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

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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.

Hospital Costs: A National Solution

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Dr. Dan Anderson, MD | Physician Informaticist, NDSC

Dr. Dan Anderson, M.D., is a physician informaticist at National Decision Support Company. He has practiced both hospital and emergency medicine and has worked extensively in clinical decision support and educational technology. Dr. Anderson has held leadership positions in multiple software companies specializing in health informatics and continues to innovate at the intersection of medicine and computer science.

 

 

 

 

The Advisory Board’s 2018 annual survey of healthcare CEOs revealed a new top priority for healthcare leaders: cost containment. Previously favored growth strategies are less able to mitigate shrinking margins as reimbursements wane and the cost of doing business continues to mount. The problem is compounded by steady transition to value-based payment and risk-sharing models, as well as the aging US population and its concomitant shift to federal payment systems.

Moody’s reported that 2016 annual expense growth for not-for profit providers exceeded revenue gains by 1.2% (7.2% versus 6%). Rising cost was driven primarily by higher labor costs, technology investments, and increasing costs for medications. Experts expect this to continue and compound, fueling the surge in hospital mergers and acquisitions. Since 2000, over 2,500 hospitals have been involved in mergers or acquisitions, with the rate tripling since 2004.

Despite the widely held belief that mergers mean significant cost reduction, evidence of this has been hard to find. Hospital costs continue to mushroom, now at over 10 times that of 1980. A recent study, published in the Journal of Health Economics, reported that although the biggest system mergers lowered costs about 7.5 percent, systems under 10 facilities saw only 3.4 percent cost reductions and independent hospitals saw virtually no improvement.

This all paints a bleak picture for hospitals, especially if they incur looming CMS payment reductions under PAMA and the Affordable Care Act. In some cases, the magnitude of those reductions could actually exceed the narrow margins they are operating on. Luckily, there is untapped opportunity for further cost reduction on a fairly large scale by reducing variations in care and eliminating unnecessary testing. The challenge is to build and deliver a solution that can be easily integrated in complex hospital systems and workflows, in a minimally invasive way that brings real value and lasting, measurable results to the organization. The best successes have involved a combination of Clinical Decision Support (CDS) with institutional commitment to a continuous process-improvement framework comprising feedback, education, and accountability at all levels. The best designs are proactive and self-correcting, rather than reactive or punitive.

Developing CDS is expensive and requires considerable high-level resources, making it impractical for most organizations to develop themselves. National Decision Support Company (NDSC) serves as a central source of best advice and brings years of experience integrating this advice into EHR and hospital workflows. Hospitals save millions of dollars by not having to create, curate, and integrate their own CDS, while their providers are confident that the advice comes from top specialty societies and academic medical centers. The CareSelect™ Platform draws from the American College of Radiology’s long-respected Appropriate Use Criteria for advanced imaging, along with other Qualified Provider Led Entities like the American College of Cardiology and the National Cancer Care Network. In addition, NDSC works closely with top academic centers namely the Mayo Clinic, Johns Hopkins, Cleveland Clinic, and others to continuously refine the CDS content and delivery.

NDSC’s CareSelect platform is an enterprise solution that controls costs by reducing variation in provider resource utilization, guiding providers to the most efficient strategies for diagnosis and management while curbing over utilization and unnecessary or duplicative testing. Health systems leverage NDSC technology and services to benchmark providers and processes and identify opportunities to reduce their overhead. They choose from thousands of rules proven to impact the metrics that they prioritize. Precision advisories within the workflow inform providers on appropriateness and superior diagnostic and treatment strategies. Coupled with a prior authorization strategy that automates the medical review process, this can substantially reduce both provider and administrative burdens.

NDSC is a preferred vendor for the top EHRs and its solutions are in use across the entire healthcare provider market, logging millions of CDS transactions in all 50 states. Organizations range from large, multi-state, integrated delivery networks to standalone ambulatory care settings, and they trust NDSC’s CareSelect Platform to manage and track the actionable delivery of thousands of evidence-based guidelines within the EHR. These guidelines help organizations comply with regulatory requirements, benchmark and reduce variations in care with the goal of improving care, reduce costs and streamline communications between providers and payers.

