Inappropriate use of medical imaging tests can cause physical harm by exposing patients to excess radiation, worsen patient outcomes and increase health care spending. But ordering the right tests can be difficult for physicians facing time constraints, pressure from patients and lack of access to evidence of tests’ effectiveness. A new training module demonstrates how clinical decision support tools can be a physician’s friend when needing to identify appropriate tests and facilitate shared decision-making.

Clinical decision support is a key functionality of health information technology and a centerpiece of the Medicare and Medicaid EHR Incentive Programs. While many electronic health record (EHR) users might associate clinical decision support with alerts and notifications, it has much more robust capability and includes a variety of helpful practice tools, from clinical guidelines to focused patient data reports.

Within diagnostics, clinical decision support promotes sound decision making by providing immediate access to details of radiation doses and other risks, as well as costs. In addition, it provides physicians with tools they need in the exam room to help patients understand the rationales for ordering, delaying or not performing specific tests. It also enables clinicians to demonstrate to payers that they are ordering appropriate imaging tests.

A new module from the AMA STEPS Forward™ collection of practice improvement strategies outlines five steps you, as a physician, can take to integrate clinical decision support for imaging into your practice:

  • Familiarize yourself with clinical decision support and its role in optimizing care delivery. Clinical decision support enables clinicians to quickly and confidently determine the appropriateness of imaging tests at the point of care. It can also help you gather data to assist you in providing higher quality care at lower cost, two key metrics of value-based payment models.
  • Select an imaging area to improve. Identify specific projects that have the potential to drive practice changes and improve appropriate imaging in your organization. Target imaging studies that you suspect are overused and could benefit from clinical decision support, and establish baselines from which to gauge improvement.
  • Prepare your practice to adopt clinical decision support tools for image ordering and appropriate use. It is important to bring radiologists and referring clinicians together to improve imaging appropriateness and streamline image ordering. This effort can be guided by an action plan found on R-SCAN, created by the American College of Radiology, and resources and recommendations on the American Board of Internal Medicine Foundation’s Choosing Wisely website. ACR has contributed to Choosing Wisely a list of five imaging orders physicians and patients should question.
  • Actively discuss imaging appropriateness with patients and begin making decisions about imaging orders together. Patients are less likely to demand a test once they understand why it is not recommended. Once you gain familiarity with clinical decision support through your participation in R-SCAN, you should feel more comfortable discussing appropriate imaging with your patients.
  • Work with your EHR implementation team to integrate clinical decision support technology. Clinical decision support technology is most useful when it is integrated into your EHR platform. Include your EHR vendor in discussions about decision support.

As with any quality improvement effort, it is important to engage your organization's administrative team, information technology team and chief medical officer as appropriate, and you might consider establishing a partnership with a radiologist to access his or her expertise.

The STEPS Forward module also includes a helpful tool for navigating the complexities of prior authorization and an illustrated PowerPoint with examples of how a particular health condition could be handled with the help of clinical decision support tools.

In addition, it provides answers to crucial practice questions, such as: What should I look for in a point-of-care imaging clinical decision support solution? Where should I begin in selecting an area to improve? And how much will integration cost?

“Practice Transformation Series: Using Clinical Decision Support to Improve Imaging Appropriateness” is a free online continuing medical education (CME) course with 0.5 credits toward AMA PRA Category 1 Credit™. It is designed to meet the educational needs of practicing physicians.

There are seven new modules now available from the AMA’s STEPS Forward collection, bringing the total number of practice improvement strategies to 42; several thanks to a grant from and collaboration with the Transforming Clinical Practices Initiative.

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