ACR Bulletin

Covering topics relevant to the practice of radiology

Taking the Lead

Clinical decision support is here, and radiologists need be at the forefront.
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November 15, 2018

Radiologists have long provided guidance on the correct exam at the right time for the right patient. This advice was formalized with the 1993 introduction of the ACR Appropriateness Criteria® (AC), expert-created documents that detail the best imaging for a given clinical scenario. But even with this information available, not all physicians were on board.

That’s about to change. Starting Jan. 1, 2020, PAMA will require referring providers to consult AUC prior to ordering advanced diagnostic imaging services (including CT, MR, nuclear medicine exams, and PET scans) for Medicare patients. To do this, physicians must use clinical decision support (CDS), which guides ordering physicians to the most appropriate imaging according to the AUC. CDS exists either as a stand-alone unit or through software embedded into the institution’s EHR. Although several CDS systems exist, the ACR and the National Decision Support Company have developed CareSelect® Imaging, which uses the AC and other guidelines to advise providers ordering imaging for patients.


“CDS reduces unnecessary imaging on patients, which not only lowers exposure to radiation dose, but also reduces costs across the healthcare spectrum,” says Terence A. S. Matalon, MD, FACR, chair of diagnostic radiology at Einstein Healthcare Network in Philadelphia.

CDS can also function as an educational tool for physicians. “As the number and complexity of tests have grown over the years, it’s difficult to keep track of what decision is most appropriate,” says Sabiha Raoof, MD, FACR, chief medical officer and patient safety officer at Jamaica Hospital Medical Center and Flushing Hospital Medical Center in Queens, N.Y. “Physicians can look at the decisions they’ve made and learn from them.” Adds Matalon, “I’ve found that a lot of our physicians are eager for that guidance.” Reducing the amount of inappropriate imaging can also help providers meet quality goals based on utilization.


CDS holds a lot of benefits for radiologists as well — as long as they jump on board with it now and lead CDS efforts within their health system, says Matalon. “Ultimately, patient welfare is our primary concern. In addition, by being the ones to bring CDS to the forefront, radiologists can become more well-known around our institutions. We can be seen as partners in care rather than the people hiding in the darkroom,” notes Raoof.

Although CDS is ultimately a mandate, and the PAMA deadline has been pushed back from its original due date (Jan. 1, 2018), radiologists will reap plenty of benefits if they get involved now, says Matalon. “By acting now and helping their institutions implement CDS, radiologists will be seen as individuals who bring in more value to their systems. And especially as we work toward a value- based healthcare system, those who bring value will be rewarded,” he notes.

Ultimately, no matter whether radiologists lead the way for CDS or not, it’s on the horizon. “CDS is going to happen. But by taking the lead, radiologists get to control and guide this valuable tool,” says Matalon. “Either we do it ourselves or someone’s going to do it for us. And I’d rather be the one in control.”

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