NDSC has unmatched experience with workflow integration of clinical guidelines. That intellectual capital combined with its close working relationships with the best content sources and EHR vendors gives NDSC a perfect recipe for continued success. Our team of clinicians, informaticists, engineers, and data scientists sustain and continuously improve a central source of best advice, scalable as a cloud-based service for any and every hospital, with minimal deployment impact. We are proud to lead the way to better, more affordable healthcare in America.

√ Read about Einstein Healthcare Network’s success in leveraging their implementation of CareSelect Imaging to develop a custom PECARN subroutine to determine the appropriateness of CT for pediatric patients with minor head trauma.

√ Read the study: Impact of a Commercially Available Clinical Decision Support Program on Provider Ordering Habits

√ Learn how Mayo Clinic saw a 33.6% average reduction in volume across the ordering of Red Blood Cells, Platelets and Plasma with the deployment of the transfusion guidelines now in CareSelect Blood.

REFERENCES:

1. Cost containment is a top priority among health system executives, by Alex Kacik, July 11, 2018.
http://www.modernhealthcare.com/article/20180711/TRANSFORMATION02/180719989/cost-containment-is-a-top-priority-among-health-system-executives

2. “Not-for-profit Providers’ Rising Expenses, Dwindling Revenue Could Spur Mergers” by Alex Kacik, Modern Healthcare, August 22, 2017. http://www.modernhealthcare.com/article/20170822/NEWS/170829975

3. “Do Hospital Mergers Really Cut Health Care Costs?”, by Dee Gill , January 31, 2018
https://www.anderson.ucla.edu/faculty-and-research/anderson-review/hospital-mergers-cost

4. “Do hospital mergers reduce costs?” by Matt Schmitt, Journal of Health Economics
Volume 52, March 2017, Pages 74-94. https://doi.org/10.1016/j.jhealeco.2017.01.007

Behind the Scenes at NDSC: An Interview with Jamie Kelly, Account Executive

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CareSelect™ Blood marries NDSC’s seamless approach to integrated CDS with Mayo Clinic’s transfusion and PBM expertise. Jamie Kelly provides insight about how this newly launched solution will impact patient blood management for both patients and providers. 

 

Jamie Kelly

Account Executive, NDSC

Jamie joined NDSC in January of this year, with a background rooted in health IT from the ambulatory EHR field. She serves as an Account Executive and collaborates with the NDSC and Mayo Clinic teams to help advance NDSC’s newly launched CareSelect™ Blood product.

Approximately 50% of transfusions aren’t clinically indicated. In addition to wasting resources, these unindicated transfusions cost billions of dollars for health systems and can cause adverse reactions for the patient. Reducing blood use saves health systems, patients, and insurance carriers money. More importantly, it reduces the length of hospital stays for patients, mitigates waste and saves lives.

What is your role at NDSC and what aspects do you enjoy the most?

In addition to selling CareSelect solutions, I have taken on the role of collaborating with the NDSC and Mayo Clinic teams to help advance NDSC’s newly launched CareSelect™ Blood product.  This entails being the product expert, knowing the field of patient blood management and ensuring that the platform’s capabilities are properly communicated.

My favorite part about being on the NDSC sales team is the collaborative and supportive team effort. We all work together and help one another with no questions asked, and we have fun doing it!

 

What are you most excited about for your team this year?

I am most excited about bringing CareSelect Blood to market. It’s always both a thrill and a challenge when you have a new product to sell. The fact that this solution is different than anything else NDSC currently has on the market makes it that much more exciting. CareSelect Blood represents the expanded relationship between NDSC and Mayo Clinic, marrying our technology with their operational consulting.

 

Why is patient blood management (PBM) important to you?

