The Problem: Health care spending in the U.S. is near 20% of or our GDP and waste has been estimated to comprise 30% of healthcare spending. Components of waste include: unnecessary, redundant, and duplicated diagnostic examinations. The downstream effects include: additional work-up of incidental findings, unnecessary biopsies, increased radiation exposure to patients, patient anxiety, and ultimately decreasing timely access to care.
The Mission: Empowering medical providers to select the “Right Test”, at the “Right Time”, for the “Right Reason”; through simulated order entry with integrated clinical decision support (CDS).
The Program: In 2013, an idea from a faculty at Baylor College of Medicine (BCM) ignited collaboration with the American College of Radiology (ACR) and National Decision Support Company (NDSC). A team began creating an on-line portal for medical education that simulates the process of ordering imaging studies with integrated clinical decision support (CDS). ACR Select® is a clinically available web service providing evidence-based feedback at the point of order entry regarding the most appropriate imaging evaluation for patients, cost of imaging, patient radiation exposure and appropriate utilization of contrast for CT and MRI. The cloud-based architecture allows for delivering actionable CDS content. A team of authors at BCM volunteered to write case vignettes for the modules, the theme for many are based upon topics from the ABIM Foundation’s Choosing Wisely campaign. The portal access and content management is performed through the ACR’s Radiology Curriculum Management System (RCMS); RCMS and ACR Select® were integrated via application programming interface (API). Since the program inception, multiple IRB approved studies have been completed or are underway, including: a pilot with medical students at BCM (published in Academic Radiology), a study completed with physician assistant students at BCM, a multi-site project is underway (University of Chicago, Augusta University, Montefiore, and Uniformed Services University of the Health Sciences are currently enrolled) and the program has received a $150,000 education grant from the Radiology Society of North America to integrate the modules into the seven required core medical student clerkships at BCM. The BCM team has grown into a multispecialty collaboration, including the seven respective clerkship specialties (Family and Community Medicine, General Surgery, Internal Medicine, Obstetrics and Gynecology, Pediatrics, and Psychiatry). The modules are also being implemented as a CME resource for a collaborative quality improvement program (R-SCAN) funded by a Transforming Clinical Practice Initiative Award (TCPI) grant from Department of Health and Human Services for up to $2.9 million.
A Key Driver: On March 31, 2014, Congress passed the Protecting Access to Medicare Act (PAMA) of 2014 (H.R. 4302) that will require referring providers to consult physician-developed appropriateness criteria when requesting advanced imaging procedures for patients covered by Medicare. The secretary of the U.S. Department of Health and Human Services (HHS) is to implement this directive. This legislative mandate will further increase positive traction towards widespread implementation of CDS into clinical practice and further highlights the need for integration into medical education curricula.
Summary: This educational program is relevant across the continuum of medical education. By utilizing a readily available CDS software program, there is an opportunity to integrate standard key components into curricula across the nation. A generation of technically advanced learners will be engaged by technology representative of our rapidly evolving healthcare environment. Through innovative programs such as this, we can better educate our future medical providers, decrease waste and further bend the cost of care curve.
Radiology-TEACHES Case Study: Teaching Imaging Appropriateness
American Medical Association ChangeMedEd Conference:
October 2015 in Chicago, IL www.dropbox.com/s/squ6yottp7en...
May 2016: ABIM Foundation - Teaching Value in Health Care Webinar
Willis MH, Frigini LA, Lin J, Wynne DM, Sepulveda KS. Clinical Decision Support at the Point-of-Order Entry: An education Simulation Pilot with Medical Students. Academic Radiology. Published Online April 29, 2016. DOI: 10.1016/j.acra.2016.01.020.
November 2015: AuntMinnie.com
May 2016: HealthImaging
Radiology Society of North America
2016 Education Scholar Grant
Educational CME Resource:
R-SCAN (Radiology Support, Communication and Alignment Network)
American College of Radiology Appropriateness Criteria (AC):
www.acr.org/Quality-Safety/App... (Evidence-based guidelines)
ACR Select®: Clinical Decision Support Software