State of Minnesota adopts clinical decision support, other states to follow

Minnesota is in the vanguard as far as implementing clinical decision support, a tool that tamps down overutilization and reduces the incidence of patients receiving inappropriate diagnostic imaging tests. Minnesota is launching a statewide initiative to adopt the tool; others states are also considering its use.

Clinical decision support, also called e-ordering, circumvents the need for radiology benefit managers. Based on appropriateness criteria, prior authorization for an exam is given in real-time through an electronic rating instrument. Primary care physicians are not allowed to order tests helter-skelter; they are guided to order the proper test through a series of questions they answer electronically.

Diagnostic Imagingpreviously reported on Minnesota’s pilot project, which found after implementing the tool the number of high-tech scans did not increase in 2007 compared with an 8% increase in the prior year. In addition, the diagnostic quality of the scans increased 10%, radiation dose was reduced, and increased efficiency shaved $84 million off of healthcare costs, according to research from the Institute for Clinical Systems Improvement.

The institute, a nonprofit organization that includes 60 medical groups and six health plans, has licensed Nuance Communication’s clinical decision support tool RadPort to support the statewide initiative.

Other states considering a statewide measure are Washington and North Carolina, according to Scott Coswill, senior product manager of diagnostic solutions at Nuance.

“Clinical decision support is not technically used by radiologists from a user perspective, so what does it really mean to them?” he said. “Ultimately, radiologists are getting more structured clinical indications for why referring clinicians are doing the studies they’re doing.”

Clinical decision support is another tool to help patients receive the right test at the right time for the right reasons, said Dr. Thomas Gilbert, a spine radiologist at the Center For Diagnostic Imaging in Minneapolis.

“Because clinical decision support provides instant feedback to the physician, those patients are able to come to our clinics for their imaging sooner than they may be able to under other methods of third-party benefits management, and therefore can receive a diagnosis and treatment plan more efficiently as well,” he said.

There are a couple of other things radiologists like, according to Coswill.

“Some radiologists don’t feel comfortable calling the referring physicians and ‘telling them how to do their job,’” Coswill said.

Clinical decision support helps those shy radiologists who don’t want to confront the referring physician, he said.

“The ones who actually do make the calls don’t want to spend their time making phone calls, or they would have been a phone operator,” Coswill said. “They want to read studies, and now they don’t have to make as many calls because they know the right test has been ordered.”

Integrating clinical decision support across the state is expected to save Minnesota more than $28 million annually, according to the Institute for Clinical Systems Improvement.