Blood is a finite and costly resource. Even so, blood transfusions are one of the top five overused medical interventions nationwide. CareSelect Blood is a much-needed solution to help guide appropriate use. Approximately 50% of transfusions aren’t clinically indicated. In addition to wasting resources, these unindicated transfusions cost billions of dollars for health systems and can cause adverse reactions for the patient. Reducing blood use saves health systems, patients, and insurance carriers money. More importantly, it reduces the length of hospital stays for patients, mitigates waste and saves lives.

 

Can you explain the current landscape of patient blood management?

PBM is a well-documented and validated approach for health systems to improve profitability as well as patient outcomes. However, most health systems have only scratched the service in their PBM efforts. Red Blood Cells (RBCs) are an easy place to start, but that can’t be the end. There is so much more that can be done that is often overlooked. One in 10 hospitalizations still has a transfusion associated with it, and we see an opportunity for that number to be reduced.

 

Why is there a need for a Clinical Decision Support (CDS) solution, such as CareSelect Blood?

While we know a successful PBM program must start with education and understanding, the power comes with the ability to impact change – and then to measure that impact – at the point of care. CareSelect Blood marries NDSC’s seamless approach to integrated CDS with Mayo Clinic’s transfusion and PBM expertise. This unique solution removes the barriers often presented by over-burdened IT departments, and helps put the required organizational structure and governance in place.

 

Can you elaborate on the components of CareSelect Blood and how they were developed?

This comes back to our partner, Mayo Clinic. After working with one another to develop CareSelect Lab, we saw patient blood management as the clear next step in our partnership. We knew that, in true Mayo Clinic fashion, any PBM program they could create would go above and beyond anything available on the market today. Mayo Clinic pushed past market standards like hemoglobin thresholds and blood unit limitations to tackle a much more comprehensive set of pervasive issues across all blood products and blood management. We couldn’t be happier with the 100 plus rules they’ve authored in combination with the end-to-end consulting that will operationalize the program.

It’s also important to note Mayo Clinic’s condition-driven approach. Blanket alerts aren’t firing across the organization. They are tailored to the setting and even the individual patient. This creates a targeted and meaningful approach to help guide providers.

 

What aspect of NDSC’s CareSelect Blood do you find most valuable and why?

It’s hard to pinpoint a specific rule, module or program aspect. I find the value stems from the fully integrated program that is tailored via customized engagement for every client.

 

Are there tangible examples of the benefits of implementing CareSelect Blood into an EHR?

Mayo Clinic Hospital – Rochester saw a $5.3 million reduction in one year across all blood products, and that was just in purchase price alone. As a nation, we spend upwards of $6 billion annually on blood, creating a huge opportunity to cut back. When reviewing the potential in the market, we are confident our clients can realize a 20-30% reduction in overall blood product use, with aggressive health systems achieving up to a 50% reduction.

 

Looking forward, can we expect CareSelect Blood to evolve as the needs in PBM change?

Absolutely. If there is one thing we can count on in healthcare, it’s constant change. CareSelect expanded from CareSelect Imaging to now include Lab and Blood solutions. We already have other solutions in the works, and our existing offerings will continue to progress and develop as the industry necessitates.

 

Outside of your professional life, what do you do for fun?

I live with my husband, Matt and black lab, Henry. Outside of work, I am a trained yoga instructor and an untrained dog whisperer. I also love to travel, watch way too much true crime TV, and brunch like it’s a sport.

Expert in the Field: Dr. Cree Gaskin, UVA Health System

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Implementation of ACR Select® led to significant improvement in the appropriateness scores of ordered imaging tests in a recent JACR published study.

 

Dr. Cree Gaskin

Dr. Cree Gaskin

Professor of Radiology, Associate Chief Medical Information Officer, Vice-Chair of Informatics for the Department of Radiology and Medical Imaging, Division Director of Musculoskeletal Imaging and Intervention, UVA Health System

In addition to his executive positions at UVA Health System, Dr. Gaskin co-authored the recent JACR published study, Impact of a Commercially Available Clinical Decision Support Program on Provider Ordering Habits, revealing implementation of a commercially available Clinical Decision Support (CDS) tool integrated into the EHR provided a significant improvement in imaging study appropriateness scores.

