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Alami Idrissi Y, Virador GM, Singh RB, Rao D, Stone JA, Sandhu SJS. Imaging 3.0: A scoping review. Curr Probl Diagn Radiol 2024; 53:399-404. [PMID: 38242771 DOI: 10.1067/j.cpradiol.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/16/2024] [Indexed: 01/21/2024]
Abstract
We aim to provide a comprehensive summary of the current body of literature concerning the Imaging 3.0 initiative and its implications for patient care within the field of radiology. We offer a thorough analysis of the literature pertaining to the Imaging 3.0 initiative, emphasizing the practical application of the five pillars of the program, their cost-effectiveness, and their benefits in patient management. By doing so, we hope to illustrate the impact the Imaging 3.0 Initiative can have on the future of radiology and patient care.
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Affiliation(s)
- Yassine Alami Idrissi
- Hillman Cancer Center, University of Pittsburgh Medical Center, 5030 Centre avenue, Pittsburgh, PA 15213, United States.
| | - Gabriel M Virador
- Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, MD, United States
| | - Rahul B Singh
- Department of Internal Medicine, New York City Health and Hospitals/South Brooklyn Health, Brooklyn, NY, United States
| | - Dinesh Rao
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States
| | - Jeffrey A Stone
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States
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2
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Shreve LA, Fried JG, Liu F, Cao Q, Pakpoor J, Kahn CE, Zafar HM. Impact of Artificial Intelligence-Assisted Indication Selection on Appropriateness Order Scoring for Imaging Clinical Decision Support. J Am Coll Radiol 2023; 20:1258-1266. [PMID: 37390881 DOI: 10.1016/j.jacr.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/20/2023] [Accepted: 04/06/2023] [Indexed: 07/02/2023]
Abstract
PURPOSE The aim of this study was to assess appropriateness scoring and structured order entry after the implementation of an artificial intelligence (AI) tool for analysis of free-text indications. METHODS Advanced outpatient imaging orders in a multicenter health care system were recorded 7 months before (March 1, 2020, to September 21, 2020) and after (October 20, 2020, to May 13, 2021) the implementation of an AI tool targeting free-text indications. Clinical decision support score (not appropriate, may be appropriate, appropriate, or unscored) and indication type (structured, free-text, both, or none) were assessed. The χ2 and multivariate logistic regression adjusting for covariables with bootstrapping were used. RESULTS In total, 115,079 orders before and 150,950 orders after AI tool deployment were analyzed. The mean patient age was 59.3 ± 15.5 years, and 146,035 (54.9%) were women; 49.9% of orders were for CT, 38.8% for MR, 5.9% for nuclear medicine, and 5.4% for PET. After deployment, scored orders increased to 52% from 30% (P < .001). Orders with structured indications increased to 67.3% from 34.6% (P < .001). On multivariate analysis, orders were more likely to be scored after tool deployment (odds ratio [OR], 2.7, 95% CI, 2.63-2.78; P < .001). Compared with physicians, orders placed by nonphysician providers were less likely to be scored (OR, 0.80; 95% CI, 0.78-0.83; P < .001). MR (OR, 0.84; 95% CI, 0.82-0.87) and PET (OR, 0.12; 95% CI, 0.10-0.13) were less likely to be scored than CT (; P < .001). After AI tool deployment, 72,083 orders (47.8%) remained unscored, 45,186 (62.7%) with free-text-only indications. CONCLUSIONS Embedding AI assistance within imaging clinical decision support was associated with increased structured indication orders and independently predicted a higher likelihood of scored orders. However, 48% of orders remained unscored, driven by both provider behavior and infrastructure-related barriers.
