From Theory to Practice

Although clinical decision support implementation is mandatory by January 2017, radiologists still need to advocate for the technology.


In April 2014, the Protecting Access to Medicare Act (PAMA) was signed into law. Among the provisions of the bill was a mandate requiring physicians who ordered advanced diagnostic imaging to consult clinical decision support
(CDS) system.

You’d think that with 2017 just around the corner, the work for advocating for CDS would be finished.

But it turns out radiologists’ role in CDS has only just begun. Hospitals and health systems should begin to adopt CDS as soon as they can — and radiologists need to be on the forefront of making that happen, says Lawrence A. Liebscher, MD, FACR, a radiologist at Cedar Valley Medical Specialists, P.C. in Waterloo, Iowa, and chair of the ACR Commission on General, Small, and Rural Practices. “It’s very important radiologists are involved in the process and that CDS not simply be turned over to IT or a clinical specialty group,” he says. “Despite the fact the information behind it is created by radiologists, if we do not take charge of CDS and claim it as our own, other groups will.”

So how do you convince your hospital or health care system to adopt CDS before the deadline? Where do you start? Check out the sections below for talking points and advice from radiologists who have successfully advocated for CDS in their health systems.

Talking About CDS

Adopting a system like CDS early may take some convincing. Check out these talking points to help steer your conversations in the right direction.

Point 1:

Although the adoption deadline is not until 2017, full implementation will likely take longer than health systems realize. Liebscher notes the larger your health care system is, the longer the approval and installation processes will take. “People may not think they’re under the gun, but the fact is, time is running out,” he says. According to Liebscher, the process commonly takes 18 months, but his hospital took over two years. With less than 18 months left until January 2017, you may want to point out that time is of the essence.

Point 2:

Ensuring appropriate imaging is the right thing to do for patients. “Creating more appropriate imaging for all patients creates better patient safety, better outcomes, and a shorter inpatient stay, all of which result in improved patient satisfaction,” says Hirschorn.

Point 3:

Ethics aside, CDS makes good business sense. At first, reducing your volume by one MRI out of ten doesn’t seem like a significant savings, notes Liebscher. And maybe it isn’t. But by avoiding one inappropriate test, you may bypass additional complications and costly follow-up, he says. “If you do an unnecessary exam and the patient needs extra imaging, or you act on an incidental finding, you may be creating an additional stream of costs,” Liebscher adds.

Point 4:

You may also want to raise the possibility of CDS’s taking the place of expensive radiology benefit managers (RBMs),1 says Kedar. By eliminating the cost of RBMs, you save your health care system money and save your referring physicians time by simplifying the cumbersome preauthorization process. “If you can show physicians that implementing CDS is simpler and faster, then that’s a big win for everyone,” notes Liebscher.


By Meghan Edwards, copywriter for the Bulletin


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