In the JACR study, ACR Select® was integrated into UVA’s EHR, without displaying appropriateness scores for 6 months. Then, appropriateness feedback was “turned on” at order entry for adult patients in the emergency and inpatient settings for 24 months. The appropriateness scores of imaging tests before and after displaying feedback at order entry were compared and evaluated by modality and attending versus trainee status. After implementation of a commercially available Clinical Decision Support (CDS) tool integrated into the EHR, there was a significant improvement in imaging study appropriateness scores, more pronounced in studies ordered by trainees.

Electronic order entry became standard, there were existing appropriateness criteria, and providers sometimes ordered the wrong imaging tests. Thus, even before the Protecting Access to Medicare Act (PAMA) of 2014 mandated decision support, it made sense that this should all be put together to ensure patients get the best care.

 

Tell us more about your role at UVA.

In the current context, I lead UVA’s Clinical Decision Support program for the ordering of imaging tests. I work with technical, clinical, and administrative staff to optimize our implementation, hopefully for the benefit of our patients and referring providers.

 

What motivated UVA’s initial adoption of ACR Select?

The radiology department at Massachusetts General Hospital published their success with home-grown decision support integrated with imaging order entry. We were impressed by this idea and in 2010 we thought it was a logical part of the future for everyone. Electronic order entry became standard, there were existing appropriateness criteria, and providers sometimes ordered the wrong imaging tests. Thus, even before the Protecting Access to Medicare Act (PAMA) of 2014 mandated decision support, it made sense that this should all be put together to ensure patients get the best care.

We waited for a product that we felt could be successful at our institution, and we decided to move forward with ACR Select. It was important to us that the clinical content had long been curated by the American College of Radiology in the form of its Appropriateness Criteria. It was also important to us to have the right technical knowledge regarding how to integrate with our electronic health record Epic. After all, the program could only be successful if the ordering experience was acceptable to ordering providers.

 

What was the impetus for the study, and who was involved?

We were an early adopter of commercially available decision support. While we believed in the concept, we were also aware that an early generation effort could fail. We knew that our providers had largely accepted the user experience, but we wanted to know if positive impacts had actually occurred. Specifically, we sought to determine if our efforts had led to improvements in the appropriateness of imaging orders. Our study team involved radiologists, a database analyst and a statistician.

 

Please summarize key learnings from the study.

Our implementation of a commercially available decision support program was associated with a significant improvement in the appropriateness scores of ordered imaging tests. This was true for MRI, CT, and ultrasound. Among provider groups, trainees exhibited a greater response, but faculty also showed improvements.

We did not study outpatient orders, because our early implementation involved only the inpatient and emergency department settings. I’d also like to emphasize that our implementation did not involve any incentive or penalty to comply for ordering providers.

 

 

 

 

Figure. The percentage of low utility studies ordered by trainees decreased from 10.8%  to 4.8%  and the percentage of indicated studies rose from 65.6%  to 83.7%. 

 

 

 

 

 

 

UVA has recently expanded its installation to CareSelect™ Lab, how will these findings inform your future decision support strategy?

Clinical Decision Support has potential to inform, and positively impact, many types of orders. It is our hope that thoughtful implementation can support our providers by informing their care decisions in a helpful manner. If we continue to see benefits, we will continue to expand decision support.

 

REFERENCES:

  1. Impact of a Commercially Available Clinical Decision Support Program on Provider Ordering Habits, by Timothy C. Huber, MD, Arun Krishnaraj, MD, MPH, James Patrie, MS, Cree M. Gaskin, MD, Journal of the American College of Radiology, July 2018 Volume 15, Issue 7, Pages 951–957. https://www.jacr.org/article/S1546-1440(18)30387-9/fulltext

Behind the Scenes at NDSC: An Interview with Ben Gold, Product Manager

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Addressing the needs of NDSC customers, the market and managing NDSC’s expanding relationship with Mayo Clinic to develop ground-breaking solutions.  

