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National Decision Support Company

Expert in the Field: Rishi Maheshwary, M.D., Allegheny Health System

November 28, 2018 By National Decision Support Company

Dr. Maheshwary explains the importance of collaboration between radiologists and physicians during implementation of Clinical Decision Support to develop an effective workflow and to prepare for PAMA.

Rishi Maheshwary, M.D.

Diagnostic Radiologist, Allegheny Health System

Dr. Rishi K. Maheshwary is a practicing Diagnostic Radiologist in Pittsburgh, PA and has been in practice for 10 years. Dr. Maheshwary is the Lead Radiologist on the CareSelect® implementation team at Allegheny Health Network along with Dr. Mark Guy, Physician Champion, Dr. David Chuirazzi, Emergency Department Physician and Dr. George Dimitriou, Internal Medicine. In this interview, Dr. Maheshwary will discuss the importance of physician engagement in implementation projects, share his view on what it takes to implement CareSelect Imaging, and  explain the value that implementing sooner rather than later will bring to an organization.

This solution [CareSelect] solves the legislative requirements, but perhaps more importantly, decreases overutilization and inappropriate ordering by referring physicians. This improves patient care when used appropriately as the right test is ordered the first time around, decreasing a patient’s length of stay.

What motivated Allegheny Health Network’s decision to implement a Clinical Decision Support (CDS) solution? What was the biggest challenge your organization was facing?

The Protecting Access to Medicare Act (PAMA) drove Allegheny Health Network to implement a CDS program sooner than planned. The radiology department was always interested in implementing CDS but the law requiring consultation from a qualified Clinical Decision Support Mechanism (qCDSM) expedited the implementation. The biggest challenge we were facing was communication with the ordering doctors about how to order and the importance of doing so. Another challenge was generating meaningful reports that we could send back to ordering doctors about their ordering habits.

 

Why is CareSelect Imaging the right fit for Allegheny Health Network? What problem does CareSelect solve for your organization?

This solution solves the legislative requirements but perhaps more importantly, decreases overutilization and inappropriate ordering by referring physicians. This improves patient care when used appropriately as the right test is ordered the first time around, decreasing a patient’s length of stay.

 

A successful project requires input from various stakeholders across the enterprise. What insights did you learn from others on your implementation team? And why is it crucial to the success of the project to have these insights?

To fully understand what goes into an order, collaboration of multiple specialties is needed. I did not realize the amount of choices and level of difficulty that a clinician faces when ordering tests. From the radiologist’s perspective, when you see the process it helps to understand and develop easier ways for the clinicians to get the information they need.

 

Now that you’ve implemented CareSelect, how does utilizing it impact the way the Allegheny team works together? Do you anticipate cost savings?

Long term I do expect savings. We need to work with our medical ordering group and express the importance of taking the right steps when choosing an exam. We also need to make sure that we have made it easy for clinicians to choose the right order. It is very important to understand both the ordering physician’s perspective as well as the radiology department’s view.

 

Improving patient care is the top priority and the end goal for health care providers. How has utilizing CareSelect positively impacted the quality of care and the patient experience at Allegheny Health Network?

I think CareSelect will help with appropriate tests being ordered first rather than after a radiologist reads the inappropriate test thus hopefully decreasing utilization, length of stay and overall health care costs for the patient.

 

PAMA requires that physicians ordering advanced imaging exams consult Appropriate Use Criteria (AUC) through a qCDSM such as CareSelect. January 1, 2020 marks the formal start of the program, where healthcare providers must consult qCDSM when ordering advanced imaging tests. Under the program, consultations must occur across all advanced imaging and evidence of consultation must be included on the claim. What advice would you give to other health systems who have yet to implement CDS, considering the looming January 1, 2020 deadline?

I would start the process now to better understand the program. In addition to improving patient quality and safety discussed above, starting early also allows time to work with your clinicians in solving any issues that come up.

You want to make ordering simple and easy to navigate for clinicians so that they can use the structured indication. From experience, if we make it too easy for clinicians to bypass a reason-for-exam or too difficult to find the right indication, clinicians will choose the area of least resistance which leads to “no score” for many exams. At the same time, it is important to understand the ordering habits of clinicians as well as the recommendations of radiologists to ensure CareSelect matches what we are expecting.

Sometimes structured indications can be very specific and too onerous for a doctor to choose. Other times, there may not be enough choices or there could be a lack of synonyms for common indications. Additionally, the list of common indications for a study might not always be appropriate. To overcome these obstacles, we created work groups to further investigate these issues and worked with the CareSelect team to implement new indications or adjust the way clinicians see the indications.