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Affiliation(s)
- Lauren A Shreve
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Jessica G Fried
- Program Director, Abdominal Imaging, Associate Medical Director of Radiology Informatics, and Co-Director, Tumor Response Assessment Core, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Fang Liu
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Quy Cao
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jina Pakpoor
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Charles E Kahn
- Vice Chair, Department of Radiology, and Vice Chair of Informatics, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania; Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hanna M Zafar
- Vice Chair of Quality, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
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Adenaw N, Wen J, Pahwa AK, Sheth S, Johnson PT. Decreasing Duplicative Imaging: Inpatient and Emergency Medicine Abdominal Ultrasound Within 72 Hours of Abdominal CT. J Am Coll Radiol 2020; 17:590-596. [PMID: 32247697 DOI: 10.1016/j.jacr.2020.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this project was to reduce abdominal ultrasound examinations in patients who had undergone abdominal CT within 72 hours previously. METHODS A best practice advisory (BPA) was created in the electronic medical record to advise against the use of abdominal ultrasound in adult inpatients and emergency department patients who had undergone abdominal CT within the preceding 72 hours. Acceptable acknowledgment reasons to proceed with the order were made available if providers chose to override. Frequency of BPA firing and subsequent ordering behavior were evaluated 6 months after integration of the BPA into the electronic medical record. Chart review was conducted for 100 patients whose orders were placed through an override of the alert to determine if the ultrasound study added value and for all patients whose ultrasound studies were canceled to confirm that patient care was not compromised by omitting the ultrasound study. RESULTS In the first 6 months, a total of 614 inpatient and emergency department abdominal ultrasound orders triggered the BPA. A total of 16% of orders (n = 96) were canceled by the provider after the BPA, reflecting 518 overrides. The majority of retained orders were to evaluate the gallbladder (44% [227 of 518]). Chart review confirmed utility for gallbladder imaging and that the canceled ultrasound examinations would not have contributed value to patients' care. CONCLUSIONS A recently performed abdominal CT scan may obviate the need for inpatient and emergency department abdominal ultrasound, particularly in the setting of hospital-acquired acute kidney injury. A BPA resulted in only 16% of orders' being canceled, whereas chart review revealed a much larger opportunity to avoid duplicative imaging.
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Affiliation(s)
- Nebiyu Adenaw
- The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica Wen
- The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amit K Pahwa
- The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sheila Sheth
- The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pamela T Johnson
- The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Aggarwal A, Lazarow F, Anzai Y, Elsayed M, Ghobadi C, Dandan OA, Griffith B, Straus CM, Kadom N. Maximizing Value While Volumes are Increasing. Curr Probl Diagn Radiol 2020; 50:451-453. [PMID: 32222265 DOI: 10.1067/j.cpradiol.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/09/2020] [Accepted: 02/25/2020] [Indexed: 01/04/2023]
Abstract
Radiologists are facing ever increasing volumes while trying to provide value-based care. There are several drivers of increasing volumes: increasing population size, aging population, increased utilization, gaps in evidence-based care, changes in the provider workforce, defensive medicine, and increasing case complexity. Higher volumes result in increased cognitive and systemic errors and contribute to radiologist fatigue and burnout. We discuss several strategies for mitigating high volumes including abbreviated MRI protocols, 24/7 radiologist coverage, reading room assistants, and other strategies to tackle radiologist burnout.
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Affiliation(s)
| | - Frances Lazarow
- Department of Radiology, Eastern Virginia Medical School, Norfolk, VA
| | - Yoshimi Anzai
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, UT
| | - Mohammad Elsayed
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Comeron Ghobadi
- Department of Radiology, The University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Omran Al Dandan
- Department of Radiology, Imam Abdulrahman Bin Faisal University College of Medicine, Dammam, Saudi Arabia
| | - Brent Griffith
- Department of Radiology, Henry Ford Health System, Detroit, MI
| | - Christopher M Straus
- Department of Radiology, The University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
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Effect of Clinical Decision Support–Generated Report Cards Versus Real-Time Alerts on Primary Care Provider Guideline Adherence for Low Back Pain Outpatient Lumbar Spine MRI Orders. AJR Am J Roentgenol 2019; 212:386-394. [DOI: 10.2214/ajr.18.19780] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Radiology Research in Quality and Safety: Current Trends and Future Needs. Acad Radiol 2017; 24:263-272. [PMID: 28193376 DOI: 10.1016/j.acra.2016.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/19/2016] [Accepted: 07/19/2016] [Indexed: 01/29/2023]
Abstract
Promoting quality and safety research is now essential for radiology as reimbursement is increasingly tied to measures of quality, patient safety, efficiency, and appropriateness of imaging. This article provides an overview of key features necessary to promote successful quality improvement efforts in radiology. Emphasis is given to current trends and future opportunities for directing research. Establishing and maintaining a culture of safety is paramount to organizations wishing to improve patient care. The correct culture must be in place to support quality initiatives and create accountability for patient care. Focused educational curricula are necessary to teach quality and safety-related skills and behaviors to trainees, staff members, and physicians. The increasingly complex healthcare landscape requires that organizations build effective data infrastructures to support quality and safety research. Incident reporting systems designed specifically for medical imaging will benefit quality improvement initiatives by identifying and learning from system errors, enhancing knowledge about safety, and creating safer systems through the implementation of standardized practices and standards. Finally, validated performance measures must be developed to accurately reflect the value of the care we provide for our patients and referring providers. Common metrics used in radiology are reviewed with focus on current and future opportunities for investigation.
