JACR: Opportunities abound for CDS to impact quality, data reporting programs

Imaging clinical decision support (CDS) can be more than a physician-friendly alternative to prior authorization, as it helps satisfy criteria for a number of quality initiatives and incentive programs, according to an article published in the December issue of the Journal of the American College of Radiology.

Authors Hanna M. Zafar, MD, of the University of Pennsylvania in Philadelphia, and colleagues explained that CDS helps with requirements for the Physician Quality Reporting System (PQRS), the Hospital Outpatient Quality Reporting Program (OQR) and others.

PQRS – After the Hospital Inpatient Quality Data Reporting Program in 2003 didn’t feature any imaging procedures or interventions, a focus on imaging was added to the PQRS, a program that began in 2007. One category of PQRS measures focuses on order entry, including appropriate imaging. For example, one measure tracks the percentage of patients with stage 0 or IA melanoma for whom no diagnostic imaging studies related to the melanoma diagnosis had been ordered. Zafar and colleagues noted that CDS could trigger an automated reminder to clinicians who include a diagnosis of melanoma during order entry that stage 0 and IA melanoma should not be evaluated with imaging.

OQR – Established along with the PQRS, the OQR includes a major focus on advanced imaging. OQR measures related to imaging largely fall into two main categories: preventing suspected overutilization and focusing on evidence-based appropriate imaging. Both of these are well suited to CDS, according to the authors.

Medicare Imaging Demonstration Project (MID) – This project targeted 11 high-cost advanced imaging studies for Medicare fee-for-service (FFS) beneficiaries and sought to assess the impact of targeted professional society guidelines delivered through CDS.

“Although the results of the MID and of meaningful use will not be available for several years, there will be a continuing focus on improving the quality of health care by optimizing imaging utilization…radiologists must recognize and respond to these initiatives,” wrote the authors.

Imaging CDS will likely have a varied economic effect, according to Zafar and colleagues. These systems can be associated with significant overall cost savings, but in fee-for-service (FFS) environments, imaging utilization may be decreased which will reduce practice revenues. “Even in a FFS ambulatory environment, if CDS is tightly integrated into relevant provider and support staff workflow (eg, online scheduling), any reduction in inappropriate imaging will create the capacity to compete for the volume of remaining appropriate imaging procedures and thus minimize the financial impact of improving appropriateness.”

The effects of large-scale implementation of imaging CDS on quality remain uncertain, but the authors concluded by noting that with more imaging CDS in place, it is becoming increasingly possible to evaluate its effects. “As these data become available, we can determine where our weaknesses and strengths lie in order to improve the delivery of imaging.”