Local, State, Federal

Imaging e-Ordering Coalition Formed

Given the widespread use and cost of imaging services, it is important to ensure the quality of these services and their appropriate utilization; that is, ensuring the right test is performed at the right time and is done correctly. The decision by a treating physician to order a particular imaging service often involves a number of complex and patient-specific determinations, and there can be significant variation in ordering physicians’ level of experience with imaging services.

In response to this situation, leading health care providers, technology companies, and diagnostic imaging organizations have joined forces to form the Imaging e-Ordering Coalition. This national initiative will promote health information technology (HIT)-enabled decision support (e-Ordering) as a solution to ensure that all patients receive the most medically appropriate diagnostic imaging test for their specific condition.

Members of the Coalition are devoting their energies to educating policy makers and health care providers about the patient-centered efficiencies of e-Ordering, as well as recommending to lawmakers that the efforts to build incentives for prescribing medications electronically (e-Prescribing) should be broadened to include diagnostic imaging e-Ordering solutions.

According to the Coalition, e-Ordering prevents many of the potential issues associated with radiology benefit managers (RBMs), which are organizations employed by some health care insurers to manage utilization and costs associated with high-tech diagnostic examinations. Concerns with the RBM model include regulatory oversight and a manually burdensome “prior authorization” system whereby physicians must receive approval before ordering an imaging service. According to the new group, under prior authorization, patients are often denied the imaging studies their physicians believe are warranted. Instead, they are steered toward lower-precision tests that may not provide needed clinical information, or are forced to wait days or weeks to receive vital imaging services. In contrast, e-Ordering provides physicians real-time, electronic access to pre-examination, case-by-case decisions that are linked to published, evidence-based clinical studies and are tailored to a patient’s specific circumstances.

E-Ordering provides a scaled utility score, not a binary (approved/disapproved) score, according to Scott Cowsill, senior product manager of diagnostic imaging, Nuance Healthcare, “The vital information is returned in real time when it is needed. You don’t want or need delays in today’s high-tech environment,” said Cowsill.

“The growing emphasis at all levels of the federal government to encourage adoption of HIT presents an opportunity for the Coalition to elevate e-Ordering as a much more provider-friendly, patient-centered alternative to the RBM model,” said Liz Quam, director, Center for Diagnostic Imaging, and founding member of the Imaging e-Ordering Coalition. “As a provider of diagnostic imaging services in nine states, my company has seen the inconsistencies in insurers’ utilization efforts. None of those efforts are without hassle for the health care providers striving to offer patient-centered care. Using an electronic decision support tool offers regulators and insurers the assurance that the patient is receiving appropriate care without adding unnecessary time or administrative expense.

“Providers detest the concept of a third party directing a clinical decision,” said Quam. “It erodes the trust relationship a patient must have with their provider. An RBM is not a consultative relationship; it’s a ‘Captain May I’ game. From experience, we know that if we just have an ordering physician or staffer stay on the phone with the RBM and keep asking for a ‘higher up,’ you can almost always get a ‘yes.’ It’s a ridiculously hassle-packed system meant to gain savings from those providers less persistent than others.”

“I still think the biggest cost is the erosion of trust,” Quam added. “As a patient, do I really know that I shouldn’t have had that MRI? Would my doctor have pursued it further if I were a relative or a VIP? There’s no place for me as a patient to figure out the RBM criteria because there is no transparency. There is with the clinical decision support tools—sitting right next to the doctor.”

Among the Coalition members are the American College of Radiology, the Center for Diagnostic Imaging, GE Healthcare, Medicalis Corp, Merge Healthcare, and Nuance Communications Inc.

—James Markland