The Protecting Access to Medicare Act of 2013 mandates that, as of January 2017, physicians who order advanced diagnostic imaging exams must consult appropriate use criteria through a clinical decision-support (CDS) system. Despite the direct effect of this new regulation on reimbursement, many radiologists and hospitals aren't aware of it, according to presenter Dr. Alexander Goehler, PhD.
The researchers sought to increase awareness of CDS at their own institution via a pilot implementation, and they also wanted to evaluate obstacles to broader use of the technology. Radiologists and ordering clinicians mostly had a positive response to the project, Goehler said.
After first identifying several imaging types that might benefit from CDS in the ordering process, a multidisciplinary team chose CT angiography (CTA) studies for pulmonary emboli (PE) as the first exam to focus on due to the established clinical evidence on risk scores. A best-practice alert was set up within the institution's RIS ordering system (Epic Systems) to guide emergency department (ED) physicians based on a diagnostic pathway algorithm developed by the multidisciplinary committee.
The alert has been live for five months, and it has recommended changing the CTA order to either a D-dimer blood test or to not performing any test at all. However, only about 10% of these recommendations led to a direct change to the order, Goehler said.
"After speaking with ordering physicians, it seems that a common reason for their deviation from the recommendation is that a CTA provides a faster turnaround time and more precise result than a D-dimer," he told AuntMinnie.com. "We plan to have a meeting with the ED ordering staff to share more granularity about the level of PE severity versus number of negative studies, and also to address our plan to expand the initiative to include inpatients -- both with a goal to increase the rate of changes in study ordering and to ensure appropriate ordering of CTA for evaluation of PE across the hospital."
