Maximizing Appropriate Use With Smart Decision Support

Reports that a quarter of New York patients who undergo cardiac catheterization likely received this invasive test unnecessarily have raised concerns for both patients and payers across the country. But when those questions arise, Creagh Milford, DO, MPH, associate medical director at Partners Health Care, and his colleagues are prepared to allay them with data that show that about 90% of catheterizations at Massachusetts General Hospital and its sister hospital Brigham and Women’s Hospital meet criteria for appropriateness.

That data and the confidence it inspires is a product of the hospital’s Queriable Patient Inference Dossier (QPID), which Milford described during a session at the HIMSS 2015 annual meeting. The QPID system is a software program that extracts data from patient records, medical literature, and relevant guidelines to help guide physicians and patients through the process of assessing the treatment options for a particular condition.

The physician still leads the process and makes the final decision, said Michael Zalis, MD, a radiologist and chief medical officer of QPID Health, a company created to commercialize the QPID platform. But the software cuts out some of the labor associated with culling relevant data from the patient’s medical record and highlights for the physician which patient data may be relevant to the decision. With these data in hand, the physician is guided through a decision tree based on the relevant clinical guidelines and professional consensus. At the end of the process, the physician and patient discuss a list of possible options graded based on their appropriateness.[[{"type":"media","view_mode":"media_crop","fid":"34247","attributes":{"alt":"Creagh Milford, DO, MPH","class":"media-image media-image-right","id":"media_crop_5822654009154","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3642","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 190px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Creagh Milford, DO, MPH","typeof":"foaf:Image"}}]]

“We are trying to move us to a system where patient and provider are making decisions based on quantitative evidence,” said Milford.

Once a decision has been made, the system guides the patient through a personalized consent process that includes calculation of the risks of the procedure given their medical background and pictures and descriptions of the procedure, explained Zalis.

“It completely changes the game in terms of the patient’s understanding of what they are getting involved in,” Zalis said.

So far, a pilot of the QPID system for lumbar spine care involved 95 cases; the care selected for 83 of them (87%) was deemed appropriate. Seven cases were deemed rarely appropriate and are currently under review. By the end of the year, the health system plans to have QPID up and running for 9 costly procedures.[[{"type":"media","view_mode":"media_crop","fid":"34248","attributes":{"alt":"Michael Zalis, MD","class":"media-image media-image-right","id":"media_crop_8202817250507","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3643","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 190px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Michael Zalis, MD","typeof":"foaf:Image"}}]]

The hospitals have reaped other benefits as well. The system has helped lower the costs of unnecessary care, Milford said. It can also be used as a selling point to patients and referring physicians who want evidence that the organization’s care is cost-effective. It has also cut the administrative work associated with prior authorizations for both the hospitals and the insurers they work with. Milford explained that some insurers have been willing to forgo preauthorization now that the QPID system is in place. Additionally, the system helps provide data for state and federal registries on appropriate use.

Ultimately, Milford said the system may not reduce the number of procedures, but it helps to improve relationships between patients, payers, and clinicians.

“The goal is not to reduce the number of procedures, but to attest to their appropriateness,” he said.