Normalizing Medical Imaging Utilization with Decision Support



Medical Imaging Professional Considering Computerized Decision Support

Medical imaging usage has slowed down in the last six years due, in part, to declining reimbursements and increasing awareness of medical imaging overutilization. Many point to the recession as another cause behind the decline in diagnostic imaging expenses. The economic recovery could be the silver lining that establishes an upward trend.

As aging baby boomers require more care, and millions of people are added to insurance plans because of the Patient Protection and Affordable Care Act, imaging services will be in greater demand. However, it’s not usage alone that will contribute to an increase in studies ordered. Technology plays a part.

Appropriate Use of Medical Imaging

“The question isn’t necessarily overall volume, the question is quality and appropriateness at a more granular level,” says Chris Sistrom, MD, PhD, MPH, of the University of Florida Health Center in Gainesville.

According to Sistrom, there’s a spectrum of physician behaviors within the field. He sees physicians who, on one end of the spectrum, willfully disregard guidelines. In the middle are those who may be pressured by patients or liability concerns to order imaging that may not be clinically beneficial. On the other end are physicians who practice appropriate use of medical imaging, assisted by decision support.

Sistrom believes that we should be moving more physicians into practicing appropriate use.

Physicians Prefer Computerized Decision Support (CDS)

Spurred on by meaningful use requirements, medical imaging appropriateness is taking center stage. Medical imaging workflow solutions, collaboration tools and point-of-care decision support technology are positioned to meet appropriateness demands.

Implementing a strategy for increased appropriate use of medical imaging requires a computerized decision support (CDS) system as a first step, maintains Sistrom. Proof of this is shown in a study conducted by HealthPartners Institute for Education and Research in Minneapolis.

Researchers found that a program using standardized CDS slowed the growth in ambulatory orders of high-tech diagnostic imaging. These systems provided a utility score during the ordering process, with alternate suggestions provided for low-scoring procedures. A random audit of 300 charts for CT or MRI showed the proportion of orders fitting appropriate use criteria rose from 79 percent to 89 percent after implementation of the CDS.

Pat Courneya, MD, health plan medical director for HealthPartners, says that in less than one year, more than half of the health plan’s membership was going to a medical group using decision support in ordering high-tech imaging and they found that physicians preferred the CDS system to receiving prior authorization from a radiology benefits manager.

An effective decision support solution automates authorization, coverage determination and network compliance processes. A clinical and financial decision support software-as-a-service solution helps reduce costs and provider hassles, including providing evidence-based support to determine medical necessity.

Are you using computerized decision support in managing your radiology utilization? If so, what results have you seen?

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