Improving the Value of High-End Imaging
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For more information on Group Health's high-end imaging improvements and innovations like this, please go to www.ghinnovates.org.
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Improving the Value of High-End Imaging
- 1. Matt Handley, MD and Robert Karl, Jr., MD Group Health Physicians Kelly Weaver, MD The Everett Clinic Improving the Value of High-End Imaging: Engaging Providers With Feedback
- 6. High End Imaging Variation in PC Across All Clinics
- 8. High End Imaging Variation in Specialty Across Service Lines
- 12. Robert Karl, Jr., MD Group Health Physicians High End Imaging
- 14. Integration of Clinical Decision Support into Epic
- 15. Headache Drop Down Options A: Evidence supports ordering for the clinical indication B: Equivocal evidence for the clinical indication C: (Not shown) No evidence for the clinical indication
- 16. Virtual Consults
- 19. Group Practice Ordering Rate
- 20. Primary Care Ordering Rates
- 21. Specialty Care Ordering Rates
- 22. Managing Advanced Imaging At The Everett Clinic Kelly Weaver, MD Advanced Imaging Center
- 27. # CT and MRI in 2009 Family Practice 800 700 600 500 400 300 200 100 0
- 31. # CT and MRI in 2009 Family Practice 800 700 600 500 400 300 200 100 0
- 32. # CT and MRI per 1000 Visits FP in 2009 120 100 80 60 40 20 0
- 37. Q4 2010 Results Compared to 2006
Notas del editor
- At the Epic user group meeting we heard the experience of some other multispecialty group practices have dealt with the increase in high end imaging costs What we saw suggested that there is a big opportunity. Because they use also use Epic, we can import their solution directly into our tool.
- At the Epic user group meeting we heard the experience of some other multispecialty group practices have dealt with the increase in high end imaging costs What we saw suggested that there is a big opportunity. Because they use also use Epic, we can import their solution directly into our tool.
- Matt Transition to how we implemented Starts with the case for change Case for change - Safety, Decision Support, Value
- Bob Our implementation – like all implementations, started with that case for change (Matt will have just summarized it) We chose to adapt a decision support package that we identified as a best practice from a high performing group that uses the same electronic medical record (its Health Partners, but I wouldn’t say that). Like all decision support for radiology ordering, it is imperfect It is no better than the evidence base that exists, which is limited The American College of Radiology, from which this was adapted, is an “easy grader” Limitations and all, it is an important tool to help make sure that we are informing ordering, rather than reducing both inappropriate and appropriate imaging Feedback of ordering rates, with transparent comparison to peers has been helpful in promoting conversations to address clinical variation
- Bob Here is what the clinical decision support looks like: Each of the questions represents a clinical issue that will almost always include the clinical issue you are work on with the patient.
- Bob After clicking on a question, indications are grouped by appropriateness, and sometimes recommend a different exam for an indication Remember that the ACR 7,8,9 are “ A ” criteria – reasonable evidence to support the imaging study for the clinical indication ACR 4,5,6 are the “ B ” criteria - borderline evidence ACR 1,2,3 are the “ C ” criteria – no evidence to support
- Bob Another resource available to clinicians is expert consultation through a “virtual consult” At any time, a clinician can send a message to their local radiologist asking a specific question to get a recommendation for ordering. Here is a mock up of one (I would read it) (transition is to a virtual consult in chart review)
- ----- Meeting Notes (2/21/11 17:49) ----- Bob The virtual consult routes back to the clinician's inbasket, and is also visible int he chart. One click and anyone working with that patient can see the recommendation (transition is to the virtual consult)
- ----- Meeting Notes (2/21/11 17:49) ----- Bob so here is a mock up of a virtual consult about imaging. Now, Matt made this mock up for us - I think more to make a larger point about this tool than to provide a representative sample. So what is our impact to date? (transition is to the overall GPD ordering rate)
- First, when we look at ordering rates in our Group Practice, we should start with the fact that our rate was significantly lower than our wider network to begin with We have seen an important decrease in ordering, on the order of 20%. So where is that coming from? (Transition is to the primary care ordering rates)
- Bob We have seen a pretty remarkable decrease in ordering of MRI and CT in primary care, now over 20% While we think that is good, there was some concern that this was just going to push the ordering into specialty, decreasing the efficiency of care delivery (Transition - Next slide is specialty ordering)
- Bob We have seen a strong trend of lower rates of ordering in specialty, despite the fact that there is a large decrease in ordering in primary care. Not shown is our urgent care rate, which has not changed to date – a remaining opportunity Transition back to Matt: We chose a decision support model to help get engagement with clinicians – we think it has been necessary but insufficient Feedback of performance has been an essential part of the program Then Matt will introduce Kelly’s presentation
- Matt ----- Meeting Notes (2/21/11 17:49) ----- Matt So what have we learned - it is a Kaiser Soze lesson: Implementation is not a binary event technical vs adaptive change Feedback matters the clinical wisdom of our group is a valuable resource Leadership matters