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Pandharipande PV, Alabre CI, Coy DL, Zaheer A, Miller CM, Herring MS, Tramontano AC, Dowling EC, Eisenberg JD, Ashar BH, Halpern EF, Donelan K, Gazelle GS. Changes in Physician Decision Making after CT: A Prospective Multicenter Study in Primary Care Settings. Radiology 2016; 281:835-846. [DOI: 10.1148/radiol.2016152887] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
OBJECTIVE Recalling a patient to repeat a radiology examination is an adverse and, in certain cases, preventable event. Our objectives were to assess the rate of patient recalls for all imaging performed in the outpatient setting at our institution and to characterize the underlying reasons for the recalls. MATERIALS AND METHODS We performed a retrospective review of all repeat imaging requests for an inadequate initial imaging study between January 2012 and March 2015. RESULTS We identified 100 recall requests (mean, 2.6 requests per month), for an overall recall rate of approximately 1 in 8046 ambulatory studies and 1 in 1684 MRI studies. Nearly all recalls (98%) involved adults. A total of 95% of the recalls were for MRI studies. The most common reason for a patient recall request was an incomplete examination, making up 24% of all requests. The other causes were inadequate coverage of the area of interest (22%), protocoling errors (20%), poor imaging quality (15%), additional imaging to clarify a finding (11%), insufficient contrast visualization (7%), and incorrect patient information (1%). CONCLUSION We found that patient recalls for imaging in the outpatient setting at our institution are not common. When recalls did occur, they were most often related to the acquisition of MR images. Improved technologist education on MRI protocoling and enhanced communication between ordering clinicians and radiologists to clarify the purpose of imaging might reduce the need for repeat ambulatory imaging.
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Kroll H, Duszak R, Hemingway J, Hughes D, Wintermark M. Same-Day Sinus and Brain CT Imaging in the Medicare Population: Are Practice Patterns Changing in Association with Medicare Policy Initiatives? AJNR Am J Neuroradiol 2016; 37:1000-4. [PMID: 26822731 DOI: 10.3174/ajnr.a4670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 11/24/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Monitoring the frequency of same-day sinus and brain CT (Outpatient Measure 14, "OP-14") is part of a recent large Centers for Medicare and Medicaid Services hospital outpatient quality initiative to improve imaging efficiency. This study investigates patient-level claims data in the Medicare population focusing on where same-day sinus and brain CT imaging is performed and how the frequency of same-day studies changed with time before and during OP-14 measure program implementation. MATERIALS AND METHODS Research Identifiable Files were used to identify all sinus and brain CT examinations from 2004 through 2012 for a 5% random patient sample of Medicare fee-for-service beneficiaries. Overall and site of service use rates were calculated for same- and non-same-day examinations. Changes were mapped to policy initiative timetables. RESULTS The number of same-day sinus and brain CT studies from 2004 to 2012 increased 67% from 1.85 (95% CI, 1.78-1.91) per 1000 Medicare beneficiaries in 2004 to 3.08 (95% CI, 3.00-3.15) in 2012. The biggest driver of increased same-day studies was the emergency department setting, from 0.56 (95% CI, 0.53-0.60) per 1000 to 1.78 (95% CI, 1.72-1.84; +215.7%). Overall use of brain CT from 146.0 (95% CI, 145.1-146.9) per 1000 to 176.3 (95% CI, 175.4-177.2; +21%) and sinus CT from 12.6 (95% CI, 12.4-12.8) per 1000 to 15.4 (95% CI, 15.2-15.6; +22%) increased until 2009 and remained stable through 2012. CONCLUSIONS Previously increasing same-day sinus and brain CT in Medicare beneficiaries plateaued in 2009, coinciding with the implementation of targeted measures by the Centers for Medicare and Medicaid Services. Same-day imaging continues to increase in the emergency department setting.
