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Clinical Decision Support in Medical Imaging
Integrating CDS into the fiber of workflow.
By StephenHerman, MD Posted on: August 8, 2011 View Comments (0) Print Article Email Article Share
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Clinical decision support (CDS) solutions are used widely across healthcare environments and bring value from both clinical and business perspectives. A study published in the April 2011 issue of Pediatrics supports the use of electronic decision support to reduce ordering of unnecessary treatments. Alerts were built into a hospital's electronic health record (EHR) to notify physicians ordering red blood cell transfusions when patients did not meet recently updatedguidelines for this procedure. According to researchers, these alerts prevented 460 unnecessary transfusions, saving approximately $165,000 over 12 months. "We demonstrated that having clinical decision support baked into the fiber of ordering practices can have a significant, durable impact on the delivery of clinical care," said study author David Cornfield, MD, medical director of critical care atLucile Packard Children's Hospital at Stanford in Palo Alto, Calif. Providing valuable info at point of care This example is one of many across various specialties that show the effectiveness of electronic CDS at the point of ordering. Research has long supported pharmacy's use of decision support to provide alerts for adverse drug interactions. In radiology, CDS use is less common and research islimited, yet there is some movement. "Decision support systems for advanced imaging are being implemented with increased frequency and are mandated under some new governmental health care initiatives," according to a January 2011 study published in the Journal of the American College of Radiology. In this study, researchers at Virginia Mason Medical Center evaluated evidence-based CDS built intoordering systems for selected high-volume imaging procedures. Results showed that the use of CDS was associated with substantial decreases in the overall imaging volumes (all diagnoses) for lumbar MRI, head MRI, and sinus CT. A report from America's Health Insurance Plans states that the cost of diagnostic imaging is growing by 18 percent to 20 percent annually. Much of this increase can be tracedto more widespread availability of high-tech diagnostic imaging equipment and confusion around many procedures including CT, MRI, and PET. In February 2011, the Centers for Medicare and Medicaid Services announced $10 million in awards to study the effectiveness of CDS solutions for imaging. The agency seeks clarity around the value of decision support at the point of care to address concernsabout inefficiency, overutilization, and excess radiation exposure. Overcoming flaws of radiology benefit management and research is limited, yet there is some Some studies compare the effectiveness of the radiology benefit movement, writes author Stephen management model (RBM) to the CDS model. As managed care Herman, MD. evolved, so too did the RBM model. RBMs exist for various reasons, withfinances being a major driver. Serving as a "middle-man," of sorts, an RBM company evaluates the appropriateness of an order and "kicks the order back" to the physician with a recommendation for a less costly imaging study if clinically indicated. This timeIn radiology, CDS use is less common
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