Novel decision support to guide medical image ordering

The Challenge: Evidence suggests that a substantial percentage of advanced medical imaging (e.g. CT, MRI) for diagnostic purposes is inappropriate. While the rate of inappropriate imaging may vary by setting, reported rates span a low of less than 20% to a high of greater than 40%. Whether imaging estimates fall within or outside these ranges, the stark reality is that patients are frequently being overexposed to radiation and billions of dollars (nationally) are being inappropriately expended. A “physician knowledge gap” regarding optimal medical imaging study ordering is frequently cited as a contributing cause and transcends settings (e.g. emergency department, cardiology, primary care).

Our idea: We propose designing, developing, usability testing, disseminating, and formally evaluating the use of novel clinical decision support (CDS) application as a tool to shape clinician ordering of diagnostic medical imaging studies. Our clinician-designed CDS application will be simple to use and provide the user with clinical guideline recommendations, cost, and estimated radiation exposure (with health risk) information on appropriate diagnostic image options for a given condition. The application will seek to guide the clinician toward the “optimal” choice which we define as: optimal = evidence-supported + minimal patient exposure to radiation + lower cost.

We have five major deliverables with the project:

  1. CDS application (accessible via clinic desktops, MAPS tablets, iPhones and iPads)
  2. Secure database for our CDS application. The database will be designed to support user-friendly modifications (updates), and both routine and ad-hoc analytic reporting
  3. Initial CDS application usability testing report to be completed and delivered to the MHS prior to initial dissemination and formal evaluation
  4. Plan for integrating our CDS application with the interagency electronic health record (iEHR)
  5. Final report on the development, testing, dissemination, and formal evaluation of our CDS application

Our CDS development and demonstration project places an evidence-supported, easy-to-use, clinician-designed, decision support tool in the hands of MHS primary care clinicians who are responsible for medical image ordering. The project is aimed at closing a current “knowledge gap” by providing MHS clinicians with the latest evidence, risk, and cost considerations to enhance decision-making. A secondary aim, albeit also important, is to assess whether our CDS format and delivery might be a viable strategy for translating other types of clinical guidelines and evidence at point of care.

Quadruple aims supported: Our MHS innovation advances two of the quadruple aims. Specifically: 1) enhancing the experience of care, and 2) reducing per capita cost.

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