1. Practice Quality Improvement (PQI) Summit Harvey L. Neiman, M.D., FACR Executive Director August 18, 2007

2. American College of Radiology Quality Timeline Quality and Safety Year Began –Voluntary Mammography Accreditation1987 –Radiation Oncology Accreditation1987 –Standards and guidelines1990 –MQSA1994 –Appropriateness Criteria1995 –CT, MR and other accreditation Ultrasound1995 MR1996 Nuclear Medicine1999 CT, PET2002 –RADPEER™ RADPEER™2002 eRADPEER™2005 –NRDR2006 –MR Safety White Paper (Kanal)2007 –Radiation Dose White Paper (Amis)2007

3. Quality Practice Targeted Education Goal The Tools (Process) RADPEERGRID Dose Index Registry Other Registries Underlying Concepts (Structure) Standards and Guidelines Accreditation Appropriateness Criteria The ACR Approach to PQI RadKat

4. RADPEER™ is an easy to use tool developed to allow radiologists to do peer review during the course of a day’s work. When a new study is interpreted with a prior study for comparison, a peer review of the accuracy of the interpretation of the previous examination occurs RADPEER™

5. RadPeer ™ – What is it? RADPEER™ is part of a department’s quality program. After submission of practice data to the ACR, the radiology chair or medical director can access the reports online at any time. The reports provide: Summary statistics and comparisons for each participating radiologist by modality Summary data for the group by modality Data summed across all RADPEER™ participants by modality

6. RADPEER ™ RADPEER ™ is a tool for PQI. It is not a project.

7. Four point scoring system: 1Concur with interpretation 2 Difficult diagnosis, not ordinarily expected to be made 3 Diagnosis should be made most of the time 4Diagnosis should be made almost every time/misinterpretation of findings Score of 3 or 4 should be reviewed through the facility’s internal QA process prior to submission to ACR RADPEER™

8. All data collected by ACR are considered to be privileged and confidential peer review records of ACR and are thus subject to legal protection of the Medical Malpractice Act of Virginia, Section 8.01-581.17 of Code of Virginia 8/10/01

9. e RADPEER™

11. RADPEER ™ - Issues Positive Aspects –Available in variety of formats – paper, PDA, Web –Easy to use –Wide acceptance (as of July 2007) 514 active sites (practices) –223 paper –291 eRADPEER 7525 Radiologists –Part of an overall program

12. RADPEER ™ - Issues (2) Deficiencies –No external validation of an institution’s reviews –No normalization of one practice to another –The number of cases entered varies significantly –Only compartmentalizes by modality –No obligatory remediation

13. RADPEER ™ - Addressing of Deficiencies Validation and normalization of data – Ideas –Web based blinded review from other practices –Site reviews for accreditation to include RADPEER reviews –Normalized to “exemplary sites” –Benchmarking using GRID Plans underway to evaluate by organ/body part and possibly disease process Systems available to “force” compliance Correlation with RadKat (Radiology Knowledge Assessment Test)

14. RADPEER ™ Committee Kenneth Chin, MD, Chair David Dixon, MD Charles Grimes, MD David Linkous, MD Albert Nemcek, MD Robert Pyatt, MD Richard Redvanly, MD Trudie Cushing

15. Quality Practice Targeted Education Goal The Tools (Process) RADPEERGRID Dose Index Registry Other Registries Underlying Concepts (Structure) Standards and Guidelines Accreditation Appropriateness Criteria The ACR Approach to PQI RadKat

16. NOPR Technical Advisory Group, Chair: David Channin, MD

17. NRDR Overview Purpose of NRDR is to enhance your practice, the specialty of radiology, and the care patients receive by providing accurate and objective measures of practice processes and outcomes. Establishes benchmarks to allow comparison of facility or physician data to that of the region and the nation. Gives unified mechanism for security, data storing, content management, common data elements for future research projects Provides users with a single front-end with ACR on-line services and single sign-on Builds on the success of RADPEER™ and the National Oncologic PET Registry

18. NRDR Overview (2) It is a data warehouse – a database of databases –Each registry functions independently –Leverages the Technology –Allows information to be shared across registries ACR Registries can be and are a cooperative effort with other societies –NOPR: Academy for Molecular Imaging, SNM, ASCO, ACRIN –ACR/NCR: SIR, ASNR, ASITN –NRDR: RSNA

19. NRDR Overview (3) ACR/NCR introduced June 2007 National Oncologic PET Registry –Over 40,000 patients entered –Over 1500 sites participating

20. General Radiology Improvement Database (GRID) GRID is a key tool for objectively measuring performance indicators for the purpose of evaluating and improving facility processes and outcomes. Simple, objective, numeric monitoring of data Standardized collection of measures allows for valid comparisons across similar facility types Performance measures include volume, structural measures, protocols, personnel training, safety, process measures, outcomes and customer satisfaction

21. General Radiology Improvement Database Sample GRID Data Elements General Facility Information –Type of institution (academic, community, community – teaching) –Location (urban, suburban, rural) –Annual volume

22. Sample GRID Data Elements Structural Measures –Flouroscopy time reported –Report access 24/7 Protocols –Pregnancy, allergies, infection control, etc. Personnel –CME hours, certification Safety –Personnel training, documentation of medications and allergies

23. Sample GRID Data Elements Process Measures –Patient wait time –Time from order to exam –Report turnaround time Outcomes –% insufficient tissue for liver biopsy –Pneumothorax rate on lung biopsy requiring intervention –% negative head CT –BIRAD code % (screening)

24. Sample GRID Data Elements Other GRID elements –Patient satisfaction survey –Referring physician satisfaction survey

25. GRID (General Radiology Improvement Database Goal is to have Version 1.0 available for pilot testing by January 1, 2008. Likely to be predominately manual Working to develop Version 2.0 as mainly electronic data entry

26. ACR Approach ACR RadKat* RADPEER™* ACR Education Center™ ACR Campus™ Benchmarking (NRDR) Do you Own it? Do you Know it? *Questions by Modality, Body Part and Disease Type SAM Credit CME Weekend Course Did you Do it?

27. Radiology Knowledge Assessment Test (RadKat) Self administered, low stress Personalized assessment of skills Based on expertise with DIXIT and TIXIT as well as CPI (Continuous Professional Improvement) 50 questions in each area of practice or areas that taker wants to be assessed Results only to the taker of the exam –Benchmarked to others with similar practice patterns Radiologist may correlate results of RadPeer and RadKAT

30. Practice Quality Improvement Summary RADPEER™ is a tool that can be used for PQI RADPEER™ has many strengths –We recognize and are addressing the deficiencies RADPEER™, GRID and RadKat are key elements in the ACR’s approach to helping practices and individual radiologists accomplish PQI;