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Clinical Decision Support: Another Chapter in Radiology Leadership

October 22, 2012
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Radiology continues to lead the way in terms of industry trade organization's role in improving Healthcare IT interoperability.


Wow!  Another year is rapidly drawing to a close.  But, before the year-end holidays there is that “little” event in Chicago after Thanksgiving called the RSNA (Radiological Society of North America) annual meeting (  For anyone who has attended, they will know that it is a huge event that is next to impossible to cover despite spanning almost a week.  I am trying to put together my “wish list” for what I need to see this year.

One topic that I expect to be red hot this year is that of Clinical Decision Support (CDS).  The recent finalization of ARRA/MU Stage 2 will only increase the urgency of applications that improve quality of care, departmental efficiency, dose reduction, and physician loyalty.  I expect that this will receive more attention in 2012 than ever before.

Part of that is driven by a novel collaboration between the radiology community and a commercial vendor.  This follows a pattern of collaboration across radiology that should inspire others to follow suit.  For example, radiology led the way with development of an imaging standard through the collaboration of the American College of Radiology ( and the National Electrical Manufacturers Association (  Together they postulated the ACR-NEMA imaging standard that became known as the DICOM (Digital Imaging and Communications) standard. 

Another collaboration has been between the RSNA ( and HIMSS (  According to the IHE website (, “IHE is sponsored by associations of healthcare professionals around the world and has welcomed participation by many of the leading manufacturers of imaging and information systems.”  As with DICOM, it is doubtful that interoperability between healthcare IT devices would be as far along as it is without the IHE collaboration.

Another intriguing arrangement involves the ACR’s decision to commercialize their “Appropriateness Criteria,” or AC toward the objective of establishing AC as the national standard guidance tool for medical imaging ordering.  To effect commercialization, the ACR entered into an exclusive agency agreement with the National Decision Support Company, or NDSC ( to provide the technical platform, support and licensing of the ACR AC under the name ACR Select. 

The ACR appropriately realized that similar to the DICOM imaging standard, the fastest way to build acceptance of clinical decision support criteria is through adoption of a standard criteria framework in the form of the ACR’s Appropriateness Criteria developed over the past twenty years.  The AC database spans 130 clinical topics and 614 variant conditions for evidenced based guidance of medical imaging procedures.  Relying on 300 volunteer physicians from more than 20 radiology and non-radiology specialty organizations, the ACR continuously updates the guidelines to assure for timely and accurate guidance. 

As with the DICOM standard, the ACR-NDSC relationship is not meant to be a commercial end-user product, but a licensing arrangement to enable Healthcare IT application vendors to capitalize on an industry solution embedded within their applications.  Application developers benefit by avoiding the capital expense of developing their own redundant criteria.  Healthcare providers benefit from a uniform approach to criteria with a proven track record in improving the quality and cost of imaging services.

One successful example of the benefits of AC is the experience of the Institute for Clinical Systems Improvement, or ICSI (  The ICSI is sponsored by five Minnesota and Wisconsin health plans, and covers over 60 medical group and hospital members representing 9,000 providers.  The ICSI implemented a pilot with nearly 5,000 providers using Clinical Decision Support to order the top 90% of high technology diagnostic imaging CPT codes for MRI, CT, PET and nuclear cardiology scans.  The pilot resulted in $84 million in reduced imaging studies, fewer administrative hours and cost, and decreased radiation exposure (from reduced and modified exams).

Another reason for AC excitement is that Clinical Decision Support fulfills a Stage 1 MU Core Measure!  With the added emphasis on Stage 2 MU, interest will continue to grow in terms of its use.

Lesson learned?  The ACR’s Clinical Decision Support initiative is further evidence of the merits of the expanded role of radiology industry organizations in fostering Healthcare IT interoperability.  Radiology has been a pioneer in such collaboration and represents an example for other related Healthcare IT organizations.  Hopefully, the success of Radiology will be a strong incentive for others to follow suit and further advance the industry!

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