.”

Aunt Minnie Europe: Spanish show the way on clinical decision support


Spanish show the way on clinical decision support

By Brian Casey, AuntMinnieEurope.com staff writer

April 7, 2014

Lluis Donoso Bach

If the ACR Select clinical decision-support software can work in Spain, it can work anywhere, Dr. Lluis Donoso Bach, PhD, said.

For the past seven months, Hospital Clinic of Barcelona at the University of Barcelona has been testing the ACR Select clinical decision-support software, which the ESR is looking at adapting for the European market under collaboration with the American College of Radiology (ACR).

The project could help Europe roll out decision support without having to go through the exhaustive process of creating its own criteria for appropriate imaging, as ACR has done with its Appropriateness Criteria, according to lead researcher on the project Dr. Lluis Donoso Bach, PhD, director of the diagnostic imaging center at Hospital Clinic of Barcelona.

“It makes no sense to reinvent every criteria because the ACR has done this,” Donoso Bach said in an interview at the recent ECR 2014 meeting in Vienna.

Reducing low-yield exams

ACR Select was developed in collaboration between the ACR and U.S. software developer National Decision Support Company. ACR Select first debuted at the RSNA 2012 meeting, and is designed to reduce inappropriate utilization by steering referring physicians away from requesting low-yield imaging exams that are most likely to be negative.

Physicians can use ACR Select through their existing computerized physician order entry (CPOE) application; the ACR Select interface pops up whenever they want to request an imaging exam. Referring physicians then input information on the clinical condition of their patient and the imaging exam they wish to request; ACR Select gives them an appropriateness score and color coding (green, yellow, or red) that tells them if the study is clinically indicated based on the ACR’s Appropriateness Criteria. It can suggest alternative exams if necessary or no exam at all.

Click image to enlarge.
The clinical decision-support software in use at Hospital Clinic grades requests for imaging exams based on their appropriateness. Image courtesy of Dr. Lluis Donoso Bach, PhD.

ACR Select was developed for the needs of the U.S. market, where inappropriate utilization is a major driver of the nation’s astronomical healthcare costs. But it’s also proving useful in Spain, which has its own economic situation to deal with, as the ongoing economic crisis has driven the country to make budget cuts that have taken a bite out of healthcare spending, according to Donoso Bach.

“We are being asked to do better with less,” he said.

The hospital has been testing a “Eurosized” version of ACR Select that’s been translated into Spanish and adapted to the unique needs of the country. In addition to translating different clinical situations, diagnostic codes were transferred as well. Donoso Bach said the work was “not all that difficult,” with consulting firm PricewaterhouseCoopers providing assistance.

Next, the software was tested by rolling it out to general practitioner (GP) physicians in Hospital Clinic Barcelona’s network, in which 80 GPs serve a population of about 400,000. GPs are a particularly good physician population in which to test clinical decision support because most GPs in a particular healthcare system typically belong to the same institution, Donoso Bach said.

How did the software perform? Donoso Bach admits that he was skeptical of clinical decision support at first, but once in operation it won him over. GPs have embraced the system, and they now welcome feedback on how well their requests for imaging exams match appropriateness criteria.

With a successful pilot project now under their belts, Donoso Bach and colleagues are looking at making the software available to other types of referring doctors, with emergency physicians most likely next on the list.

European rollout

The pilot project has worked well enough that Donoso Bach believes the software should be rolled out throughout Europe, and indeed the ESR has a project underway to do just that. Called iGuide, the ESR’s version of clinical decision support is also based on the National Decision Support Company’s user interface and the ACR’s Appropriateness Criteria.

As described in a poster in the EuroSafe Imaging area of ECR 2014, ESR first tried to develop clinical decision support based on guidelines created by the U.K. and French radiological societies. But initial work found “considerable discrepancies” between the two sets of rules, so the ESR signed an agreement with ACR to adapt its Appropriateness Criteria into iGuide as an interim product that can be brought to market quickly.

ESR sees a variety of benefits to clinical decision support: In addition to reducing inappropriate utilization, it could also lead to lower radiation exposure to patients through fewer unnecessary imaging tests. The Barcelona project thus could be the harbinger of a wider rollout of clinical decision support throughout Europe.

“If it works here, then it could be exported to other regional systems,” Donoso Bach said. “Lots of people are looking at us.”


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Last Updated bc 4/4/2014 3:33:42 PM

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