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Research: CDS Tools Need Improvement to Reduce Unnecessary Imaging Costs

June 2, 2015
by Gabriel Perna
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Clinical decision support tools can lead to a reduction in the ordering of inappropriate advanced imaging tests, according to new research from the RAND Corporation. The tools just need to improve.
Researchers from RAND, a Santa Monica, Calif.-based nonprofit organization, recently looked at the effectiveness of a clinical decision support (CDS) tools in reducing the inappropriate ordering of advanced diagnostic imaging procedures for Medicare fee-for-service patients. Over a two-year period, the researchers found that the tools, computer-based programs that match a patient's characteristics against treatment criteria and recommend a treatment, increased the proportion of appropriate tests, according to the findings. 
However, the findings weren't all positive. The researchers were not able to assign appropriateness ratings for a majority of tests because there was no appropriateness criteria available or because the tool was not able to find matching criteria.
“The increase in orders rated as appropriate is promising, but the number of tests that were not rated indicates there is room for further improvement of these tools,” Peter S. Hussey, a senior policy researcher at RAND, said in a statement. “In our full report to Congress, we’ve outlined a series of improvements to the decision support tools that we expect can lead to greater reductions in unnecessary tests.”
Those improvements, they say, include a more-comprehensive set of evidence-based guidelines that cover a greater proportion of advanced imaging orders for Medicare patients.
For the study, 3,340 clinicians placed 117,348 orders for advanced diagnostic imaging procedures. The participating organizations were located in eight states and included three academic medical centers, two integrated delivery systems, one group of independent practices in a single geographic area and one group of independent practices recruited by a radiology benefits management organization.
The findings were published in the Journal of the American Medical Association. The Centers for Medicare and Medicaid Services sponsored the study. Beginning in 2017, federal rules will require that decision support tools must be used before ordering any advanced diagnostic imaging study paid for by Medicare.

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