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Affiliation(s)
- H Kroll
- From the Department of Radiology (H.K., M.W.), Neuroradiology Section, Stanford University, Stanford, California
| | - R Duszak
- Harvey L. Neiman Health Policy Institute (R.D., J.H., D.H.), Reston, Virginia Department of Radiology and Imaging Sciences (R.D.), Emory University School of Medicine, Atlanta, Georgia
| | - J Hemingway
- Harvey L. Neiman Health Policy Institute (R.D., J.H., D.H.), Reston, Virginia
| | - D Hughes
- Harvey L. Neiman Health Policy Institute (R.D., J.H., D.H.), Reston, Virginia Department of Health Administration and Policy (D.H.), George Mason University, Fairfax, Virginia
| | - M Wintermark
- From the Department of Radiology (H.K., M.W.), Neuroradiology Section, Stanford University, Stanford, California
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Schneider E, Zelenka S, Grooff P, Alexa D, Bullen J, Obuchowski NA. Radiology order decision support: examination-indication appropriateness assessed using 2 electronic systems. J Am Coll Radiol 2015; 12:349-57. [PMID: 25842015 DOI: 10.1016/j.jacr.2014.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 12/15/2014] [Indexed: 10/23/2022]
Abstract
PURPOSE The goal of the study was to determine the effects of guideline implementation strategy using 2 commercial radiology clinical decision support (CDS) systems. METHODS The appropriateness and insurance dispositions of MRI and CT orders were evaluated using the Medicalis SmartReq and Nuance RadPort CDS systems during 2 different 3-month periods. Logistic regression was used to compare these outcomes between the 2 systems, after adjusting for patient-mix differences. RESULTS Approximately 2,000 consecutive outpatient MRI and CT orders were evaluated over 2 periods of 3 months each. Medicalis scored 60% of exams as "indeterminate" (insufficient information) or "not validated" (no guidelines). Excluding these cases, Nuance scored significantly more exams as appropriate than did Medicalis (80% versus 51%, P < .001) and predicted insurance outcome significantly more often (76% versus 58%, P < .001). Only when the Medicalis "indeterminate" and "not validated" categories were combined with the high- or moderate-utility categories did the 2 CDS systems have similar performance. Overall, 19% of examinations with low-utility ratings were reimbursed. Conversely, 0.8% of examinations with high- or moderate-utility ratings were denied reimbursement. CONCLUSIONS The chief difference between the 2 CDS systems, and the strongest influence on outcomes, was how exams without relevant guidelines or with insufficient information were handled. Nuance augmented published guidelines with clinical best practice; Medicalis requested additional information utilizing pop-up windows. Thus, guideline implementation choices contributed to decision making and outcomes. User interface, specifically, the number of screens and completeness of indication choices, controlled CDS interactions and, coupled with guidance implementation, influenced willingness to use the CDS system.
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Affiliation(s)
- Erika Schneider
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Stacy Zelenka
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Paul Grooff
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Dan Alexa
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jennifer Bullen
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nancy A Obuchowski
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
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Huber T, Gaskin CM, Krishnaraj A. Early Experience With Implementation of a Commercial Decision-Support Product for Imaging Order Entry. Curr Probl Diagn Radiol 2015; 45:133-6. [PMID: 26701115 DOI: 10.1067/j.cpradiol.2015.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/01/2015] [Indexed: 11/22/2022]
Abstract
Clinical decision support platforms for imaging order entry have recently been mandated by the federal government. Little data exists outside of the convener sites on how to go about the implementation process. As an early adopter of a commercially available clinical decision support program for imaging order entry, we present our initial experience.
