Learn how Einstein Healthcare Network engaged more than 250 physicians and had a 17% increase in appropriate use studies utilizing CDS
Dr. Ryan K. Lee, MD, MBA, MRMD
Clinical Associate Professor of Radiology, SKMC at Thomas Jefferson University
Magnetic Resonance Medical Director
Director of Quality
Section Chief, Neuroradiology
Department of Radiology
Einstein Healthcare Network
Dr. Ryan K. Lee, MD, MBA, MRMD is Clinical Associate Professor at the Sydney Kimmel College at Thomas Jefferson University. He is the Section Chief of Neuroradiology in the Einstein Healthcare Network, and serves as the Director of Quality and Magnetic Resonance Medical Director in the Department of Radiology. Areas of expertise include radiation management in imaging, radiology clinical decision support, and MRI Safety. Dr. Lee is known for his work not only in CT radiation dose reduction, but also in the reduction of variance in radiation dose. An authority on quality in radiology, he serves on several quality and safety committees in the Einstein Healthcare Network. Dr. Lee has worked with National Decision Support Company (NDSC) to incrementally implement the CareSelect™ Platform across the Einstein Healthcare Network.
When did you start working with NDSC to implement CareSelect™ solutions at Einstein Healthcare Network?
We began our association with National Decision Support Company in 2015 and began our pilot program shortly thereafter.
Our initial pilot program consisted of approximately 60-70 physicians that volunteered to use Clinical Decision Support. Participants were specifically chosen to reflect a cross section of different physicians, including ER, internal medicine, family medicine, neurology, surgery, hospitalists, and oncologists.
The CareSelect™ Platform was activated either related to upgrades on the technical side or based on feedback we received from the pilot physicians. We have weekly phone conferences with our CareSelect representative, IT, PACS, and administration to make sure we stay on track with agenda items and issues.
Recently, we have entered into an expanded pilot phase, and have recruited over 250 additional physicians into the pilot. I am eager to solicit feedback from this now larger pool of physicians that are enrolled.
“Recently, we have entered into an expanded pilot phase, and have recruited over 250 additional physicians into the pilot. I am eager to solicit feedback from this now larger pool of physicians that are enrolled.”
What was the driving force behind choosing the CareSelect Platform to manage your CDS program?
We were acutely aware of workflow problems related to a previous vendor we had used for CDS. This service was not well received by our pilot physicians mainly due to the additional work required to order studies. When it became clear that the inherent design of that service would not allow for a smooth workflow regardless of changes, we decided to look for a new technical solution. As you can imagine, high on our priority was finding a CDS solution that had as minimal an impact on workflow as possible, one of the major complaints. This is exactly what we found with NDSC’s CareSelect. NDSC provided us with a solution that seamlessly integrated with our EMR and had minimal effect on our existing workflow.
In your experience, how has CareSelect helped improve the quality of healthcare at Einstein Healthcare Network?
The feedback we received from our pilot users, particularly those in primary care, was that it was a welcome tool in helping them choose the correct study. Some have told us that they feel more confident in ordering studies using the tool. Ordering the right study prevents having to reorder a script, causing inconvenience for both the patient and the facility. In addition, reducing the number of tests being ordered reduces the amount of radiation being applied to patients. CDS gives immediate test feedback during the time of order for the appropriate test. In addition to the standard CDS in CareSelect, we have also collaborated with NDSC in developing a tool to help clinicians decide if ordering head CTs in patients with minor head trauma are warranted using a well described algorithm in the literature. We believe that this is a future untapped potential in radiology CDS, which if applied in similar fashion to other clinical scenarios can have even more impact on utilization.
“Some have told us that they feel more confident in ordering studies using the tool. Ordering the right study prevents having to reorder a script, causing inconvenience for both the patient and the facility.”
What aspect of CareSelect do you think is most valuable for Einstein Healthcare Network and why?
The way CareSelect integrates into our EMR with minimal impact on the existing structure of our ordering process is a key component of clinician buy-in. In fact, we were able to recently recruit over 250 new clinicians into our now extended pilot program. This would not have been possible if the initial pilot physicians were not satisfied with our implementation.
What have you learned from implementing CareSelect and what impact has it had on the way Einstein orders tests today?
We performed retrospective evaluation of orders placed by our pilot clinicians when we first turned on CareSelect, and compared it to a time period five months after it was turned on. We found that there was a 17% increase of appropriate studies initially ordered months after it was turned on. Although this was a relatively small number of studies we evaluated, this could suggest that simply having a CDS embedded into the EMR may have an educational effect on ordering clinicians. It could be that over time as clinicians repeatedly order tests for similar indications, they learn the appropriate studies to choose.
“We found that there was a 17% increase of appropriate studies initially ordered months after it [CareSelect] was turned on.”
What advice would you give to other healthcare organizations looking to adopt NDSC’s CareSelect solutions?
Because every network has different needs, each application of CareSelect can be unique to that site. It is worth allowing sufficient lead time to work with your NDSC representative, IT department, and ordering clinicians to optimize the solution to best suit your network.
What do you envision for the future of imaging as it relates to CDS?
In addition to the clear utility of providing clinicians with evidence based information for the best study for each indication, I believe that using CDS to affect clinical management by applying algorithms which can help decide if studies are warranted are the next frontier.