Diagnostic imaging specialists may encounter difficult situations on a daily basis, providing patients with complex scan results gleaned from MRIs and other modalities. This is where clinical decision support systems can play integral roles for radiologists faced with hard-to-choose treatment strategies.
Radiology should embrace CDS platforms
Health care providers have debated the effectiveness of CDS and appropriateness guidelines for years, with implementation being the topic of discussion at the recent annual meeting of the Radiological Society of North America in Chicago, Illinois. The main focus was getting referring physicians to understand the benefits of CDS and use it consistently. Otherwise they could cost radiologists money.
According to Ramin Khorasani, M.D., vice chair of the Brigham and Women's Hospital radiology department, radiologists will not be paid for outpatient, non-emergent services as of Jan. 1, 2017, if their referring physician did not consult a CDS tool. This stipulation is keeping with standards established by the Protecting Access to Medicare Act. However, it is difficult to determine how radiologists can teach other providers about medical imaging appropriateness. The Medicare Imaging Demonstration, a recent pilot initiative, showed some improvement in educating doctors about ordering exams, but many participants expressed dissatisfaction with CDS software.
"The Demonstration's intent was to measure and improve the appropriateness of advanced imaging, but the implementation was not an effective means to improve ordering," Katherine Kahn, M.D., distinguished chair in Health Care Delivery Measurement and Evaluation at the Rand Corporation, told Diagnostic Imaging.
More than 5,100 physicians participated in MID, ordering roughly 140,000 imaging studies throughout the pilot. During the study, it was revealed that between 62 percent and 83 percent of referring doctors followed appropriateness guidelines for radiology exams. After using CDS systems, the percentage increased to between 75 percent and 84 percent.
The MID study highlighted the benefits of using CDS in combination with diagnostic radiology. This is underscored by a recent announcement from the U.S. Food and Drug Administration.
FDA aims to prioritize CDS in 2015
FierceEMR reported that the FDA published a regulatory agenda for 2015 that included plans to focus on medical device accessories, CDS software and adaptive design for medical device clinical studies.
These stipulations sprang up from negotiations over the Medical Device User Fee Amendments of 2012, which resulted in the FDA agreeing to meet a variety of goals. The decision called for the agency to post annual lists of prioritized device guidance documents as part of its yearly agenda. In addition to CDS, the FDA aims to promote medical device interoperability and patient access to information.
With these goals in mind, the FDA could help propel radiology into more comprehensive services and capabilities in 2015. Digital imaging providers could share data with patients and help narrow down treatment strategies to identify the optimal course of action for all stakeholders that yields the best outcomes.
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Ronny Bachrach
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