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Evidence Based e-Ordering Coalition Formed to Promote Solutions for Appropriate Diagnostic Tests

Posted Jun 16 2009 6:09pm

This is an interesting press release as now a new area is coming in to focus due to cost and the quest to find a solution to provide services and yet image keep the cost down.  Just as e-Prescribing has been included in the EHR/EMR solution, this is the targeted area here with the coalition.  I have posted in the past about the tools such as speech recognition that make it easier for physicians to use when ordering tests, which is a big help, but back on the subject here, this appears to be one big task, especially today with adjustments being made for the shortage of isotopes we are encountering, how can you keep cost down when a shortage in this area requires immediate shifting of decision processes?  

I see this too as a very hot political issue as well, being cities like McAllen, Texas were recently in the news with a focus on why their care is higher in that city and questions about their imaging requests from doctors and hospitals.   Perhaps a study will create some new information that can help with the processes, and not interfere with what the doctor recommendsIf used wisely instead of perhaps another news exploit of how someone is costing people money, then the information evaluated could prove to be useful, teamwork and not pointing fingers is the answer.   Let’s not also forget the emerging technology of genomics that is coming in to play with personalized medicine, another element to add to the final decision making software presented to a physician, a very big job all the way around and perhaps in time all these elements can meet together for the ultimate data solution.   BD

Press Release:

Imaging e-Ordering Coalition Formed to Promote
Evidence-based Solutions for Ordering Appropriate Diagnostic Tests

Healthcare Leaders Promote HIT enabled Decision Support Tools to Assure Medically Appropriate Imaging Tests for All Patients: The Right Test, at The Right Time

WASHINGTON, D.C. June 16, 2008 — An alliance of leading healthcare providers, technology companies and diagnostic imaging organizations have joined forces to form the Imaging e-Ordering Coalition (The Coalition).  This national initiative will promote Health Information Technology (HIT) enabled decision-support (e-Ordering) as a solution to assure that all patients receive the most medically appropriate diagnostic imaging test for their specific condition. Members of the Coalition are devoting their energies to help educate policy makers and healthcare providers about the patient-centered efficiencies of e-Ordering, as well as recommending to lawmakers that the efforts to build incentives for prescribing medications electronically (e-Prescribing) should be broadened to include diagnostic imaging e-Ordering solutions.  

“As the healthcare industry, federal government and various regulatory bodies evaluate strategies to contain the rising cost of healthcare, e-Ordering is increasingly recognized as a cost-effective and data-driven approach to assure clinical best practices are applied to all ordering decisions,” said Bibb Allen, M.D., of the American College of Radiology, and founding member of the Imaging e-Ordering Coalition. “Expanding on the e-Prescribing model, e-Ordering will do for diagnostic imaging what e-Prescribing has done for the drug prescription process - simplify the way physicians’ decisions for patient care are verified as medically appropriate and safe without compromising the physician-patient relationship.”

There are a variety of active legislative and regulatory proposals that attempt to address the utilization of imaging services for publicly subsidized programs such as Medicare and Medicaid.  The Coalition is focused on the following components and has achieved measured progress within each:

  • Promote existing HIT legislative concepts to inform policy makers on the value of e-Ordering to enable the appropriate use of imaging.
  • Ask lawmakers to include e-Ordering in the development of healthcare system efficiency incentives.
  • Act as a resource for the Centers for Medicare and Medicaid Services (CMS) on its Medicare Imaging Demonstration Project established by Congress in Section 135(b) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
  • Work with policy makers to have the Coalition’s e-Ordering proposal for CMS scored to validate long-term value and savings for the healthcare industry.
  • Work with stakeholders to establish standards to accelerate e-Ordering as a meaningful and valuable application with EHRs.

According to the Coalition, e-Ordering prevents many of the potential issues associated with radiology benefit managers (RBMs), which are organizations employed by some healthcare insurers to manage utilization and costs associated with high-tech diagnostic exams.  Concerns with the RBM model, include regulatory oversight and a manually burdensome “prior authorization” system whereby physicians must receive approval before ordering an imaging service.  Under prior authorization, patients are often denied the imaging studies their physicians believe are warranted, are steered towards lower-precision tests that may not provide needed clinical information, or are forced to wait days or weeks to receive vital imaging services.  e-Ordering, on the other hand, provides physicians real-time, electronic access to pre-exam, case-by-case decisions that are linked to published, evidenced-based clinical studies and are tailored to a patient’s specific circumstances.  

