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.