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Imaging Under Scrutiny

Cora Nucci, for HealthLeaders Media, April 14, 2011
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Widespread availability of computed tomography, magnetic resonance imaging technology, and positron emission tomography has contributed to a surge in the use of high-tech diagnostic imaging scans in hospitals. 

Despite growing concerns about long-term risks of exposure to high doses of radiation, several developments are driving physicians to order HTDI tests: increased availability of CT scanners, the superiority of CT scans over x-rays for diagnosing certain emergent conditions, and concerns about malpractice lawsuits. But the tests come with a hefty price tag. According to a report from America’s Health Insurance Plans, the cost of diagnostic imaging is growing by 18% to 20% annually. By comparison, prescription drug costs, the group says, are growing by 6% to 8% annually.

Health information technology offers a solution in the form of clinical decision-support systems. Such systems can guide providers to evidence-based decisions about which imaging tests to order and deliver benefits to patients and payers, as well.

Targeted use of clinical decision-support systems is associated with decreases in the number of orders for three common imaging exams, according to findings published in the January Journal of the American College of Radiology.

Providers using a CDSS can get instantaneous feedback—at the point of service—on the appropriateness of an imaging order. The need to secure payer approval via prior notification may be eliminated, saving time and administrative costs. And data collected by the system may be aggregated and analyzed, potentially yielding valuable clinical insight that providers may apply to future patients.

Minnesota’s Institute for Clinical Systems Improvement is evaluating CDSS for HTDI. The independent nonprofit organization is sponsored by five health plans in Minnesota and Wisconsin. It represents 60 medical group and hospital members and 9,000 physicians. Its mission is to deliver patient-centered, value-driven healthcare.

The institute undertook a 12-month pilot involving 4,500 providers from five ICSI medical groups and five payers: BlueCross BlueShield of Minnesota, Health Partners Health Plan, Medica, UCare, and Minnesota’s Department of Human Services.

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