 

Ben Gold

Product Manager, NDSC

Ben has served as the product manager for NDSC’s CareSelect™ Lab and CareSelect™ Blood. Ben’s role is to quarterback the launch and management of our CareSelect Clinical Decision Support solutions. He connects-the-dots internally and focuses on addressing the needs of our customers and the market. Ben also manages NDSC’s expanding relationship with Mayo Clinic to develop ground-breaking solutions.

My day ranges from troubleshooting a technical issue to helping to shape our messaging around product benefits for commercial payors and ACOs. At the end of the day, what I do is meaningful, satisfying, stimulating, and pretty difficult – what more could you want!

What is your role at NDSC and what aspects do you enjoy the most?

I am a product manager for CareSelect Lab, CareSelect Blood, and as with all of our solutions there is a strong tie to our work to automate prior authorization. My favorite aspect of the role is supporting a cross-functional team and charting the future of the product. It’s satisfying to know every nook and cranny of the products: EHR specific implementation details; interactions with our code-base; key contractual details; and specifics for the sales team.

My day ranges from troubleshooting a technical issue to helping to shape our messaging around product benefits for commercial payors and ACOs. At the end of the day, what I do is meaningful, satisfying, stimulating, and pretty difficult – what more could you want!

 

What has been your team’s greatest accomplishment at NDSC?

There are two main areas of pride for our team. The first is the speed that we developed CareSelect Lab and made it available to the market. The second is building and expanding NDSC’s relationship with Mayo Clinic to cover additional content areas.

Our engineering team has developed a platform flexible and powerful enough to create CareSelect Lab in a matter of months. The time from content hand-off to being ready for our first install was close to 90 days. That’s speed that makes you re-think how fast healthcare I.T. can move.

Regarding our expanding relationship with Mayo Clinic, as a company, we pride ourselves on the authenticity and depth of our relationships with our clinical and EHR partners. Mayo Clinic, as an organization, is a tough group to win over. There are vendors and partners that line up around the block to work with them. It’s a well-deserved honor and testament to our work together to continue expanding our relationship.

 

Can you explain the importance of NDSC’s relationship with Mayo Clinic?

Our roots are in imaging, and we have an ongoing, deep relationship with the American College of Radiology (ACR). We deliberately work with leading academic medical societies and academic medical centers to transform their clinical rules into guidelines and deliver those guidelines to providers at the point-of-order. Each clinical service line is different. We knew there was a need, but there was a lack of vetted content with the breadth and depth we saw our customers were clamoring for.

Enter Mayo Clinic and Mayo Medical Labs, a US News and World Report number one hospital, the fourth largest reference lab, and a leader in integrated care delivery. Mayo Clinic authored 1,500 best practice guidelines for ordering labs ranging from daily labs to high-cost genetic and molecular tests. In a narrow sense, no other organization could bring to the table what Mayo Clinic could for the lab space.

Zooming out, Mayo Clinic has a wealth of clinical expertise and an organizational dedication to disseminating that knowledge across healthcare. We see a natural alignment between world class clinical care with academic scholarship and our highly scalable clinical content delivery platform with deep relationships with EHRs – the future is bright.

 

What makes the collaboration between NDSC and Mayo Clinic unique?

A business relationship can look and feel a lot of different ways. On one side of the spectrum is the quid-pro-quo approach; I do something for you and then you do something for me. On the other side of the spectrum, which is where I place Mayo Clinic and NDSC, you are working together in pursuit of a shared goal that aligns with your shared values. In a matter of months, we felt like NDSC was part of the Mayo Clinic family and like Mayo Clinic was part of the NDSC family. That’s the difference that makes our partnership unique

 

Can you elaborate on the process of transforming Mayo Clinic’s advisories into actionable clinical guidance for CareSelect Lab?

It’s a difficult and complicated process. I applaud any organization with the resource commitment and wherewithal to do this in-house because it is a serious undertaking. Between both organizations, we have approximately 10 full-time informaticists, equally split, devoted to curating clinical content and transforming it into the I.T. logic deployable by the CareSelect Platform.

