Diagnostic imaging offers countless benefits for determining diagnoses and treatments for health conditions. However, when doctors order too many of these exams, overdiagnosis occurs. To improve patient safety and adhere to the U.S. Centers for Medicare and Medicaid Services' Meaningful Use guidelines, health care providers must work on limiting their usage of medical imaging. Researchers believe they have found the way to ensure that happens.
Clinical decision support guides physicians in patient care
Clinical decision support can significantly improve patient care by aiding physicians in making choices that affect the people they care for. The program takes the person's medical history, clinical guidelines and context into consideration when determining the best course of action and then alerts health care providers to suggestions that would most likely lead to a successful diagnosis, the CMS explained. Clinical decision support offers the necessary details to the right people to make the best decisions for the patient.
If eligible providers and hospitals want to adhere to MU guidelines, they must implement the software. Stage 2 calls for medical professionals to use five clinical decision support interventions for at least four clinical quality measures, the CMS reported. This will help improve quality care, safety and efficiency. Ideally, clinical decision support will lead to fewer diagnostic imaging tests, which will reduce overall costs for both patients and medical facilities. With a lower number of exams, there will also be fewer misdiagnoses, and people will not be treated for conditions they do not have.
New solution for overtesting
Despite the benefits of clinical decision support, they are not preventing doctors from ordering too many medical imaging scans. According to a study in Academic Emergency Medicine, researchers from various universities and medical centers in Los Angeles, California, discovered that approximately two-thirds of health care providers schedule imaging tests for patients because of a fear of missing a condition or malpractice lawsuits.
"Overtesting is not due to lack of physician knowledge or insight or to poor medical judgment, but really reflects our cultural response both within and outside medicine to uncertainty and error," Hemal Kenzaria, M.D., an emergency medicine doctor at the Ronald Reagan University of California, Los Angeles, Medical Center, told MedPage Today.
However, in a recent study published in the American Journal of Roentgenology, researchers from Brigham and Women's Hospital, Harvard Medical School and the University of Pennsylvania discovered that clinical decision support software is not enough of a motivator to prevent doctors from overusing medical imaging. For two years, the team observed attending physicians in an emergency department for guideline adherence. Of the nearly 110,000 patient visits, 2,167 people underwent CT scans for possible pulmonary embolisms. The researchers provided feedback based on Wells criteria, which is used to diagnose pulmonary embolisms, to a randomized group of physicians each quarter. They saw a 6.9-percent increase in points and 8.8-percent relative growth in the group that received comments. The control group remained generally unchanged at 78.8 percent in 2012 and 77.2 percent in 2013.
The key to successful medical imaging is to combine clinical decision support with consistent feedback from hospital superiors. While the software offers suggestions as to the best course of action, it does not force people to follow their instructions. Health care providers ultimately make their own decisions regarding their patients. However, by adding constructive criticism from managers, doctors will be able to determine when it is appropriate to order diagnostic imaging tests. This will help adhere to MU Stage 2 criteria and improve patient safety and satisfaction.
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Ronny Bachrach
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