1. Implementing evidence into Practice: Imaging as an example Keith Hentel, MD MS Executive Vice Chairman Vice Chairman for Clinical Operations Chief, Emergency/Musculoskeletal Radiology Department of Radiology NewYork-Presbyterian Hospital/Weill Cornell Medical College New York Roentgen Society

2. Pre-operative Imaging Prior to Surgery vs. Pre-operative Chest X-RAY

3. Pre-operative Imaging Prior to Surgery vs. Pre-operative Chest X-RAY Meta-analysis of 28 prior studies 28 – abnormality rates 18 – effect on clinical management 6 – effect on relevant adverse events No evidence to support a policy of of performing routine pre- operative chest x-rays. Health Assessment Technology, 1997

4. “Appropriate Imaging” Useful versus Avoidable Imaging

5. Clinical Decision Support

6. Clinical Decision Support (CDS) “Clinical Decision Support systems link health observations with health knowledge to influence health choices by clinicians for improved health care". Robert Hayward, Center for Health Evidence

7. Clinical Decision Support

9. Sistrom et al, Radiology 2009 Data courtesy of Ramin Khorasani, MD

10. Pre-operative Imaging

11. Clinical Decision Support

13. November 15, 2015 – HHS will specify appropriate use criteria for advanced imaging services April 1, 2016 – HHS will publish a list of approved appropriate use mechanisms January 1, 2017 – Providers must include information about qualified clinical decision support mechanism used to receive payment January 1, 2020 – HHS will establish a process for identifying outlier ordering professionals and require prior authorization for services ordered by outliers

14. Summary : Pre-operative imaging Pre-operative chest x-ray per routine is an example of an avoidable test Clinical Decision Support (CDS) is one mechanism that has been utilized to reduce avoidable imaging Individual practices can have an effect