The American College of Radiology (ACR) said that recent findings from a Medicare demonstration project on clinical decision support (CDS) show the positive effect of the technology, despite a research letter earlier this month in the Journal of the American Medical Association that questioned its effectiveness.
On June 2, JAMA published a research letter from RAND that reiterated an analysis from December 2014. The researchers had concluded that a CDS tool that was an early version of the ACR Select software did not significantly improve appropriate ordering of imaging studies in the 2010 Medicare Imaging Demonstration (MID) project.
Despite the letter, ACR said that the research supports its ongoing efforts to broaden the number of clinical scenarios covered by ACR Appropriateness Criteria. ACR Select evolved independently from MID, and the current version reflects nearly all recommended enhancements from the MID findings, according to ACR. Furthermore, the organization said it has leveraged MID to further explore and enhance the ACR Select technology and experience.
ACR noted that the MID project was a limited exploration of the state of CDS in 2010; the demonstration's design allowed groups of participants to adopt their own nonstandardized CDS technology. This led to variability in mapping orders to guidelines, user interfaces, usability, and more, according to ACR. In addition, other MID deficiencies included small sample sizes, a relatively short time frame, suboptimal implementation, lack of system and workflow integration, and outdated interfaces.
Thanks to more recent technological enhancements such as the refinement of ACR Select, direct incorporation of ACR Select into electronic health record systems, and the expansion of ACR Appropriateness Criteria guidelines to cover more clinical scenarios, the MID report findings were obsolete when they were published in late 2014, ACR said.
