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Minnesota Institute for Clinical Improvements Using Nuance RadPort Evidence Based Decision Order Support Solution For Imaging

Posted Nov 10 2010 8:22am

Nuance continues with adding new features to the radiology areas to where CPOE, computerized physician order entry, information is given to help determine the best image type of imaging needed for patient care.  In other words the software will help determine whether an MRI, CT Scan, X-ray or any other type of imaging process is best for the patient based on evidence based data.  Last year Nuance had introduced speech recognition to radiology. 

We all know about duplicate imaging too and that has gone on for years with prior images not being available.  The process uses a scoring algorithm and the physician is presented a choice of options which he can select from or there is still the option to bypass if needed.  There’s the “A” word once more as I talk about here quite frequently.  The press release shows a substantial savings in imaging costs and can save radiation exposure times for the patient.  Symptoms are entered by the doctor along with all the other notes and the analysis goes to work.  It has audit trails and creates a digital receipt for using the process and I am guessing the receipts might find their way into the payer areas eventually for checking to see if a decision making process was conducted as everyone is looking at the dollar signs today and utilization departments audit and backtrack what courses of action were taken at the time of diagnosis.  In the video and image, good demonstration of a mobile tablet being used as well with touchscreen capabilities with allowing interactions with the patient at the same time.  BD 

Press Release:

Burlington, MA. November 1, 2010 Nuance Communications, Inc . (NASDAQ: NUAN) is today announcing that the Institute for Clinical Systems image Improvement (ICSI), a nonprofit organization whose members include 60 medical groups and six sponsoring health plans throughout Minnesota and surrounding states, has licensed Nuance’s RadPort , an electronic, evidence-based, decision-support (e-Ordering) solution to support a statewide initiative to help ensure Minnesotans only receive medically appropriate high-tech (MRI, CT, PET and nuclear cardiology) diagnostic imaging (HTDI) tests. 

The ICSI initiative, which is the first of its kind in the country, is expected to save the Minnesota healthcare community more than $28 million annually.  In addition, ICSI will use Nuance’s RadCube software solution to analyze physician-ordering trends in parallel with patients’ actual clinical outcomes.

“This is an exciting statewide initiative that will yield many patient, provider, health plan and community benefits, and potentially serve as a national model for how to help reduce the more than $100 billion spent annually on high-tech diagnostic imaging tests across the U.S,” said Cally Vinz, vice president of clinical products and strategic initiatives, ICSI.  “With Nuance’s electronic decision-support and patient outcome analysis solution, we will work to guide appropriate ordering at the point-of-order to ensure the best exam is ordered for the patient every time.  We will also have better insight into physician ordering habits and their impact on patient care.” 

After a yearlong pilot program, in which more than 2,300 physicians from five Minnesota medical groups, five health plans (Allina Medical Clinic, Fairview Health Services, HealthPartners Medical Group, Park Nicollet Health Services, and St. Mary’s/Duluth Clinic Health System, BlueCross Blue Shield of Minnesota, HealthPartners, Medica, and UCare), and the Minnesota Department of Human Services used e-Ordering to order high-tech diagnostic imaging exams, it was found that the exams ordered with evidence-based decision-support technology had an increase in medical appropriateness versus orders initiated without it.  The pilot also showed that using decision-support appropriateness criteria in the physician’s office reduced patient exposure to unnecessary radiation, and contributed to a 0 percent increase in HTDI scans ordered in 2007 (following an 8 percent increase in Minnesota in 2006).  During the time of the pilot, an estimated $28 million in healthcare cost savings was reported. 

Since the pilot, all five medical groups have continued to use the decision-support criteria.  The groups report improved patient satisfaction and clinic efficiencies, as well as a reduction in administrative costs. In total, it is estimated that by using e-Ordering for the past three years, the five medical groups have helped save Minnesota $84 million, as there has not been an increase in the use of HTDI scans in Minnesota since 2007. image

A Different Approach to Prior Notification

As part of this ICSI-led initiative, Nuance is helping Minnesota medical groups order HTDI exams in the way Minnesota insurers reimburse them, which will reduce administrative costs.  Medical groups that use RadPort will likely be able to forego Radiology Benefit Management (RBM) prior notification procedures that require the time-consuming task of completing phone calls to RBM companies to gain assurance of insurer reimbursement for the exam.  An RBM is an organization employed by healthcare insurers to manage utilization and costs associated with high-tech diagnostic exams.

With the RadPort process, ordering clinicians enter patient-specific information along with the requested exam into the e-Ordering system and, based on the exam’s utility score (clinical appropriateness), the system will either verify the order or provide alternative procedures that better suit the patient’s indications.  The physician can then select the recommended procedure, or override the system’s suggestion to move ahead with their originally requested exam. 

