Focus on appropriate imaging

Among this week’s top headlines were a few stories that touched on appropriate imaging—both how to encourage appropriate imaging utilization and the costs when unnecessary imaging is ordered.

On the subject of costs, a white paper issued by HEALTHeLINK, the western New York clinical information exchange, found that cutting unnecessary duplicative CT scans could have saved the region’s hospital systems $1.3 million over a six-month period.

Many of the unnecessary scans appear to have been avoidable. About half of the patients who had a duplicative CT scan had already consented to allowing their providers to access their information through HEALTHeLINK, but 90 percent of the scans were ordered by physicians who either never or infrequently used the information exchange, according to the white paper.

In an effort to improve value of emergency care, an expert panel published in JAMA Internal Medicine a list of five clinical actions that are of low value and potentially overused, with a heavy focus on imaging. The study, which included a survey of 283 emergency medicine clinicians, made the following five recommendations:

1. Do not order CT of the cervical spine for patients after trauma who do not meet high-risk criteria.

2. Do not order CT to diagnose pulmonary embolism without first determining the patient’s risk for pulmonary embolism.

3. Do not order MRI of the lumbar spine for patients with lower back pain without high-risk features.

4. Do not order CT of the head for patients with mild traumatic brain injury who do not meet high-risk criteria.

5. Do not order anticoagulation studies for patients without hemorrhage or suspected coagulopathy.

The expert panel suggested that clinical decision support (CDS) could be leveraged to improve appropriate care, and another study this week, published in Academic Radiology, also touted the benefit of CDS.

That study, which included more than 2,400 patients who were imaged for suspected pulmonary embolism, found that the use of CDS increased adherence to national imaging quality measures from 56.9 percent to 75.6 percent.

Improving healthcare value through IT will, as always, be the focus of the HIMSS annual conference in Orlando, Fla., next week. Health Imaging will be on site and reporting on the latest in imaging informatics. Check out our newsletter next week for coverage, and if you’re going to the show, see you in Florida!

-Evan Godt
Editor – Health Imaging