Minnesota Launching e-Ordering System For Imaging Tests

Health IT Boosts Patient Care, Safety

A non-profit organization representing 60 medical groups, 9,000 physicians and six payers and health plans in Minnesota has launched the nation’s first statewide effort to use electronic ordering and decision support technology to reduce inappropriate diagnostic testing of patients.

The Institute of Clinical Systems Improvement is expanding a pilot program launched about a year ago that uses technology tools from Nuance Communications to help doctors choose the most appropriate High Tech Diagnostic Imaging tests for patients. HTDI tests include MRI, CT and PET scans. The non-profit organization's members range from small doctor practices to large healthcare organizations, such as Mayo Clinic, and health insurers that include the state’s Medicaid programs and five private firms including Blue Cross Blue Shield of Minnesota.

ICSI is licensing from Nuance RadPort, an e-Ordering system that incorporates evidence-based clinical decision-support tools and Nuance’s RadCube software, which analyzes physician ordering trends and how they match up with patients’ clinical outcomes.

During the yearlong pilot involving more than 2,300 ICSI-member physicians, ICSI saw zero growth in the number of high-tech diagnostic imaging (HTDI) tests ordered. In years prior to using the technology, the number HTDI tests ordered grew about 8% annually, said Cally Vinz, VP of ICSI clinical products and strategic initiatives. That translates to a savings about $28 million for the year.

With the success of the pilot, ICSI is rolling out the Nuance tools for use by all its member doctors and hospitals, which represent between 80% and 90% of all healthcare providers in Minnesota, as well as non-members of ICSI, said Vinz.

This is the country’s first statewide rollout of e-ordering and clinical decision support tools for healthcare providers, she said. ICSI has also advised the Centers of Medicare and Medicaid Services on demonstration projects that could also utilized the technology for nationwide use for Medicare patients, she said.

Meanwhile, as healthcare providers throughout Minnesota (like doctors and hospitals nationwide) roll out e-medical records and other health IT systems in compliance to the federal government’s HITECH Act meaningful use programs, ICSI will investigate other tech-enabled capabilities to help healthcare providers “capitalize on their investments in health IT by providing clinical decision support at their fingertips,” she said.

Health IT Boosts Patient Care, Safety

The Nuance tools integrates with e-medical record and computerized physician order entry systems, including Epic’s platform, which is used by many hospitals and other healthcare providers in Minnesota, said Peter Durlach, Nuance senior VP of product marketing and strategy. For doctors practices that don’t have an EMR, physicians or clinical staff can order HTDIs using RadPort via the web, Durlach said.

When RadPort is used by doctors electronically ordering a HTDI, the system does not attempt to steer physicians to the least expensive test, but rather makes recommendations for the most medically appropriate diagnostic test based on patient-specific information that’s entered by the doctor, said Durlach.

Doctors can override the RadPort recommendations and order the original test selected. However, on the back end of patient test results, RadCube’s clinical business intelligence tools are used to analyze whether the diagnostic tests ordered resulted in best patient outcomes, such as confirming a suspected diagnosis. The use of the tools help reduce the number of inappropriate tests (and then subsequent diagnostic imaging) ordered by doctors, which cannot only help rein in costs, but also helps reduce patients exposure to unnecessary radiation.

The six payers and health plans participating in ICSI are paying for the license for Nuance’s tools, whose cost is based on a per transaction basis, said Durlach. The use of the technology also greatly reduces the need to use radiology benefit management firms, that provide on behalf of payers the authorization for tests to be performed and assurance that diagnostic tests will be paid by the insurers.

“RBMs cost payers money and doctors can’t stand them,” said Durlach.

RadCube uses natural language processing technology to extract data such as diagnoses, positive findings, and recommended treatment from radiologists’ dictation and reports.

Technology used in RadPort and RadCube was originally developed at Massachusetts General Hospital for use by its physcians. That software was later licensed to Commissure Inc., which Nuance acquired in 2007, said Durlach.

RadPort’s HTDI test appropriateness criteria is based on more than 15,000 clinical guidelines that are continuously updated in accordance with patient demographics, imaging procedures, the American College of Radiology, as well as input from a clinical committee at Massachusetts General Hospital and other clinical partners across the country, said Nuance in a statement.