Filed Under: Blog, Expert in the Field

ACR Bulletin: Homing in on Quality

November 13, 2018 By ACR Bulletin

Radiologists in rural western North Carolina are strengthening their relationships with local physicians and reducing inappropriate imaging via R-SCAN®. For radiologists at Asheville Radiology Associates, paving a new route means success in educating their referring clinicians about appropriate image ordering. However, the group faces a unique challenge in doing so: Their referring providers are distributed across a wide geographical area in rural western North Carolina.

Filed Under: In The News

ACR Bulletin: Critical Support

November 13, 2018 By ACR Bulletin

Teaming up with referring providers can preserve reimbursement and boost quality of care. To ensure success under PAMA, radiologists need to take the lead in educating physicians and other referring providers on the importance of adopting an approved CDS in their workflow.

Filed Under: In The News

ACR Bulletin: Circling the Wagons for CDS

November 13, 2018 By ACR Bulletin

One health system changed CDS from a top-down mandate to a team-based, patient-centered goal. When Cambridge Health Alliance (CHA) set out to introduce clinical decision support (CDS), leaders carefully planned the logistics for its implementation. However, they also started early, getting buy-in from referring clinicians and radiologists — the ones who would actually be using the tools. Two CHA physicians (one radiologist and one family medicine physician) explain how it all came together and how CDS benefits both patients and clinicians.

Filed Under: In The News

ACR Bulletin: CDS Deadline Moves Forward Under CMS

November 13, 2018 By ACR Bulletin

The PAMA requirement has been reconfirmed for referring providers to consult AUC for advanced diagnostic imaging services starting Jan. 1, 2020. Following the implementation dates and guidelines for Appropriate Use Criteria (AUC) is both important and confusing. Here are the most current mandates to maintain your reimbursement status.

Filed Under: In The News, Uncategorized

National Decision Support Company Announces Expanded Cerner Capabilities

September 25, 2018 By National Decision Support Company

CareSelect™ solutions for Laboratory, Patient Blood Management and Choosing Wisely®+ unleash millions of dollars in savings for Cerner EHR users.

Madison, WI (September 25, 2018) – National Decision Support Company (NDSC) announces first of kind capabilities for Cerner EHR users that include CareSelect solutions focused on laboratory services, patient blood management, and the ABIM Foundation’s Choosing Wisely. These expanded capabilities enable healthcare organizations to identify and eliminate unnecessary and wasteful services.

CareSelect combines evidence-based guidelines from nationally respected publishers with advanced analytics capabilities to enable healthcare organizations to identify and address variations in care, reduce inappropriate utilization and save money. The CareSelect guideline library and associated clinical standards represent millions of dollars in savings for healthcare providers. In Washington State alone, the Washington Health Alliance (WHA) examined 47 common treatment approaches and identified over $282 million dollars in unnecessary services furnished over twelve months.1 This represents 1.52 million total services, of which 44% were deemed unnecessary. All the measures examined in the WHA report are covered by the expanded CareSelect guidelines.

NDSC’s flagship CareSelect Imaging solution is already in widespread use by Cerner clients. More than 140 organizations that use Cerner have contracted and installed CareSelect Imaging to drive imaging stewardship programs and support compliance with federal legislation that requires Appropriate Use Criteria consultation for Medicare Advanced Imaging Services by January 1, 2020. CareSelect Lab and CareSelect Blood, now available to Cerner EHR users, feature guidelines from Mayo Clinic. Guidelines for high-value procedures from Choosing Wisely are also available.

CareSelect’s advanced analytics guide progressive organizations on their clinical transformation journey.  Measurement against clinical standards, built on evidence-based guidelines, establishes the foundation of CDS governance programs that identify and empower targeted practice improvement opportunities to increase appropriate utilization and quality, and decrease cost.

Until now, healthcare providers have lacked the combination of comprehensive, robust clinical standards and the ability to deliver and measure provider interactions within the EHR. CareSelect provides empirical evidence of utilization and waste. This data enables organizations to create and monitor targeted practice improvement initiatives in the areas of highest yield.  

The expanded CareSelect solutions are immediately available to Cerner users and initial client implementations are already underway.

Contact us today for more information.

About National Decision Support Company

National Decision Support Company’s CareSelect™ Clinical Decision Support and Analytics solutions influence clinician ordering to manage utilization and control costs while reducing administrative burden and streamlining the payor-provider data exchange. CareSelect delivers medical guidelines at the point-of-care and measures provider interaction to foster dynamic clinical transformation and revenue cycle optimization programs across the enterprise. CareSelect has been adopted by over 500 health systems covering over 3,500 facilities which process over 5 million decision support transactions monthly.

 

Join NDSC at Cerner Health Conference 2018

National Decision Support Company will be at Cerner Health Conference 2018 in Kansas City from October 8-11, 2018. Join us in booth #733 to learn more about the expanded CareSelect capabilities now available.

 


  1. Washington State’s Health Care Waste: https://www.acsh.org/news/2018/09/17/washington-states-health-care-waste-13279

 

Filed Under: News & Insights

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