The Institute for Clinical Systems Improvement, a nonprofit organization comprised of 60 medical groups and six health plans in Minnesota and surrounding states, will use decision support technology to help ensure patients receive medically appropriate diagnostic imaging tests.
The ICSI initiative, billed as the first of its kind in the country, is expected to save the Minnesota healthcare system more than $28 million annually. Much of the savings is expected to come from the prevention of unnecessary MRI, CT, PET and nuclear cardiology testing.
The ICSI has licensed RadPort decision support technology from Burlington, Mass.-based Nuance Communications for the project, as well as Nuance's RadCube software to analyze physician-ordering trends in parallel with patients' actual 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."
A year-long pilot program included more than 2,300 physicians from five Minnesota medical groups and five health plans – Allina Medical Clinic, Fairview Health Services, HealthPartners Medical Group, Park Nicollet Health Services and St. Mary's/Duluth Clinic Health System, along with BlueCross Blue Shield of Minnesota, HealthPartners, Medica and UCare. The praticipants, along with the Minnesota Department of Human Services, used e-Ordering to order high-tech diagnostic imaging exams, and found that the exams ordered with evidence-based decision-support technologywere determined to be more medically appropriate.
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 zero percent increase in HTDI scans ordered in 2007 (following an 8 percent increase in Minnesota in 2006). During the time of the pilot, an estimated $28 million in healthcare cost savings was reported.
The five medical groups have continued to use the decision-support criteria and reported improved patient satisfaction and clinic efficiencies, as well as a reduction in administrative costs. It is estimated that by using e-Ordering for the past three years, the five medical groups have helped save $84 million, as there has not been an increase in the use of HTDI scans in Minnesota since 2007.
"The ICSI solution is a win-win-win," said Patrick Courneya, MD, medical director for care delivery systems for the 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."
"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."