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With an eye toward improving patient care and reducing costs, the Centers for Medicare and Medicaid Studies (CMS) is taking a closer look at ways to help doctors select better imaging tests for their patients. BWH was recently selected by CMS to participate in its Medicare Imaging Demonstration project, which will collect data on the use of decision support systems, a type of computer program that helps doctors select the imaging test best suited for a particular patient.
“Advanced imaging studies like MRI, CT and Nuclear Medicine are tools that doctors use to diagnose patients’ conditions more rapidly and monitor the effects of treatment,” said Ramin Khorasani, MD, director of the Department of Radiology’s Division of Medical Imaging and Information Technology and the project liaison to CMS. “The appropriate use of these types of medical imaging studies can help patients avoid invasive surgical procedures and lengthy hospital stays. This would lead to better patient care and significant cost savings.”
Decision support systems run a rapid, real-time assessment of an imaging request based on information in the patient’s medical record and criteria for appropriate imaging set by professional societies such as the American College of Physicians. The doctor sees the result of the assessment as a handy, easy-to-apply cost-benefit ratio.
CMS’s Medicare Imaging Demonstration project will show the impact decision support systems can have on the ordering patterns for 11 advanced imaging tests, such as MRI of the spine, CT of the brain and MRI of the brain. Data will be collected during two time periods: at six months, after imaging orders have been made without decision support, and again six months later, after decision support has been turned on at all sites.
“At BWH, we use a decision support system that has a feature for limiting test-ordering mistakes,” Khorasani said. “During the six years since the electronic tool was installed, it has contributed to reductions in the overall number of imaging tests ordered and the number of tests that are repeated.”
The BWH-led portion of the study will cover the ordering patterns of more than 5,500 physicians, meaning that the Medicare Imaging Demonstration project will have far-reaching implications for patient care and health policy, Khorasani added.
“When ordered appropriately, MRIs, CTs and Nuclear Medicine studies provide essential, valuable information. However, they are expensive tests and some of them, specifically the CT and Nuclear Medicine studies, expose patients to radiation,” he said.
“If this project shows that decision support systems significantly improve the appropriateness of the imaging requests, it could lead to more widespread use of the technology and corresponding cost reductions and improvements to patient safety.”