The value of imaging decision support

In a study published last week in JAMA Internal Medicine, researchers at the Center for Evidence-based Imaging and Brigham and Women's Hospital in Boston found that a clinical decision support tool that alerted physicians if they were about to order a duplicate imaging exam was able to reduce the number of canceled CT exams six-fold.

Clinical decision support is part of a broader pattern to improve the quality and reporting of imaging procedures, but there has been some resistance to it among radiologists and other physicians. As Keith Dreyer, M.D., vice chairman of radiology informatics at Massachusetts General Hospital said in an interview with Healthcare Informatics last November, "there's a general resistance among all people to change."

But as Dreyer, and others, have pointed out, there are multiple benefits to imaging CDS. For starters, imaging clinical decision support educates providers about evidence-based-guidelines at the time of image order entry. It can help with the selection of alternative imaging procedures that may be better suited to resolve a clinical question, according to evidence-based guidelines, and as a result, reduces unnecessary testing.

In addition, patients are becoming smarter and more aggressive about the kind of treatment they want to receive. If they come in asking for an MRI procedure for some kind of orthopedic problem, for example, physicians can explain that the situation doesn't meet appropriateness criteria and thereby avoid an unnecessary--and expensive--test.

As the study published in JAMA Internal Medicine shows, clinical decision support has the capability of radically reducing inappropriate or redundant imaging exams. Studies have suggested that eliminating duplicate imaging exams could save billions of dollars annually.

What's more, from a patient perspective, by avoiding inappropriate or redundant examinations, patient safety is improved by avoiding unnecessary radiation exposure or unnecessary downstream procedures.

Continuing efforts to optimize imaging utilization--like imaging clinical decision support--should be led by radiologists. After all, they are the ones who know the most about the appropriate use of medical imaging. - Mike  @FierceHealthIT

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