Clinical decision support is potentially an ideal method for improving the evidence-based use of imaging; clinical decision support systems have the desired properties of being educational, transparent, efficient, practical, and consistent, according to C. Craig Blackmore, MD, MPH, lead author of the study.
That echoes the paper's conclusion: Implementation of imaging clinical decision support for selected high-utilization imaging procedures "can aid the elimination of unnecessary imaging, increasing both patient safety and quality and decreasing health care costs."
Some questions remain about how the findings may be generalized, however. The research was performed in a multispecialty integrated healthcare network and, the authors acknowledge that the setting "likely had a substantial effect" on the program's success.
"At Virginia Mason, we have an integrated healthcare delivery system that leads the country in both quality and efficiency. Our success is attributable in part to the Lean manufacturing strategy we employ through our Virginia Mason Production System," Blackmore explains. (VMPS is a system-wide program to change the way the facility delivers healthcare based on the basic tenets of the Toyota Production System.) VMPS allows for enterprise-wide quality initiatives, such as imaging computer decision support, he says.
Implementation might be more challenging in a less integrated healthcare model, he acknowledges. But the payoff is worth it, given the alternative. "The usual alternative to computer decision support for controlling inappropriate utilization is a pre-authorization program. Pre-authorization is more costly, more intrusive, and less well accepted than CDS. So, I would recommend CDS as the preferred imaging utilization approach for other provider groups and hospitals."