Clinical Decision-Support Tools Show Promise, but Need Work

June 4, 2015 in News

Computerized clinical decision-support tools can help to reduce the amount of inappropriate advanced imaging tests ordered, but more work remains to improve the tools, according to a study published in the Journal of the American Medical Association, Healthcare Informatics reports (Perna, Healthcare Informatics, 6/2).


According to Healthcare IT News, the overuse of imaging tests, such as MRI and CT scans, plays a key role in the rising cost of health care (Miliard, Healthcare IT News, 6/2). Beginning in 2017, CMS — which sponsored the study — will require the use of clinical decision-support before ordering any advanced diagnostic imaging tests that Medicare covers.

Study Details

For the study, researchers from the RAND Corporation sought to determine whether physician guidelines for the appropriateness of advanced imaging could help to reduce unnecessary tests for Medicare beneficiaries.

The study involved a total of 3,340 clinicians who worked at organizations located in eight states. The participating organizations included:

  • Three academic medical centers;
  • Two integrated delivery systems;
  • One group of independent practices in a single geographic area; and
  • One group of independent practices recruited by a radiology benefits management organization (Healthcare Informatics, 6/2).

The researchers relied on several medical specialty societies to review research and develop a structured rating process for the appropriateness criteria, which were loaded into the clinical decision-support tools at all participating organizations.

Study Findings

During the two-year study period, participating clinicians placed 117,348 orders for advanced diagnostic imaging procedures (Healthcare IT News, 6/2).

Overall, the researchers found that the clinical decision-support tools, which matched a patient’s characteristics against treatment criteria and recommended treatment options, increased the proportion of appropriate tests (Healthcare Informatics, 6/2). That means fewer patients were exposed to potentially costly, harmful tests.

However, the study showed that a majority of orders placed were unable to be assigned appropriateness ratings by the clinical decision-support tools because:

  • No such criteria were available; or
  • The clinical decision-support tool was unable to find the appropriate criteria (Healthcare IT News, 6/2).

In a statement, RAND senior policy researcher Peter Hussey, said, “The increase in orders rated as appropriate is promising, but the number of tests that were not rated indicates there is room for further improvement of these tools” (Healthcare Informatics, 6/2).

RAND is delivering a report to Congress on the findings. Hussey said the company has “outlined a series of improvements” to the clinical decision-support tools for lawmakers, such as “more-comprehensive set of evidence-based guidelines that cover a greater proportion of advanced imaging orders for Medicare patients” (Healthcare IT News, 6/2).

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