Mayo Clinic proposes clinical rules that are thoroughly vetted by the cross-functional Clinical Practice Committee (CPC). The CPC’s membership includes pathology and other traditionally represented clinical specialties: Internal Medicine, Emergency Medicine, and so on. What’s unique about Mayo Clinic’s process is the rigor each rule goes through and the commitment to, at minimum, yearly reviews of the recommendation.

Once a rule is approved, the logic and supporting academic literature is handed over to NDSC to build, test, and package up the logic. I like to think we have the easy part of this effort, the thousands of hours of spent researching, debating, and agreeing to the clinical logic is the larger effort.

 

Why a lab solution?

A combination of reasons. First, our customers saw what we could do with CareSelect Imaging and were asking how we can help with lab. The real question is why does lab need a CDS solution that affects ordering clinical behavior?

20-40% of lab tests are unnecessary and wasteful. The margins on reimbursement are shrinking across healthcare and acutely in lab with downward price pressure from the 2018 CMS Lab Fee Schedule. As health systems are transitioning to value-based care arrangements with their payors, quality and reimbursement are aligning around the best care for a patient. At the same time, molecular, genetic, and specialty tests are increasing in price. We see labs feeling the pressure to do more with less and the looming threat of being outsourced. Most difficult, their hands are tied when it comes to the folks that affect their bottom lines. Looking at it from that perspective, labs are some of the hungriest clinicians for CDS and care model standardization.

 

What aspect of NDSC’s CareSelect Lab do you find most valuable and why?

Our genetics and molecular content, hands down. What we hear consistently from ordering clinicians, pathologists, and payors is that staying up to date with the best practices of genetic test orders is difficult. With rapid advancement and changes in genetics testing, it’s an area that benefits everyone.

 

How has NDSC’s partnership with Mayo Clinic expanded and evolved the CareSelect Platform?

Mayo Clinic’s content and thought leadership caused us to re-think how we look at CDS and the direction of patient care.

Mayo Clinic’s integrated practice model produces a unique perspective on patient care driven by the suspected condition. We’ve always supported pathways and arranging information as a series of decision trees, but never stepped back and holistically evaluated how a team of clinicians treat a condition.

Step one in a patient’s care odyssey starts with the PCP and the underlying condition becomes less pixelated each step of the way as the patient moves towards more specialized practitioners. This perspective of organizing clinical knowledge was an eye-opener for us.

 

Looking forward, how do you see CDS evolving?

The future of medicine is the return to what we want medicine to be focused on: providers and patients making shared and informed decisions about what to do next. If we can eradicate the knowledge gap for providers such that any patient – anywhere – can receive the best care in accordance with the research, then what is left for CDS to do?

Choosing Wisely was and is barking up the right tree, the concept of shared decision making is the future of medicine. We can strip away the promising science and new, fad technologies, but what are we left with? Providers that know the best choices available and a patient that can share in determining what is best for them. It’s easy to get caught up in the “what” and “how” of the new technologies and clinical innovations. It’s harder and more important to step back and remember why these advances are important and get back to the core of enabling providers to practice high quality medicine.

 

Outside of your professional life, what do you do for fun?

I live in Madison with my wife, Katie and two cats, Remy and Bella. Outside of work, I love to travel abroad, drink wine, read books, play squash, cook, and spend time with friends and family. Also, I’m a huge healthcare policy and industry nerd. It’s funny, and not surprising to me, that my personal blurb is ten times shorter and less interesting than my musings on healthcare.

Expert in the Field: Don Flott of Mayo Medical Laboratories

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CareSelect™ Lab and Mayo Clinic help to mitigate 20-40% of unnecessary lab tests through provider order guidance. 

 

Don Flott

Don Flott

Director of Utilization Management and Integration Services, Mayo Medical Laboratories

Don Flott has 30 years of experience in administrative leadership roles at Mayo Clinic. During the past several years, he has focused on the value of laboratory diagnostics and its impact on a patient’s total cost of care. Flott — together with pathologists, scientists, and clinicians — has developed data-driven methodologies for producing validated diagnostic clinical evidence that can drive out waste and impact the total cost of care for both hospitalized patients and those treated outside of the hospital setting.

