A technology solution for the high-tech diagnostic imaging conundrum.

Area of Science:

• Health Services Research
• Health Informatics
• Medical Imaging

Background:

• High-tech diagnostic imaging (HTDI) orders have seen significant growth.
• Controlling the volume of HTDI services is crucial for healthcare cost management.
• Standardized decision support systems can improve the appropriateness of medical imaging orders.

Purpose of the Study:

• To describe a statewide initiative implementing electronic decision support for ambulatory high-tech diagnostic imaging (HTDI) orders.
• To evaluate the impact of a pilot decision support system and prior notification on HTDI order volumes.
• To assess physician acceptance and payer support for a statewide electronic decision support system.

Main Methods:

• Description of a statewide initiative to implement electronic decision support for HTDI orders.
• Analysis of aggregated claims data for HTDI studies from 2003 to 2010.
• Evaluation of a pilot electronic medical record-based decision support system and prior notification/authorization by payers.

Main Results:

• Statewide ambulatory HTDI orders increased by 9% annually from 2003 to 2006, then leveled off through 2010.
• The trajectory change coincided with the implementation of an electronic decision support system and prior notification.
• Physician acceptance of the decision support system was significantly higher than prior notification approaches.

Conclusions:

• The electronic decision support system, coupled with prior notification, appears to have stabilized HTDI order volumes.
• Greater physician acceptance of the decision support system prompted payers to support its statewide implementation.
• The decision support system is poised to replace prior notification/authorization processes for HTDI orders.