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Affiliation(s)
- Timothy Huber
- Department of Radiology and Medical Imaging, The University of Virginia, Charlottesville, VA
| | - Cree M Gaskin
- Department of Radiology and Medical Imaging, The University of Virginia, Charlottesville, VA
| | - Arun Krishnaraj
- Department of Radiology and Medical Imaging, The University of Virginia, Charlottesville, VA.
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Sabbatini AK, Merck LH, Froemming AT, Vaughan W, Brown MD, Hess EP, Applegate KE, Comfere NI. Optimizing Patient-centered Communication and Multidisciplinary Care Coordination in Emergency Diagnostic Imaging: A Research Agenda. Acad Emerg Med 2015; 22:1427-34. [PMID: 26575785 DOI: 10.1111/acem.12826] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 07/06/2015] [Indexed: 12/17/2022]
Abstract
Patient-centered emergency diagnostic imaging relies on efficient communication and multispecialty care coordination to ensure optimal imaging utilization. The construct of the emergency diagnostic imaging care coordination cycle with three main phases (pretest, test, and posttest) provides a useful framework to evaluate care coordination in patient-centered emergency diagnostic imaging. This article summarizes findings reached during the patient-centered outcomes session of the 2015 Academic Emergency Medicine consensus conference "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." The primary objective was to develop a research agenda focused on 1) defining component parts of the emergency diagnostic imaging care coordination process, 2) identifying gaps in communication that affect emergency diagnostic imaging, and 3) defining optimal methods of communication and multidisciplinary care coordination that ensure patient-centered emergency diagnostic imaging. Prioritized research questions provided the framework to define a research agenda for multidisciplinary care coordination in emergency diagnostic imaging.
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Affiliation(s)
| | - Lisa H. Merck
- Department of Emergency Medicine; Brown University; Providence RI
- Department of Diagnostic Imaging; Brown University; Providence RI
| | | | | | - Michael D. Brown
- Department of Emergency Medicine; Michigan State University; Grand Rapids MI
| | - Erik P. Hess
- Department of Emergency Medicine; Mayo Clinic; Rochester MN
- Knowledge and Evaluation Research Unit; Division of Healthcare Policy Research; Department of Health Services Research; Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery; Mayo Clinic; Rochester MN
| | - Kimberly E. Applegate
- Department of Radiology and Imaging Sciences; Emory University School of Medicine; Atlanta GA
| | - Nneka I. Comfere
- Department of Dermatology; Laboratory Medicine & Pathology; Mayo Clinic; Rochester MN
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Rapoport RJ, Parker L, Levin DC, Hiatt MD. A Large State Medicaid Outpatient Advanced Imaging Utilization Management Program. Med Care Res Rev 2015; 73:369-80. [DOI: 10.1177/1077558715607749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/31/2015] [Indexed: 11/17/2022]
Abstract
A decade of rapidly rising outpatient advanced imaging utilization ended toward the end of the past decade, with slow growth since. This has been attributed to repetitive reimbursement cuts, medical radiation exposure concerns, increasing deductibles and patient copayments, and the influence of radiology benefit management companies. State Medicaid programs have been reluctant to institute radiology benefit management preauthorization programs since the time burden for obtaining test approval could cause providers to drop out. Also, these patients may lack the knowledge to appeal denials, and medically necessary tests could be denied with adverse outcomes. Little data exist demonstrating the efficacy of such programs in decreasing utilization and cost. We report a 2-year experience with an outpatient advanced imaging prior notification program for a large state Medicaid fee-for-service population. The program did not allow any denials, but nevertheless the data reveal a large, durable decrease in advanced imaging utilization and cost.
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Affiliation(s)
| | | | | | - Mark D. Hiatt
- Regence BlueCross BlueShield of Utah, Salt Lake City, UT, USA
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14
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Rao S, Rao S, Harvey HB, Avery L, Saini S, Prabhakar AM. Low Back Pain in the Emergency Department—Are the ACR Appropriateness Criteria Being Followed? J Am Coll Radiol 2015; 12:364-9. [DOI: 10.1016/j.jacr.2014.10.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 10/27/2014] [Indexed: 12/14/2022]
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15
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Ten Commandments for Effective Clinical Decision Support for Imaging: Enabling Evidence-Based Practice to Improve Quality and Reduce Waste. AJR Am J Roentgenol 2014; 203:945-51. [DOI: 10.2214/ajr.14.13134] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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16
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Swayne LC. Of mice and men: escaping the relative value unit trap. J Am Coll Radiol 2014; 11:777-80. [PMID: 24709554 DOI: 10.1016/j.jacr.2013.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
Abstract
Although radiologists have kept pace with the dramatic growth of medical imaging during the past two decades through the use of PACS, digital dictation, and 3-dimensional reconstruction, radiology is approaching the point of diminishing returns. As reimbursements further decline, attempts to increase radiologists' productivity risk commoditization of the specialty. The continued evolution of US health care policy, however, presents an opportunity for radiologists, using their core competencies, to shape the future direction of medicine.