“At Fairview Health Services, we’re ecstatic over this option.  It helps our physicians get patients the right test the first time without an administrative hassle.  It flows seamlessly into the normal office procedure and consumes no extra time,” said Barry Bershow, MD, vice president, quality, Fairview Health Services, Minneapolis, MN.

RadPort provides access to a common set of decision-support appropriateness criteria (via direct integration into an electronic health record (EHR) or via a standalone Web portal).  RadPort’s appropriateness criteria contains more than 15,000 clinical guidelines that are continuously updated in accordance with patient demographics, imaging procedures, the American College of Radiology (ACR) Appropriateness Criteria®, as well as input from a clinical committee at Massachusetts General Hospital and other leading clinical partners across the country.

Provider Support and Patient Benefits image

Electronic decision-support benefits providers, health plans and patients alike.  In addition to avoiding the expenses and inefficiency of phone-in RBM prior notification, providers have immediate information about the usefulness of the high-tech imaging test they want to order.  Furthermore, the immediate feedback from the RadPort system eliminates patient’s wait times for exam scheduling, reduces the risk of unnecessary radiation exposure, can enhance the patient-physician relationship through point-of-order shared decision making, and expedites high-tech imaging by increasing the likelihood that patients have the appropriate diagnostic study already done when they are referred onto a specialist.

“The ICSI solution is a win-win-win.  Physicians aren’t hassled, the patient receives the right test and avoids unnecessary radiation, and the payer – whether health plan, employer, government or patient – incurs no unnecessary expense,” said Patrick Courneya, MD, medical director for care delivery systems, HealthPartners Health Plan.

Nuance’s RadCube software solution will be available for use by Minnesota medical groups and hospital-based clinics that adopt the decision-support e-Ordering option.  RadCube is a Web-based intelligence tool for the collection, analysis and sharing of data that can be viewed via one interface for instantaneous analytics to drive appropriate order monitoring, forecasting, and provider productivity.  ICSI will also have access to the de-identified data of all medical groups using RadCube, thereby improving the state’s knowledge of which diagnostic imaging tests get the best patient outcomes.

Nuance Working on National Level to Address Costly Inappropriate Imaging

“In alignment with President Obama’s healthcare reform goals, the initiative to reduce unnecessary exams, costs and administrative efforts that do not contribute to better patient care and improved patient outcome is an area ripe for change,” said Mike Mardini, vice president of medical imaging at Nuance.  “The ICSI effort is a shining example of how we nationally should be applying healthcare IT to meaningfully impact patient care and cost of delivery.  Electronic decision-support provides physicians with the information they need at the point-of-order to support the best care delivery plan possible for the patient.  In addition to the $28 million dollars the ICSI initiative is expected to save annually, patients will miss less work, as well as spend less time and money on travel, day-care and co-pays associated with diagnostic imaging tests they do not need.” image

As part of this nationwide effort, Nuance co-founded the Imaging e-Ordering Coalition with the Center for Diagnostic Imaging (CDI).  This Coalition is compromised of members including Nuance, the Advanced Radiology Consultants, Alliance for Quality Imaging, American College of Radiology (ACR), CDI, Connecticut State Medical Society – IPA, GE Healthcare, Insight Imaging, MedCurrent, Medicalis Corporation, Merge Healthcare and Radnet.  Currently, the Coalition is focused on educating the U.S. Congress on issues inline with the ICSI initiative.  The Coalition is promoting Health Information Technology 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 at that time of care.

For more information on all of Nuance’s healthcare solutions please visit http://www.nuance.com/for-healthcare/index.htm

Nuance’s Healthcare Business

Nuance’s healthcare portfolio of proven, speech-enabled clinical documentation and communication solutions enable healthcare provider organizations to improve financial performance, enhance patient care, and increase patient safety. With more than 10,000 healthcare provider organization customers and 450,000 clinicians worldwide, Nuance has the experience and solutions that meet the individual needs of any size healthcare provider organization.

Nuance is a leading provider of speech and imaging solutions for businesses and consumers around the world.  Its technologies, applications and services make the user experience more compelling by transforming the way people interact with information and how they create, share and use documents. Every day, millions of users and thousands of businesses experience Nuance’s proven applications and professional services.  For more information, please visit www.nuance.com .

Institute for Clinical Systems Improvement

Founded in 1993 by HealthPartners, Mayo Clinic and Park Nicollet Health Services, ICSI today is comprised of 60 medical group and hospital members representing 9,000 physicians in Minnesota and surrounding states, and is sponsored by six health plans in Minnesota and Wisconsin.  An independent, nonprofit organization, ICSI’s mission is to champion health care quality and help its members implement best clinical practices for their patients.  ICSI is also leading the transformation of the health care system into a more patient-centered and value-driven entity.

 

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