In search of an alternative to prior authorization and prior notification programs to reduce the rate of diagnostic imaging and to increase appropriateness of tests, a Minnesota pilot program reports success in point-of-order decision-support.
The program, facilitated by the Institute for Clinical Systems Improvement, a regional quality improvement collaborative, involved five large medical groups with more than 6,000 physicians. Results of the pilot have been published at The American Journal of Managed Care.
In the study 300 randomly selected charts from patients with a head CT, head MRI or spine MRI were audited, half six months before the decision-support system was implements and half six months after. It found that the proportion of orders fitting the appropriateness criteria increased from 79 percent to 89 percent with computer decision support, but there was no change in the frequency of positive findings or apparent impact on patients.
At the same time, the number of orders overall plateaued. Spine MRI orders declined by 20 percent and head CT orders fell 36 percent; there was no change in orders for head MRI. Though prior notification programs were still in use, though, it's difficult to fully separate out the effects of the computer decision support, reports Health Imaging.
The authors, however, estimated savings of $84 million from 2007 through 2009 from the combined implementation of prior notification and decision support compared with the previous rate of growth. The medical groups also reported other savings. The phone calls for prior notification, estimated to take 10 minutes each, took 308 hours of staff time to gain approval on 1850 HTDI scans during one month under the previous system.
One of the biggest pluses for the new system: Doctors like it.
"The physician leaders of each pilot group reported that the use of decision support was much more efficient, patient-centered, and clinician supportive than having to call in orders for external review," the authors wrote.
Their satisfaction with the system has lead four nonprofit payers to financially support a statewide implementation. A common appropriateness criteria is to be set up within EHR systems and offices not using EHRs can access the system online. Results are to be aggregated to further refine the system.
More clinical decision support is coming down the pike among the requirement of Meaningful Use Stage 3 helping to boost the adoption of such tools. Meanwhile, imaging rates have slowed and declining reimbursements are among the issues facing radiology.