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Affiliation(s)
- Lawrence C Swayne
- Department of Diagnostic Radiology, Morristown Medical Center, Morristown, New Jersey.
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Improving the Application of Imaging Clinical Decision Support Tools: Making the Complex Simple. J Am Coll Radiol 2014; 11:257-61. [DOI: 10.1016/j.jacr.2013.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 10/09/2013] [Indexed: 12/26/2022]
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18
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Appropriateness, Scheduling, and Patient Preparation. J Am Coll Radiol 2014; 11:225-6. [DOI: 10.1016/j.jacr.2013.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 12/06/2013] [Indexed: 11/21/2022]
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Williams A, Sachs PB, Cain M, Pell J, Borgstede J. Adopting a Commercial Clinical Decision Support for Imaging Product: Our Experience. J Am Coll Radiol 2014; 11:202-4. [DOI: 10.1016/j.jacr.2013.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 06/24/2013] [Indexed: 11/17/2022]
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20
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Williams CN, Bratton SL, Hirshberg EL. Computerized decision support in adult and pediatric critical care. World J Crit Care Med 2013; 2:21-8. [PMID: 24701413 PMCID: PMC3953873 DOI: 10.5492/wjccm.v2.i4.21] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/02/2013] [Accepted: 08/20/2013] [Indexed: 02/06/2023] Open
Abstract
Computerized decision support (CDS) is the most advanced form of clinical decision support available and has evolved with innovative technologies to provide meaningful assistance to medical professionals. Critical care clinicians are in unique environments where vast amounts of data are collected on individual patients, and where expedient and accurate decisions are paramount to the delivery of quality healthcare. Many CDS tools are in use today among adult and pediatric intensive care units as diagnostic aides, safety alerts, computerized protocols, and automated recommendations for management. Some CDS use have significantly decreased adverse events and improved costs when carefully implemented and properly operated. CDS tools integrated into electronic health records are also valuable to researchers providing rapid identification of eligible patients, streamlining data-gathering and analysis, and providing cohorts for study of rare and chronic diseases through data-warehousing. Although the need for human judgment in the daily care of critically ill patients has limited the study and realization of meaningful improvements in overall patient outcomes, CDS tools continue to evolve and integrate into the daily workflow of clinicians, and will likely provide advancements over time. Through novel technologies, CDS tools have vast potential for progression and will significantly impact the field of critical care and clinical research in the future.
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Sierzenski PR, Linton OW, Amis ES, Courtney DM, Larson PA, Mahesh M, Novelline RA, Frush DP, Mettler FA, Timins JK, Tenforde TS, Boice JD, Brink JA, Bushberg JT, Schauer DA. Applications of justification and optimization in medical imaging: examples of clinical guidance for computed tomography use in emergency medicine. Ann Emerg Med 2013; 63:25-32. [PMID: 24134958 DOI: 10.1016/j.annemergmed.2013.08.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/29/2013] [Accepted: 08/29/2013] [Indexed: 11/26/2022]
Abstract
Availability, reliability, and technical improvements have led to continued expansion of computed tomography (CT) imaging. During a CT scan, there is substantially more exposure to ionizing radiation than with conventional radiography. This has led to questions and critical conclusions about whether the continuous growth of CT scans should be subjected to review and potentially restraints or, at a minimum, closer investigation. This is particularly pertinent to populations in emergency departments, such as children and patients who receive repeated CT scans for benign diagnoses. During the last several decades, among national medical specialty organizations, the American College of Emergency Physicians and the American College of Radiology have each formed membership working groups to consider value, access, and expedience and to promote broad acceptance of CT protocols and procedures within their disciplines. Those efforts have had positive effects on the use criteria for CT by other physician groups, health insurance carriers, regulators, and legislators.
