The Protecting Access to Medicare Act (PAMA), which will go into effect on January 1, 2020, requires all healthcare institutions serving Medicare patients to implement electronic clinical decision-support systems. In practice, PAMA will require clinicians to reference appropriate use criteria using CDS software when ordering advanced diagnostic imaging studies for Medicare patients for those exams to be reimbursed.
"The implementation of imaging clinical decision support and its impact on ordering behaviors offers a ripe opportunity to explore decision science and utilization in the field of imaging," said presenter Dr. Jessica Fried of the Hospital of the University of Pennsylvania in Philadelphia.
Seeking to identify opportunities to improve the use of radiology CDS software, the researchers initially piloted CDS at their institution in "silent mode"; clinicians were prompted to choose a study indication from a drop-down menu when ordering advanced imaging studies, but they were not given feedback on their order.
The researchers determined that successful implementation of imaging CDS systems is predicated upon context-relevant mapping of indications to the appropriate use criteria. In addition, it's critical to understand local, regional, and practice-level variation in how and why clinicians order advanced diagnostic imaging exams to design efficient interactions with the imaging CDS software, Fried said.
"Our study demonstrated that if given the opportunity, a significant proportion of clinicians in our system preferentially entered free-text responses instead of providing structured indications, even if their desired indication was a mapped selectable criterion from a structured menu," she told AuntMinnie.com. "These findings will guide next steps in our implementation of imaging CDS at our institution as we work with our vendor to optimize the delivery for our health system enterprise."
This paper received a Roadie 2018 award for the most popular abstract by page views in this Road to RSNA section.
