BURLINGTON, MA – Nuance Communications announced Wednesday that the Institute for Clinical Systems Improvement (ICSI), a nonprofit organization made up of 60 medical groups and six health plans throughout Minnesota and surrounding states, has licensed its RadPort decision support technology to help ensure patients only receive medically appropriate diagnostic imaging tests.
As it prevents unnecessary MRI, CT, PET and nuclear cardiology testing, the ICSI initiative, which is the first of its kind in the country, is expected to save the Minnesota healthcare system more than $28 million annually.
In addition, ICSI will use Nuance’s RadCube software to analyze physician-ordering trends in parallel with patients’ clinical outcomes.
“This is an exciting statewide initiative that will yield many patient, provider, health plan and community benefits, and potentially serve as a national model for how to help reduce the more than $100 billion spent annually on high-tech diagnostic imaging tests across the U.S.,” said Cally Vinz, vice president of clinical products and strategic initiatives at ICSI. “With Nuance’s electronic decision-support and patient outcome analysis solution, we will work to guide appropriate ordering at the point-of-order to ensure the best exam is ordered for the patient every time. We will also have better insight into physician ordering habits and their impact on patient care.”
After a yearlong pilot program, in which more than 2,300 physicians from five Minnesota medical groups, five health plans (Allina Medical Clinic, Fairview Health Services, HealthPartners Medical Group, Park Nicollet Health Services, and St. Mary’s/Duluth Clinic Health System, BlueCross Blue Shield of Minnesota, HealthPartners, Medica, and UCare), and the Minnesota Department of Human Services used e-Ordering to order high-tech diagnostic imaging exams, it was found that the exams ordered with evidence-based decision-support technology had an increase in medical appropriateness versus orders initiated without it.
The pilot also showed that using decision-support appropriateness criteria in the physician’s office reduced patient exposure to unnecessary radiation, and contributed to a 0 percent increase in HTDI scans ordered in 2007 (following an 8 percent increase in Minnesota in 2006).
Since the pilot, all five medical groups have continued to use the decision-support criteria. The groups report improved patient satisfaction and clinic efficiencies, as well as a reduction in administrative costs. In total, it is estimated that by using e-Ordering for the past three years, the five medical groups have helped save Minnesota $84 million, as there has not been an increase in the use of HTDI scans in Minnesota since 2007.
As part of the ICSI-led initiative, Nuance is helping Minnesota medical groups order HTDI exams in the way Minnesota insurers reimburse them, which will reduce administrative costs. Medical groups that use RadPort will likely be able to forego Radiology Benefit Management (RBM) prior notification procedures that require the time-consuming task of completing phone calls to RBM companies to gain assurance of insurer reimbursement for the exam. An RBM is an organization employed by healthcare insurers to manage utilization and costs associated with high-tech diagnostic exams.
Right test the first time
With the RadPort process, ordering clinicians enter patient-specific information along with the requested exam into the e-Ordering system and, based on the exam’s utility score (clinical appropriateness), the system will either verify the order or provide alternative procedures that better suit the patient’s indications. The physician can then select the recommended procedure, or override the system’s suggestion to move ahead with their originally requested exam.
"At Fairview Health Services, we’re ecstatic over this option," said Barry Bershow, MD, vice president, quality, Fairview Health Services in Minneapolis. "It helps our physicians get patients the right test the first time without an administrative hassle. It flows seamlessly into the normal office procedure and consumes no extra time."
RadPort provides access to a common set of decision-support appropriateness criteria – via direct integration into an electronic health record or via a standalone web portal. RadPort’s appropriateness criteria contains more than 15,000 clinical guidelines that are continuously updated in accordance with patient demographics, imaging procedures, the American College of Radiology (ACR) Appropriateness Criteria, as well as input from a clinical committee at Massachusetts General Hospital and other leading clinical partners across the country.
Electronic decision-support benefits providers, health plans and patients alike. In addition to avoiding the expenses and inefficiency of phone-in RBM prior notification, providers have immediate information about the usefulness of the high-tech imaging test they want to order. Also, the immediate feedback from the RadPort system eliminates patients' wait times for exam scheduling, reduces the risk of unnecessary radiation exposure, can enhance the patient-physician relationship through point-of-order shared decision making, and expedites high-tech imaging by increasing the likelihood that patients have the appropriate diagnostic study already done when they are referred onto a specialist.
“The ICSI solution is a win-win-win," said Patrick Courneya, MD, medical director for care delivery systems, HealthPartners Health Plan. "Physicians aren’t hassled, the patient receives the right test and avoids unnecessary radiation, and the payer – whether health plan, employer, government or patient – incurs no unnecessary expense,”
Nuance’s RadCube software solution will be available for use by Minnesota medical groups and hospital-based clinics that adopt the decision-support e-Ordering option. RadCube is a Web-based intelligence tool for the collection, analysis and sharing of data that can be viewed via one interface for instantaneous analytics to drive appropriate order monitoring, forecasting, and provider productivity. ICSI will also have access to the de-identified data of all medical groups using RadCube, thereby improving the state’s knowledge of which diagnostic imaging tests get the best patient outcomes.
“In alignment with President Obama’s healthcare reform goals, the initiative to reduce unnecessary exams, costs and administrative efforts that do not contribute to better patient care and improved patient outcome is an area ripe for change,” said Mike Mardini, vice president of medical imaging at Nuance. “The ICSI effort is a shining example of how we nationally should be applying healthcare IT to meaningfully impact patient care and cost of delivery. Electronic decision-support provides physicians with the information they need at the point-of-order to support the best care delivery plan possible for the patient. In addition to the $28 million dollars the ICSI initiative is expected to save annually, patients will miss less work, as well as spend less time and money on travel, day-care and co-pays associated with diagnostic imaging tests they do not need.”