“The U.S. spends approximately $3.2 trillion a year on healthcare. For health care providers, reimbursement levels are declining at the same time the cost of care for patients is rising. CareSelect Lab allows providers to introduce appropriateness in order to better align cost to reimbursement and mitigate downstream costs.”

Why is it important for health systems to have Clinical Decision Support within the laboratory?

The transition from volume to value is accelerating. Appropriate lab testing can lead to fewer tests, while delivering the same level of quality patient care. Additionally, the explosion of technology and associated information around the ordering of complex testing – combined with high costs – is leading to the need for additional guidance.

 

Why is Mayo Clinic’s collaboration with NDSC unique?

Currently, there isn’t a single source of trusted, vetted laboratory guidance on appropriate test ordering. Health care providers are required to reference multiple sources, which can be a very time-consuming task. By partnering with NDSC, Mayo Clinic is able to provide a single source of test guidance, integrated into the electronic health record, available at point-of-order entry. This allows for minimal workflow disruptions, giving health care providers more time to spend with their patients.

 

Can you elaborate on the process of turning Mayo Clinic best practice guidelines into clinical advisories for CareSelect Lab?

Mayo Clinic sees more than 1 million patients every year, with conditions that range from community patients to high complexity patients. Having the opportunity to see, diagnose and treat these patients allows us to create unique integrated care models. These models represent the highest standard of care delivery with a focus on patient outcomes and efficiency. Mayo Clinic has taken these care models and converted the laboratory testing knowledge into outputs that NDSC then translates for the electronic health record. The end result is CareSelect Lab, which is then available at the provider’s fingertips. Additionally, Mayo Clinic has an internal team that is constantly reviewing and updating the care models to ensure accuracy.

 

The average 500-bed hospital performs over $750,000 worth of clinically redundant and duplicative tests annually, how does CareSelect Lab help mitigate this?

Literature has identified that 20% to 40% of laboratory orders are unnecessary. When examining a subset of CareSelect Lab guidance against a 5 million life database, it was identified that the average 500-bed hospital has $750,000 of potentially unnecessary laboratory testing.

CareSelect Lab provides healthcare organizations the ability to benchmark their laboratory test ordering against best practices. In doing so, areas for greatest opportunity are highlighted and specific guidelines can be seamlessly activated with minimal intrusion to the provider workflow.

 

How does CareSelect Lab solve current problems within health care?

The U.S. spends approximately $3.2 trillion a year on healthcare. For health care providers, reimbursement levels are declining at the same time the cost of care for patients is rising. CareSelect Lab allows providers to introduce appropriateness in order to better align cost to reimbursement and mitigate downstream costs.

 

Why was it important to expand CareSelect Lab to deliver guidance for an expanded range of difficult and uncommon clinical scenarios?

Complex condition management is what Mayo Clinic excels at – we’ve been seeing patients with complex diseases and conditions for over 150 years. Many times, these complex conditions have high-costs associated with them, and can have a large impact on the clinical diagnosis and treatment for the patient. By expanding CareSelect Lab, we’re now able to provide guidance to a variety of patients and healthcare providers – whether you’re a community hospital or a large academic medical center.

 

What impact does having clinical decision support have for patients?

Clinical Decision Support (CDS) assists healthcare providers in ordering the right test, at the right time, for the right patient. This assistance allows for numerous benefits to the patient, including:

  • Fewer lab tests ordered, resulting in less expensive care and fewer blood draws
  • Lower total cost of care through appropriate diagnosis and treatment
  • Improved quality of life by arriving at a diagnosis quicker and allowing treatment to begin sooner
  • Enhanced transparency on care delivery options and costs

 

Looking forward, what do you hope for the future of CDS with respect to laboratory testing?

CDS enables providers to leverage the full potential of laboratory testing to appropriately diagnose and treat patients. As a result, solutions like CareSelect Lab are critical to bending the unsustainable growth rate of healthcare spending. Mayo Clinic and NDSC are committed to an ongoing partnership to continually deliver existing and emerging best practices to healthcare providers and the patients they serve.