The Challenges of Implementing Medical Imaging Clinical Decision Support


Medical imaging professional making clinical decisionMedical imaging professionals can improve quality and efficiency with clinical decision support (CDS). CDS provides the right medical imaging to the right person at the right time and represents a process designed to aid directly in clinical decision making. With this type of support, characteristics of individual patients are used to generate specific interventions, assessments and recommendations that are then presented to decision makers involved in care delivery.

A Hospital’s Real-Time Experience

During an educational session at the annual meeting of the Society for Imaging Informatics in Medicine (SIIM), Keith Hentel, MD, vice chairman for clinical operations at New York Presbyterian Medical Center-Weill Cornell Medical Center in New York City, spelled out how their enterprise decision support implementation signified a steep challenge.

The current healthcare model demands that providers focus on high-value care to patients, Hentel said, and that the medical imaging ordering process presents an opportunity to meet this goal.

Hentel and his team surmised that reducing inappropriate medical imaging was a real opportunity to improve patient care. The center embraced CDS for their medical imaging process by joining the Medicare Imaging Demonstration (MID) project in 2011.

The project required that clinicians order 80 percent of 33 high-cost CPT codes through clinical decision support in the first year, and raised the bar to 90 percent in year two.

Lessons Learned in Medical Imaging CDS Application

Hentel and colleagues ambitiously decided to apply the same medical imaging criteria to all patients and learned key lessons in the process.

Emphasizing how the implementation of medical imaging decision support was critical, Hentel highlighted the distinction between medical imaging utilization and appropriate medical imaging by explaining that utilization can be controlled with deductibles or radiology benefits managers. Yet, neither method can ensure appropriate medical imaging. “Understand what you are trying to achieve and have realistic expectations,” he urged.

Don’t Let CDS Disrupt Workflow

Medical imaging process workflow is another vital element which Hentel addressed. CDS should not disrupt the physician workflow, being applied only when essential in order to minimize redundant data entry and enable users to act on the CDS recommendation.

Hentel concluded by encouraging his colleagues to consider CDS and to leverage the experiences of early adopters to set the stage for a smooth implementation.

What challenge or success has your organization experienced in implementing CDS?

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