By Dr. Ashima Lall MD and Diane Curran
Riddle Hospital participated in the R-SCAN Pilot Program, an American College of Radiology (ACR) collaborative project sponsored by the Centers for Medicare and Medicaid Innovation , a division of CMS, Transforming Clinical Practice initiative (TCPi), in which radiologists and referring clinicians work to improve imaging appropriateness centered on a mutually agreed upon Choosing Wisely topic. R-SCAN provides access to ACR Select, an imaging clinical decision support tool developed in partnership with the National Decision Support Company. A stand-alone web-based version of ACR select was used for the pilot project. In 2018, ACR Select will be available in the EPIC EMR platform at Main Line Health.
The Riddle Pilot was led by Drs. Lall and Wahba, Radiology, and Drs. Pasdon and Dr. Moonblatt, Emergency Medicine. They collaborated on the use of computed tomography for the diagnosis of pulmonary embolism. Before starting the project, we sought input and advice from the Main Line Health office of Patient and Family Engagement, marking the first time, to our knowledge, that patient participation in project design has occurred under the national R-SCAN program. In the redesigned project, patient experience and satisfaction with the new ED process was measured using follow up surveys. The Radiology-ED review of processes, application of CDS, and educational interventions detailed below are complete; the patient engagement data collection and analysis is expected to be complete by January 2018.
The program improves communication between referrers and specialists by encouraging the use of nationally vetted appropriateness criteria designed to optimize imaging, lower cost, and reduce unnecessary imaging. R-SCAN also provides impetus for enhanced consultation and communication to improve collaboration between members of the healthcare team to support better patient care using this web-based, self-contained program.
High-Value Exams ordering increased from 37% baseline to 68% post intervention.
Next steps and future direction:
- Plan to roll out in other ED departments in the system 2018 with possible patient and family engagement initiative
- Shared the results with CMS’s Directors of Centers for Medicare and Medicaid Innovation
- Abstract accepted for presentation at CMS’s National Quality Conference February 2018
- Partner with American Board of Internal Medicine Foundation to develop resource guide/tools for other Choosing Wisely topics for CMS’s Transforming Clinical Practice initiative.