Clinical Decision Support Improves Appropriate Use of Advanced Diagnostic Imaging

In an open access, online paper, the Journal of Digital Imaging published the results of a peer-reviewed article called, “Improved Appropriateness of Advanced Diagnostic Imaging After Implementation of Clinical Decision Support Mechanism.” The study evaluates the relationship between clinical decision support mechanism (CDSM) and imaging appropriateness ratings within hospitals and health systems.

The authors concluded that “The positive association of increased CDSM exposure with improved requisition appropriateness scores supports CDSM consultation for high-cost imaging.”

This is the largest study of Clinical Decision Support (CDS) data on imaging appropriateness performed to date. It includes data from 288 US institutions collected from January 1, 2017 to December 31, 2019 and features 7,345,437 unique imaging requisitions in the observational analyses.

The study tracks and aggregates changes in appropriateness score as a function of CDS exposure – and not with respect to time. This may set a standard of how to analyze CDS workflows going forward as a reliable methodology.

It measured changes in appropriateness of imaging requisitions for CT, MRI, ultrasound, and nuclear medicine among four appropriateness categories: “usually appropriate” [green], “may be appropriate” [yellow], “usually not appropriate” [red], and unmapped [gray].

Providers with the greatest exposure to CDS selected imaging studies identified as “usually appropriate” a significant 8.5% more than providers with the least exposure reflecting the impact CDS can have on physician practice.

The study’s validation of CDS efficacy to improve appropriateness supports the goals of PAMA to enable an alternate method to control imaging expenditure without prior authorization or reimbursement cuts. A 2014 federal mandate via section 218(b) of the Protecting Access to Medicare Act (PAMA, 42 CFR 414.94.) drove national adoption of CDS.