Putting the Patient First


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CDS implementation supports patient- and family- centered care.

Clinical decision support (CDS) places radiologists at the center of value-based care and connects them with ordering physicians — but there are just as many benefits to patients. The implementation of CDS has been found to decrease inappropriate imaging, help patients understand why the procedure they’re undergoing is the most appropriate, and reduce the time it takes for patients to undergo a procedure. Research has shown that appropriate imaging also leads to costs savings, less patient anxiety, and reduced radiation exposure.
“One of the top benefits of CDS implementation is that we’ll reduce the number of inappropriate imaging orders,” says Ryan K. Lee, MD, MBA, section chief of neuroradiology at Einstein Healthcare Network in Philadelphia. Lee, whose radiology team implemented a CDS algorithm to help ED physicians determine whether or not to order head CTs for pediatric patients, believes that CDS implementation will improve the overall workflow for the patient.
To illustrate his point, Lee points to a not-uncommon scenario — a patient comes in to an imaging center with an order and the technologist discovers that the ordered study may be inappropriate for the clinical indication. He or she then calls the radiologist about getting a new order. In the worst case scenario, a new pre-authorization has to be done, which means that the patient can’t get the study done that same day — leading to inconvenience and potential anxiety for the patient.

“This situation pinpoints myriad problems,” says Lee. “You’ve wasted the patient’s time and he or she has to make another appointment. You’ve wasted the imaging center’s time and there’s now an unfilled slot that could have been used for somebody else. With CDS, the right order is placed at the right point of care and all those inefficiencies go away. The patient isn’t inconvenienced and the imaging center and radiologist aren’t inconvenienced.”
Ashima Lall, MD, MBA, FACHE, system chief of performance improvement at the Radiology Associates of the Main Line in Media, Pa., agrees. Lall reviewed 90 cases of suspected pulmonary embolism in the ED and found that with CDS, the appropriateness of the ED physicians’ CT orders for the indication improved by 45 percent. In addition to improving the accuracy of ordering, Lall believes CDS can be used by physicians to help patients understand why the procedure they’re undergoing is the most appropriate for their condition.

“Because CDS is based on the ACR Appropriateness Criteria® (AC), physicians have evidence-based reasoning to explain the decision that was made,” says Lall.
Lee asserts that CDS also reduces the time it takes for a patient to undergo a procedure. In some cases, CDS can reduce prior authorization time by eliminating the need for a radiology benefits manager who can take days or even months to receive approval from insurance companies. With CDS, patients can receive confirmation for a needed service in minutes.
“It’s a simple solution,” says Lee. “When you have the appropriate order, you’re doing the best thing for the patient. You’re saving them time, money, and anxiety.”

David Andrews, a patient advocate, believes implementing CDS can strengthen patient trust and make care more patient centered. Andrews, who serves on the ACR AC Patient Engagement Subcommittee, believes it’s important for radiologists to get behind CDS implementation.
“Most everyone knows that there’s an overuse of imaging,” says Andrews. “It’s important for the ACs to become available — not just to the radiologists who may be familiar with them but also to the referring physicians who are then in a better position to request the appropriate imaging — or no imaging, if that’s the right decision.”

According to Andrews, CDS is an important vehicle for including the patient as part of the discussion as to what imaging is appropriate. As part of his work on the ACR AC Patient Engagement Subcommittee, he looked at how to better communicate with patients about appropriate imaging — which led to the creation of the patient-friendly summaries of the AC. These summaries are comprised of about 300 evidence-based guidelines, created and continually updated by multidisciplinary teams of expert physicians to help providers make the most appropriate diagnostic imaging and image-guided treatment decisions for specific clinical conditions (see sidebar).

“These days, patients often come to a medical encounter with some prior conceptions of what ought to happen,” says Andrews. “A classic case is a patient has lower back pain who thinks he or she has to have an MRI — and in most cases that’s not appropriate. That’s where these patient summaries can help.”

Lee agrees. He believes that without employing the ACs, a patient runs the risk of receiving unnecessary radiation exposure. “A patient comes and gets a CT scan, for example, and it ends up being the wrong study,” says Lee. “So he or she has to come back for another scan or X-ray. Now, in addition to wasting resources, you’ve also given the patient radiation that could have been avoided.”
According to Lall, what providers ultimately need to think about when considering implementing CDS is the patient’s best interest. “From what I see, the stakeholders may ask ‘what’s in it for me? Why should I adopt this?” says Lall. “I will tell them that it is here to stay because it’s all about doing the right thing. It’s for the greater good. It’s for the patient.”
By Nicole B. Racadag, MSJ, managing editor, ACR Bulletin.

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