CDS in the hot seat

After a four-year wait, the results of the Medicare Imaging Demonstration project have arrived. You will understand why they are underwhelming if you have ever gone swimming in a pond full of algae: Murky.

If you’ve forgotten the project’s design, CMS set out to measure the effect of the use of clinical decision support (CDS) on the ordering of 13 of the most common advanced imaging procedures, specifically to see if the use of CDS would reduce overutilization of advanced imaging. Unfortunately, just 35% of orders were covered by the guidelines.

Is this the fault of the guidelines, as inferred by the Rand report to Congress, the study design, or the delivery mechanism? Plenty will be said on this in the ensuing months, but the first person we asked to weigh in was CDS veteran Mike Mardini, CEO, National Decision Support Company, which is licensed to market ACR Select, the college’s web-ready appropriateness criteria.

Remember Imaging Advantage (IA)? Six years ago, when IA showed up on the national radar by displacing a local radiology group at Toledo, Ohio-based Mercy Health Partners, many people thought it wouldn’t last. I don’t know whether IA continues to provide professional services at Mercy due to the opaqueness of its web site, but I do know that they just bought themselves a PACS company—BRIT Systems.

IA has made some smart moves in six years and one of them was nabbing a grant to develop a CDS system from CMS. Instead of working under the constraints of a study designed by the government, IA received a grant from the government to develop a CDS system. Who knows—and I’m just speculating—some of those dollars may even have gone to buying an informatics company to help them refine that system.

Cheryl Proval