Physicians and insurers have joined forces in Minnesota to create an entry decision-support system that promises to improve the quality of physician referrals for high-tech medical imaging while linking the process to webbased electronic medical records.
The Institute for Clinical Systems Improvement, a nonprofit organization with a history of resolving conflicts between Minnesota’s physicians and insurers, was called in when the two groups clashed in late 2006 over the impending imposition of mandatory prior notification for high-tech imaging.
To foster cooperation, ICSI identified decision support as a potential alternative. First developed and applied by radiologists at Massachusetts General Hospital, orderentry decision support advises referring physicians about the consensus clinical appropriateness of imaging procedures planned for their patients. Operated on a laptop computer, it enables the referring physician to modify an order before its electronic submission.
ICSI developed its own prototype decision-support software and clinical criteria to assess the appropriateness of physician orders for MR, CT, PET/ CT, and nuclear cardiology.
Five large integrated medical groups tested the prototype in a yearlong pilot study. In cooperation with insurers, physicians—including radiologists— worked with ICSI to develop clinical criteria for the decisionsupport software. It expanded upon appropriateness criteria from the American College of Radiology and American College of Cardiology.
The HealthPartners insurance plan and its 600-physician HealthPartners Medical Group helped refine the criteria. Even before the pilot study, the group moved forward to make imaging order-entry decision support broadly available to all its members, said HealthPartners medical director Dr. Patrick Courneya.
“We felt that given good information with the guidance of appropriateness criteria, physicians would tend to make better, more cost-efficient decisions,” he said.
Kevin Palattao, HealthPartners vice president for information technology, developed order-entry software, while Dr. John Butler, physician lead for IT and automation, recruited physicians to assemble clinical criteria that would later be used to strengthen ICSI’s assessment software.
HealthPartners rolled out its order-entry product in February 2007, the same month it introduced mandatory imaging prior notification. Palattao’s engineers also wrote additional software making the system compatible with the EPIC Electronic Patient Record. It was shared with the Minnesota EPIC User Group and made available to the 70% of physician groups that use EPIC in Minnesota.
