– 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.


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