College Call Girls Mumbai Alia 9910780858 Independent Escort Service Mumbai
IHE / RSNA Image Sharing Project - IHE Colombia Workshop (12/2014) Module 5c
1. IMAGING INFORMATICS: IHE
RADIOLOGY ORDER ENTRY CLINICAL
DECISION SUPPORT
Based on the RSNA 2014 presentation, December 2014
Written by: David S. Mendelson, M.D.
Professor of Radiology
Senior Associate- Clinical Informatics
The Mount Sinai Medical Center
Co-chair IHE International Board
Adapted and presented for the
IHE Colombia IHEWorkshop by:
Elliot B. Sloane, PhD, CCE,
FHIMSS
Co-chair IHE International Board
President, Center for Healthcare
Information Research and Policy
(CHIRP)
2. Radiology Orders
The right order
The right reason for
exam and background
information
Automated scheduling
Pre-defined Procedure
steps at the modality
Uniformity of exam
Radiology Order Entry
Clinical Decision Support
Standard Exam
dictionary
RADLEX Playbook
ModalityWorklist
Standard Protocols
mapped to a modality
RADLEX Playbook
Series pre-defined
What do we need? Enablers
4. Radiology Order Entry
Clinical Decision Support
Ensure the correct order based upon
standardized rule sets
Utilization control
Inappropriate Utilization
Redundant Imaging
Replacement for Radiology Benefit Managers
Education for the clinician
Compare their ordering metrics to their peers
5. Inappropriate Utilization
Defensive Medicine – Liability concern
Tort Reform
Patient Demand
Financial Incentives
Self referral
Pressures to minimize overall cost of an episode of
care
Physician lack of knowledge
Duplicate exams
Results not easily available
Patient lack of understanding of exams already performed
Fragmented care – no coordination of care
Up to 20% of imaging exams may be inappropriate
6.
7. Iglehart JK. Health Insurers and Medical-Imaging Policy — A Work
in Progress. N Engl J Med 2009;360:1030-1037
8. A Roadmap for National Action on
Clinical Decision Support-June 13,
2006
9. Decision Support
Collegial advice
Text references
Web sites
Computer systems
Passive
Active
Alerts
Reminders
CorollaryOrders
Guidelines
10. Clinical Decision Support
Systems (CDSS or CDS)
Incorporates
Patient data (EHR)
Rules Engine
Medical Knowledge
Produces a patient specific recommendation
11. Clinical Decision Support - CDS
CDS is a technology that may help to
significantly improve the appropriateness of
orders through dissemination of Comparative
Effectiveness Research (CER) to clinicians at
the point of order-entry.
12. American College of Radiology
Appropriateness Criteria (ACR AC)
A formal mechanism to determine the utility of
imaging exams to diagnose disease
Evaluate existing evidence comparing candidate
modalitites
Synthesize a utility index
Rand/UCLA Appropriateness method
Evidence
Consensus
Limitation – evidence is generally not on double
blinded randomized studies
13. Radiology Benefit Managers
RBM services to obtain pre-clearance for high
cost procedures
Effectively Diminish Utilization
Issues
Burden of a frustrating time consuming solution
with a significant cost in manpower
Implementation
Is this done rationally?
14. CDS- some data
Pilot study in Minnesota with members of
Institute for Clinical Systems Improvement (ICSI)
Imaging growth was curbed while
simultaneously improving the rate of indicated
examinations (ambulatory environment
Added benefit was that while RBM pre-
certification required an average of 10 minutes of
interaction, the CDSS only required 10 seconds
Efficient workflow and scheduling, with a diminished
need to reschedule patients
21. Utilization Management 3.0
• Drive towards appropriate
utilization of imaging
– Ensure value of proper
imaging (and the
Radiologists role) is
defined as valuable
– Right test, right time,
properly performed and
interpreted
– Create a platform and
tools to promote the value
of imaging
23. Decision Support System
• The ACR Appropriateness Criteria ® must
become a “digitally consumable” DSS to be used
as part of a Clinical Decision Support System
• The ACR has formed a commercial entity so that
the AC® can be used to integrate this
“knowledge base” into CDS systems
23
24. National Decision Support Company
• The ACR manages the content of the knowledge
base. NDSC is the exclusive agent of the ACR
for delivery of the content into the market
• NDSC is the commercial entity to manage the
delivery and integration of this knowledge base
into CDS systems
24
25. ACR’s Role
• Curates the clinical content based on market feedback
obtained by NDSC, development of new imaging
procedures, and member feedback.
Aggregate user experience
Content Updates Market Feedback
New Releases
26. CDS- Challenges
Issue Definition Approach to Resolution
Alert Fatigue users begins to ignore (white noise) or override
alerts due to a high frequency of alerts
Content domains and triggers for the selected Imaging
CDSS
Overriding CDSS interventions
that appear all too frequently,
Assess local practice and correct if necessary; re-assess AC
Delivery to the wrong population Delivery of CDS to the correct user population
also impacts adherence and success
Selectively turn off CDSS for certain category of clinicians.
Appropriateness Criteria is
incorrect
Accuracy of CDSS is a critical factor in CDSS
success
Review and correct in system. Feedback to clinical staff
Game the system Enter inaccurate information merely to obtain
approval for desired examination
Look for disproportionate utilization even if seemingly
justified. Check if rules never trigger. Counsel offenders
(?Penalize- last resort)
27. Close the loop
Measure each clinicians performance
Communication
Compare anonymously to peers
28. Mount Sinai Experience
Data Collection Phase
System is in place with discrete orders
No feedback
Determine Baseline performance
Presentation state is important
Change management
Utility scores of 1-3
Consistently 8%
Educate
Plan – turn on feedback
Notas del editor
We are here today to talk about a concept called Imaging 3.0 that has been put forth by the American College of Radiology.
Imaging 3.0 is more than an initiative of the ACR. It is a critical framework for the future of radiology—one that involves all radiologists, support professionals, IT teams, and vendors.
Simply put, Imaging 3.0 brings together the information and tools to create a framework that will help the radiology community navigate the transition from volume-based care to value-based care.
maging 3.0 is a change process led by the ACR for the field of radiology. It includes a set of technology tools that equip 21st-century radiologists to ensure their key role in evolving health care delivery and payment models—and quality patient care.
Define Utilization Management
How current models have used payment reduction as UM management tool
Opportunity to drive quality with a better approach to UM driven by ACRSelect
Introduce linkage to Imaging 3.0
NEED BETTER TEXT. LINK IMAGING 3.0 Concept of new value, one of them is Radiologist as UM.
Decision Support System
Define process to create computer based model from the AC
Introduce ACRSelect
Define NDSC role
Define ACR Role
Content Curation. Describe feedback model. ACR is “source of truth. Not a static knowledge base