The CDSS tested by ICSI was an application called RadPort, developed by Nuance Communications. The software is available via electronic medical record system, but may also be accessed via the Web, for providers without EMR. RadPort’s decision-support criteria are based on American College of Radiology and American College of Cardiology standards. Participating health plan criteria may also be added; ICSI’s trial included provisions for Medicaid, Medicare, and the uninsured. On the back end, a companion piece of software handles analytics and reporting tasks.
Here’s how it works in a clinical environment: At the point of service, a provider enters the patient’s data into the CDSS tool and, based on the patient’s indications, selects an imaging test. The tool responds by displaying a series of nine rankings across three categories: indicated, marginal, or low utility. If the scan order is ranked as low or marginal utility, the software recommends an alternative. The provider may override the system, though there may be requirements set by the payer.
There is no appeals process, per se. “Health plans at this point aren’t putting the hard stop in. Once we have a chance to look at more data and slice and dice all kinds of indications and procedures, it is possible there could be a hard stop for certain things that are significantly contraindicated. At this point there is no hard stop, so there is no appeals process,” explains Cally Vinz, RN, ICSI’s vice president of clinical products and strategic initiatives.
The results of the pilot suggest a viable option to prior notification, which adds a level of complexity that can slow the process of delivering care. According to ICSI, “One pilot group previously took an average of 10 minutes for each HTDI order with a call-in radiology benefits firm; with [CDSS] it now takes 10 seconds.”
Providers are not the only beneficiaries. Patients could benefit by undergoing fewer scans to reach a diagnosis. Health plans benefit from reduced administrative costs and from the aggregated clinical data captured and analyzed.
Exact ROI is difficult to calculate partly because software costs will vary depending on a number of factors including whether a provider has an EMR. ICSI estimates $84 million in savings over three years in reduced claims filed based on orders for more than 1 million HTDI scans.