Information technology may be solution to the overuse of imaging technology.
Clinical decision support systems may save money by reducing the number of inappropriate medical imaging procedures, including computed tomography and magnetic resonance imaging, researchers at Virginia Mason Medical Center find.
Targeted use of imaging clinical decision support is associated with large decreases in the number of orders for three common imaging exams, according to findings published this month in the Journal of the American College of Radiology.
The research comes from Virginia Mason Medical Center in Seattle.
The findings are particularly significant as cost-containment efforts increasingly target imaging. Providers are under pressure from payers to limit imaging to evidence-based applications, the authors note. Clinical decision support systems appear to provide a way to do just that. They can provide real-time feedback to providers ordering imaging tests, including information on test appropriateness for specific indications.
The retrospective cohort study looked at evidence-based clinical decision support built into ordering systems for selected high-volume imaging procedures: lumbar MRI, brain MRI, and sinus CT. Brain CT was included as a control.
Results showed the rates of imaging after intervention were 23.4% lower for lumbar MRI (for low-back pain), 23.2% lower for head MRI (for headache), and 26.8% lower for sinus CT (for sinusitis).
The data came a regional health plan's billing data as well as the institutional radiology information system, the authors explained.
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."
Pages
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
