© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. Reasons Radiologists Should Embrace Point Of Care Clinical Decision Support for Diagnostic Imaging Using Specialty Society Developed Guidelines 1 Improving quality and bending the cost curve by better integrating radiologists and their knowledge into healthcare delivery. Bibb Allen, Jr., MD, FACR Vice Chair, ACR Board of Chancellors American College of Radiology

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. 2

3 Value-based Care Volume-based Care

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. 4 radiologists should embrace point of care clinical decision support for diagnostic imaging using specialty society developed guidelines ›› Five reasons 15234

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. 5 Clinical decision support provides many benefits over unmanaged imaging care or call-in prior authorization programs

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. 1. Clinical decision support provides many benefits over unmanaged imaging care or call-in prior authorization programs 6 CDS reduces unnecessary care Inappropriate Imaging Utilization Drives decreases in FFS system payments Introduces prior authorization imaging management programs to FFS payment systems

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. 1. Clinical decision support provides many benefits over unmanaged imaging care or call-in prior authorization programs 7 PatientsPhysicians 3 rd Party Authorization Workflow

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. 1. Clinical decision support provides many benefits over unmanaged imaging care or call-in prior authorization programs 8 Patients CDS is transparent, educational, and efficient for ordering physicians with a focus on patient care rather than navigating 3 rd -party authorization workflows. Patient Care Physicians

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. 1. Clinical decision support provides many benefits over unmanaged imaging care or call-in prior authorization programs 9 For ordering physicians: Workflow solution that offers graded appropriateness score or more appropriate examinations based on clinical scenarios or exam requested For radiologists: Structured indications with meaningful reasons for exam translatable to correct protocol and ICD coding

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. 10 Clinical decision support provides high-quality evidence to the patient’s treating physicians

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. 2. Clinical decision support provides high-quality evidence to the patients’ treating physicians 11 Medical specialty societies are best equipped to develop guidelines for an effective utilization management program Appropriateness Criteria 300 volunteer radiologists Created more than multidisciplinary consensus from cross-section of medical societies Guidance for ordering physicians for >900 scenarios documented with evidence from literature, consensus from over 20 specialties, transparency, and inherent flexibility from cycle of community-driven updates.

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. 2. Clinical decision support provides high quality evidence to the patients’ treating physicians 12 Standardization vs. Localization Too many rule sources can produce a “Tower Of Babel” effect and send mixed messages to referring physicians and the public. It is possible that standardization can stifle innovation and so it is important to have selective localization at certain sites.

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. 13 Clinical decision support informs treating physicians’ decision making at the point of care

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. 3. Clinical decision support informs treating physicians’ decision making at the point of care 14 Paper and searchable PDF are useful, but rarely used at the point of care. A digitized clinically consumable format allows integration into EHRs. All the work that went into developing the AC is reaching its potential in informing better patient care. A web-services delivery model brings the Appropriateness Criteria into clinical use. Appropriateness Criteria

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. 3. Clinical decision support informs treating physicians’ decision making at the point of care 15 The widespread use of CPOE, and the integration of the AC into EHR supports adoption. Some institutions may choose to add another layer to provide utility beyond the EHR, but eventually all orders will have to flow through the EHR to be valuable. CDS increases the relevance of radiologists at the point of care.

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. 16 Clinical decision support increases the relevance of radiologists to ordering physicians and the health system

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. Exams may still be ordered without radiologist involvement, but low appropriateness scores drive ordering physicians to engage in consultation with a radiologist, increasing visibility and value. CDS provides an appropriateness score for every examination; these data are the basis for analytics of inappropriate ordering allowing education of ordering physicians.

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. 4. Clinical decision support increases the relevance of radiologists to ordering physicians and the health system 18 Nationally, radiology will be seen by policy makers as part of the solution not part of the problem. Appropriateness x Outcome Cost Value No matter how good everything else is, if the reason for doing an exam is inappropriate, there is no value.

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. There are value scenarios for radiologists who embrace clinical decision support in both accountable care and FFS payment systems

© 2014 | AMERICAN COLLEGE OF RADIOLOGY | IMAGING 3.0 TM | ALL RIGHTS RESERVED. 5. There are value scenarios for radiologists who embrace clinical decision support in both accountable care and fee-for-service payment systems 20 There are value scenarios for radiologists who embrace clinical decision support in both accountable care and FFS payment systems. Fee-for-serviceValue-based systems & solutions Accountable Care & Capitation UM is valuable and necessary and if run by radiologists it could be a significant source of revenue. $