ICSI Board Approves Moving Ahead With High-Tech Diagnostic Imaging Initiative

ICSI’s Board of Directors has given the organization approval to develop a new approach to support the ordering of appropriate high-technology diagnostic imaging (HTDI) procedures.

The approach consists of a common set of HTDI appropriateness criteria that would be:

• available in the physician’s office to provide clinical decision support at the time care is being discussed with the patient and prior to ordering HTDI tests
  
• embedded into an electronic medical record (EMR), or made available via an Internet Web site
  
• continually enriched and expanded for improved outcomes

In addition, the clinical outcomes data gathered from HTDI scan interpretations can be correlated with the ordering physician’s clinical indication.

Decision Supported by Pilot
The HTDI approach was developed at the request of ICSI member provider groups and health plan sponsors to provide another option to prior notification, which requires providers to call a vendor to determine insurance coverage before ordering HTDI tests. Health plans instituted prior notification as a way of ensuring appropriate imaging in response to the increased use of such HTDI tests as MRIs, CTs, PETs and Nuclear Cardiology over the last decade. The ICSI approach would be another option available for that purpose.

The ICSI option was developed by ICSI’s HTDI Steering Committee, which is comprised of representatives from provider groups, health plans, and the MN Department of Human Services.

It’s based on a pilot that demonstrated ICSI’s HTDI option improves the diagnostic utility of provider-ordered images. The five Minnesota medical groups participating in the pilot as well as health plans said this option was more efficient, patient-centric and preferred over vendor-provided prior notification processes.

ICSI Board-approved Actions

1. License the use of appropriateness criteria
   
2. Develop a business plan to support the option in a way that results in no financial risk to ICSI
   
3. Develop detailed education, communications, and implementation plans
   
4. Develop detailed evaluation plans and timelines
   
5. Explore research options related to this initiative

Implementation
ICSI’s goal is to complete the first four of five Board-approved action items before the end of 2008 in order for the option to be available to provider groups and health plans in the first quarter of 2009.

ICSI has begun negotiations to license the common set of appropriateness criteria from one of the vendors reviewed by the HTDI Steering Committee. That committee will also address the other four action items with the goal of generating recommendations to present to the ICSI Board on the best way to fund and implement this option.

Option Described
Medical groups adopting the ICSI option will process all HTDI orders using a common set of appropriateness criteria for decision support at the point of service (when the doctor and patient are together, before ordering a test). The criteria will initially be made available to outpatient/ambulatory settings in Minnesota and bordering communities.

The appropriateness criteria will be accessed through integration into an EMR or via an Internet Web site. Aggregated, de-identified utilization data will be tracked and trended for all HTDI orders. Individual organizations will have the option to have radiology reports analyzed and obtain detailed reports of patient outcomes.

ICSI will assemble and facilitate the following groups to assure the smooth operation of this program and continual refinement of appropriateness criteria:

• Appropriateness Criteria Work Groups consisting of clinical experts participating in the HTDI initiative will review criteria, literature and utilization on specified codes. Feedback on how the appropriateness criteria can be improved will be provided to the HTDI appropriateness criteria vendor.
  
• Learning/Networking Collaboratives will support the implementation and ongoing maintenance of the HTDI option through educational sessions, collaborative meetings, networking calls and/or Webinars.
  
• An Outcomes Data Collaborative will analyze/review radiology utilization and outcomes data to determine how it correlates with patient outcomes.
  
• The HTDI Steering Committee will oversee the work of these groups, monitor the program’s overall operation, and evaluate its effectiveness.

More Information
For background on HTDI usage, prior notification and the pilot findings that serve as the basis for the option, go to: http://www.icsi.org//news/health_care_redesign/diagnostic_imaging, or contact [email protected] or [email protected].

Benefits of ICSI’s HTDI Approach
The ICSI HTDI Steering Committee believes this approach is a patient-centered, value-driven and better way to ensure that patients are provided with the most appropriate imaging tests. Findings from the ICSI pilot conducted with Allina Medical Clinic, Fairview Health Services, HealthPartners Medical Group, Park Nicollet Health Services, and St. Mary’s/Duluth Clinic Health System suggest that the ICSI approach offers these potential benefits for the health care system.

Provider Benefits:

• Helps ensure the appropriate use of HTDI procedures
  
• Reduces patient exposure to harmful radiation and possible cancers
  
• Enables ordering of HTDI procedures at the point of care
  
• Provides support in decision-making using best available evidence and practice standards
  
• Educates and engages patients in ordering HTDI test at point of care
  
• Ensures timely and affordable updates of comprehensive appropriateness criteria
  
• Improves patient flow and clinic efficiencies
  
• Cuts administration costs associated with prior notification
  
• Tracks how the decision-making tool impacts patient outcomes

Health Plan Benefits:

• Helps ensure the appropriate use of HTDI procedures
  
• Reduces patient exposure to harmful radiation and possible cancers
  
• Provides a more effective option than prior notification
  
• Ensures use of a consistent set of appropriateness criteria
  
• Ensures timely and affordable updates of comprehensive appropriateness criteria

Employer Benefits:

• Reduces patient exposure to harmful radiation and possible cancers
  
• Helps ensure the appropriate use of HTDI procedures
  
• Can help slow health care costs increases linked to overuse of HTDI

Patient Benefits:

• Helps ensure the appropriate use of HTDI procedures
  
• Reduces exposure to harmful radiation and possible cancers
  
• Gets HTDI tests ordered with fewer delays or rescheduling
  
• Contributes to faster diagnosis and initiation of care
  
• Provides shared decision-making on their health care

Policy Maker Benefits

• Helps ensure the appropriate use of HTDI procedures
  
• Reduces patient exposure to harmful radiation and possible cancers
  
• Can help slow health care costs increases linked to overuse of HTDI
  
• Results in more patient-centered and value-driven care