How does CDS impact imaging utilization?

Clinical decision support (CDS) systems can play a role in reducing unnecessary imaging orders, according to a study published in PLOS ONE. However, the authors noted, the reduction may be relatively modest.

“There is a lot of debate about the health risks and high costs that stem from the overuse of potentially inappropriate tests,” co-author Joseph Doyle, Erwin H. Schell Professor of Management and Applied Economics at the MIT Sloan School of Management in Cambridge, Massachusetts, said in a prepared statement. “Our research shows that technology can improve healthcare delivery by helping physicians make the right decisions about which diagnostic scans to use when.”

A CMS mandate requiring advanced imaging orders to be placed using CDS software goes into effect on Jan. 1, 2020, meaning that the technology is getting more attention now than ever before.

The team’s research involved more than 3,500 healthcare providers. Half of those providers were chosen at random and advised to use a CDS system, and the other half did not use one, ordering imaging examinations as they always had.

Overall, the CDS system reduced targeted examinations by approximately 6% compared to the providers that did not use CDS. Good news for providers rooting for CDS to be successful was that its effects persisted over time, showing that the new technology has the potential to make a lasting impact on imaging utilization. The bad news, however, was that the number of images ordered overall did not change. The study’s authors noted that “one reason for such a muted response” was that CDS would regularly make recommendations for alternative examinations that also included at least one high-cost image.

“Our study was meant to understand whether software alone has potential to help doctors improve their decision-making around ordering these expensive and often risky tests because such an intervention is easily scaled,” Doyle said in the same statement. “This is especially the case for diagnostic testing given the imminent mandate that CDS be used for high-cost imaging to be eligible for Medicare reimbursement. Further understanding of the most effective ways to employ the technology beyond simply showing the information about the guidelines remains an important area for future research.”