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Affiliation(s)
- Paul R Sierzenski
- Section of Emergency Ultrasound, Department of Emergency Medicine, Christiana Care Health Services, Newark, DE.
| | | | - E Stephen Amis
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - D Mark Courtney
- Department of Emergency Medicine, Northwestern University, Chicago, IL
| | | | - Mahadevappa Mahesh
- Russel H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert A Novelline
- Harvard Medical School and Emergency Radiology Division, Massachusetts General Hospital, Boston, MA
| | - Donald P Frush
- Division of Pediatric Radiology, Duke University Medical Center, Durham, NC
| | - Fred A Mettler
- Department of Radiology, New Mexico VAHCS, Albuquerque, NM
| | | | - Thomas S Tenforde
- National Council on Radiation Protection and Measurements, Bethesda, MD
| | - John D Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD
| | - James A Brink
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Jerrold T Bushberg
- Department of Radiology, University of California, Davis, Sacramento, CA
| | - David A Schauer
- National Council on Radiation Protection and Measurements, Bethesda, MD
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22
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Sierzenski PR, Linton OW, Amis ES, Courtney DM, Larson PA, Mahesh M, Novelline RA, Frush DP, Mettler FA, Timins JK, Tenforde TS, Boice JD, Brink JA, Bushberg JT, Schauer DA. Applications of justification and optimization in medical imaging: examples of clinical guidance for computed tomography use in emergency medicine. J Am Coll Radiol 2013; 11:36-44. [PMID: 24135540 DOI: 10.1016/j.jacr.2013.09.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Availability, reliability, and technical improvements have led to continued expansion of computed tomography (CT) imaging. During a CT scan, there is substantially more exposure to ionizing radiation than with conventional radiography. This has led to questions and critical conclusions about whether the continuous growth of CT scans should be subjected to review and potentially restraints or, at a minimum, closer investigation. This is particularly pertinent to populations in emergency departments, such as children and patients who receive repeated CT scans for benign diagnoses. During the last several decades, among national medical specialty organizations, the American College of Emergency Physicians and the American College of Radiology have each formed membership working groups to consider value, access, and expedience and to promote broad acceptance of CT protocols and procedures within their disciplines. Those efforts have had positive effects on the use criteria for CT by other physician groups, health insurance carriers, regulators, and legislators.
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Affiliation(s)
- Paul R Sierzenski
- Section of Emergency Ultrasound, Department of Emergency Medicine, Christiana Care Health Services, Newark, Delaware.
| | | | - E Stephen Amis
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - D Mark Courtney
- Department of Emergency Medicine, Northwestern University, Chicago, Illinois
| | - Paul A Larson
- Radiology Associates of the Fox Valley, Neenah, Wisconsin
| | - Mahadevappa Mahesh
- Russel H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert A Novelline
- Harvard Medical School and Emergency Radiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Donald P Frush
- Division of Pediatric Radiology, Duke University Medical Center, Durham, North Carolina
| | - Fred A Mettler
- Department of Radiology, New Mexico VAHCS, Albuquerque, New Mexico
| | | | - Thomas S Tenforde
- National Council on Radiation Protection and Measurements, Bethesda, Maryland
| | - John D Boice
- National Council on Radiation Protection and Measurements, Bethesda, Maryland
| | - James A Brink
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jerrold T Bushberg
- Department of Radiology, University of California, Davis, Sacramento, California
| | - David A Schauer
- National Council on Radiation Protection and Measurements, Bethesda, Maryland
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23
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Jha S, Baker T. Introduction to the special issue-the Patient Protection and Affordable Care Act: an unsentimental perspective. J Am Coll Radiol 2013. [PMID: 23206641 DOI: 10.1016/j.jacr.2012.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Saurabh Jha
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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24
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Abramson RG, Berger PE, Brant-Zawadzki MN. Accountable Care Organizations and Radiology: Threat or Opportunity? J Am Coll Radiol 2012. [DOI: 10.1016/j.jacr.2012.09.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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