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Referrer: “Does my patient need medical imaging?” Clinical guidelines IT Solution Appropriate test & treatment
Demand Optimisation (CDS) Workshop Dr Raj Burgul What is - - PowerPoint PPT Presentation
Demand Optimisation (CDS) Workshop Dr Raj Burgul What is - - PowerPoint PPT Presentation
Demand Optimisation (CDS) Workshop Dr Raj Burgul What is Clinical Decision Support (CDS)? Referrer: Does my Clinical IT Appropriate patient need guidelines Solution test & treatment medical imaging? The Aim The CDS
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The CDS project will explore what impact the use
- f CDS can have as a
demand management tool
- n the Radiology Service
in Scotland
The Aim
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Guidelines
- Available guidelines:
– iRefer (Royal College of Radiologists; developed with ) – iGuide (European Society
- f Radiology; based on
the American College of Radiology appropriateness test) – SIGN – NICE
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'Pull’ resources
iRefer
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European Council Directive 97/43/Euratom requires Member States “to ensure that recommendations concerning referral criteria for medical exposures, including radiation doses, are available to the prescriber of medical exposures” The Protecting Access to Medicare Act (PAMA) The Protecting Access to Medicare Act
- f 2014 mandates that starting January
1, 2019, physicians ordering advanced diagnostic imaging exams must consult qualified, evidence-based appropriate- use criteria, namely through a Clinical Decision Support Mechanism.
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How has CDS performed elsewhere?
University of Virginia, Charlottesville, Virginia. J Am Coll Radiol 2018; CDS installed 2015 – initial silent mode Appropriateness Score categorization for 6754 cases Pre intervention 16909 cases post intervention
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How has CDS performed elsewhere?
Pilots have been ongoing across Europe using iGuide by the European Society of Radiology Their latest report has shown that once CDS is introduced:
- number of unnecessary/duplicate exams goes
down
- number of avoidable referrer-radiologist
consultations reduce
- diagnostic yield of exams actually carried out is
increased
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How has CDS performed elsewhere?
- Pilots in Hillingdon and North West London
using RCR’s iRefer guidelines:
- Pilots are ongoing.
- There have been delays due to integration issues and
no results are available yet.
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SRTP CDS Pilot – The story so far
- Additional funding was made available through the
Scottish Government to fund a CDS pilot
- There has been a PIN notice via NHS GGC
- The Scottish Government is testing CDS software in
a national pilot. The SRTP is currently exploring if the contracted provider is able to support a Radiology CDS solution in Scotland.
- Boards have been approached to note their interest
to participate in the pilot. Further discussions to be held.
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Run CDS pilot within one or more NHS boards Use the experience
- f the pilot to
inform a national approach in this area Depending on
- utcome of pilot, to
implement a national CDS solution
SRTP CDS Project Objectives
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Group Discussion
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- 1. CDS will only be as good as the guidance. What
guidance should we use?
- 2. Should we try to standardise guidance across
Scotland? If so how?
- 3. Are there existing Scottish audits and guidance we
can use?
- 4. Should DGH guidance be aligned with their tertiary
centre?
Group Discussion
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- 5. Structured Requests?
- 6. How to assess a CDS project? What metrics and
balancing metrics should be used?
- 7. Do we think CDS will reduce demand?
- 8. Is there an educational benefit?
Group Discussion
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- 9. How do we utilise the data CDS will provide
regarding clinician requesting behaviour?
- 10. Pilot sites?
- 11. Are there any other ways to manage demand?
What is the role of Vetting?
- 12. Is there any current way to quantify the
number of unjustified requests?
Group Discussion
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