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Implementing a Health System-Wide CDS System for Diagnostic Exam Ordering in Los Angeles

January 30, 2016
by Mark Hagland
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In Los Angeles’s public hospital system, Maitraya Patel, M.D. is leading an enterprise-wide diagnostic imaging CDS system

Radiology decision support is coming into its own within the Los Angeles County Department of Health Services (LADHS) health system, as Maitraya Patel, M.D., can attest. Dr. Patel, a practicing radiologist and the vice-chair of clinical operations in the Department of Radiology at Olive View-UCLA Medical Center in Los Angeles, is helping to lead the staggered rollout of decision support across the health system’s hospitals. He and his colleagues are working with the Toronto-based MedCurrent Corporation. As the Sept. 24, 2014 press release announcing the collaboration noted,  “MedCurrent Corporation, a leading provider of clinical decision support solutions, today announced that Los Angeles County Department of Health Services (LADHS), the 2nd largest municipal health system in the U.S., has chosen MedCurrent’s OrderRight™ Radiology Decision Support system to ensure appropriate ordering of advanced medical imaging.” The Los Angeles County Department of Health Services, the press release noted, “operates four public hospitals; 16 local health clinics; one multi-service ambulatory care center; and provides services to over 800,000 patients in Los Angeles County. LADHS has recently purchased a Cerner Millennium™ EMR system and will be including OrderRight with their Millennium rollout.” And the press release quoted LADHS CMIO Rob Bart, M.D., as saying that “MedCurrent’s OrderRight encompasses the workflow and clinical depth that best fits our system for today and tomorrow. In particular, its seamless integration into our Cerner Millennium electronic medical record system will ensure that adoption by our providers will be accelerated.”

In fact, Patel and his colleagues are getting ahead of the mandate from the Centers for Medicare & Medicaid Services (CMS), originally scheduled to go into effect on Jan. 1, 2017, but which now has been delayed for an undetermined period of time, perhaps six or more months, that will require Medicare-participating physicians ordering diagnostic imaging exams to use clinical decision support tools and follow appropriateness guidelines.

Recently, HCI Editor-in-Chief Mark Hagland spoke with Dr. Patel about the ongoing rollout of these systems. Below are excerpts from that interview.

Can you share about the timeline and forward progress of this overall initiative?

With regard to the L.A. County health system, we’re on long-term initiative to implement an enterprise-wide EHR [electronic health record] with Cerner. The MLK Outpatient Center went live with the MedCurrent solution in February 2015; then in June, LA County-USC Medical Center; and then Olive View and High Desert went live in November 2015. By March, every site in the health system, including all the outpatient ones, will be live.

What capabilities are being implemented, over time?

We’re using MedCurrent for decision support for ultrasound, CT, MRI, nuclear medicine, and breast imaging diagnostic procedure ordering.

What elements are involved for end-users?

When the ordering provider orders an exam in the EHR, the MedCurrent platform pops up and interfaces with the Cerner EHR, and the clinician has to answer one or two questions, and it provides recommendation levels.

What are the recommendation levels, and how do they work?

There are three levels: 1-3 is a low-strength recommendation, 4-6 is a medium-strength recommendation, and 7-9 is a high strength recommendation. If it’s high-strength, the order is automatically created in the EHR. If it’s a medium-strength recommendation, the solution brings up the entire recommendation panel of choices for that procedure, and the ordering physician can either go ahead and order what they wanted, or select a more highly recommended procedure. If it’s low, 1-3, it will tell you so, and it will list a higher-scoring set of procedures. If all the procedures are 1-3, it will recommend that the ordering physician cancel it.

It could still be overridden, then, correct?

Yes, that is correct.

How has this system worked out for the physicians?


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