“The growing emphasis at all levels of the federal government to encourage adoption of HIT presents an opportunity for the Coalition to elevate e-Ordering as a much more provider-friendly, patient-centered alternative to the radiology benefit managers (RBM) model,” said Liz Quam, Director, Center for Diagnostic Imaging Institute, and founding member of the Imaging e-Ordering Coalition.  “As a provider of diagnostic imaging services in nine states, my company has seen the inconsistencies in insurers’ utilization efforts.  None of those efforts are without hassle for the healthcare providers striving to offer patient-centered care. Using an electronic decision support tool offers regulators and insurers the assurance that the patient is receiving appropriate care without adding unnecessary time or administrative expense.”

The Imaging e-Ordering Coalition is represented by legal authority and lobbying firm, Holland & Knight. For information on membership please call +1 (202) 457-7004. To date, the following organizations are members of the Imaging e-Ordering Coalition: American College of Radiology (ACR), Center for Diagnostic Imaging (CDI), GE Healthcare, Medicalis, Merge Healthcare and Nuance Communications, Inc.


Imaging e-Ordering Coalition

The Imaging e-Ordering Coalition has been established to proactively interact with policymakers and health care providers on certain issues related to imaging services. In particular, the Coalition proposes to advance the use of electronic decision-support technologies that provide clinicians with guidance regarding the ordering of patient-appropriate imaging services.

AmericanCollegeof Radiology

The 32,000 members of the American College of Radiology include radiologists, radiation oncologists, medical physicists, interventional radiologists and nuclear medicine physicians. For over three quarters of a century, the ACR has devoted its resources to making imaging safe, effective and accessible to those who need it. The mission of the ACR is to serve patients and society by maximizing the value of radiology, radiation oncology, interventional radiology, nuclear medicine and medical physics by advancing the science of radiology, improving the quality of patient care, positively influencing the socio-economics of the practice of radiology, providing continuing education for radiology and allied health professions and conducting research for the future of radiology.


Headquartered in Minneapolis, Center for Diagnostic Imaging (CDI) has been a leader in high-quality, cost-effective, outpatient radiology imaging services since 1981, and currently owns and/or operates 51 diagnostic imaging centers in nine states, including Indiana, Ohio, Illinois, Wisconsin, Minnesota, Kansas, Missouri, Washington and Florida. CDI partners with hospitals and health systems to offer physician-led, outpatient radiology services and the expertise of sub-specialized radiologists focused on neurological, spine, musculoskeletal, body and cardiovascular imaging, in addition to advanced diagnostic injections and pain management procedures. CDI is owned by CDI physicians and management along with Onex Partners, a subsidiary of Onex Corporation in Toronto, Canada. For more information, visit CDI’s Web site at image

GE Healthcare

GE Healthcare provides transformational medical technologies and services that are shaping a new age of patient care. Our broad expertise in medical imaging and information technologies, medical diagnostics, patient monitoring systems, drug discovery, biopharmaceutical manufacturing technologies, performance improvement and performance solutions services help our customers to deliver better care to more people around the world at a lower cost. In addition, we partner with healthcare leaders, striving to leverage the global policy change necessary to implement a successful shift to sustainable healthcare systems.

Our “healthymagination” vision for the future invites the world to join us on our journey as we continuously develop innovations focused on reducing costs, increasing access and improving quality and efficiency around the world. Headquartered in the United Kingdom, GE Healthcare is a $17 billion unit of General Electric Company (NYSE: GE). Worldwide, GE Healthcare employs more than 46,000 people committed to serving healthcare professionals and their patients in more than 100 countries. For more information about GE Healthcare, visit our website at

Medicalis Corporation

Medicalis is a leading provider of healthcare information technology and Clinical Decision Support for diagnostic imaging. Medicalis delivers web-based clinical and integration services to physicians, providers and health plans to provide advanced diagnostic imaging solutions that improve quality and efficiency of diagnostic services. Medicalis delivers solutions that provide clinical guidelines for use at the point-of-care, point-of-service and point-of-analysis that address the issues of unnecessary testing, resource utilization and patient safety. For more information visit

Merge Healthcare

Merge Healthcare Incorporated builds software solutions that automate healthcare data and diagnostic workflow to build a better electronic record of the patient experience. Merge products, ranging from standards-based development toolkits to fully integrated clinical applications, have been used by healthcare providers worldwide for over 20 years. Additional information can be found at

Nuance Communications, Inc.

Nuance Communications, Inc.’s (NASDAQ: NUAN) healthcare portfolio includes closed-loop radiology management solutions to support the radiology practice from start to finish. Nuance’s solutions significantly improve the diagnostic imaging workflow by adding radiology decision support ( RadPort ) to enable data driven, real-time e-Ordering, speech recognition reporting ( PowerScribe and RadWhere ), critical test result management ( Veriphy ) communication, and a business intelligence solution ( RadCube ) for utilization management, patient and outcomes analysis, as well as clinical and operational trending.

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