RSNA: Rads exhorted to make MU meaningful

CHICAGO—The consensus on Meaningful Use (MU) for radiology is that the program is an awkward fit for the specialty. Consequently, radiologists have been slow to accept MU. An expert panel challenged radiologists to accept the challenge of MU and work to make it meaningful for radiology at the annual meeting of the Radiological Society of North America (RSNA).

David E. Avrin, MD, PhD, vice chairman of informatics University of Calif., San Francisco, summed radiologists’ perception of MU as “kind of annoying.” Radiology, after all, lives and breathes digital medicine and federal intervention to encourage electronic health records doesn’t mesh with the reality of radiology.

Avrin and fellow panelist, Curtis P. Langlotz, MD, PhD, vice chairman of informatics University of Pennsylvania in Philadelphia, asked a pair of questions:

• What would meaningful criteria for radiology look like?
• Can MU focus on measures that meaningfully improve radiology practices?

RSNA partnered with KLAS in 2011 on a survey focused on these questions. The RSNA-KLAS survey of 216 radiologists identified 37 meaningful measures for radiology practices, covering seven categories: digital image storage and display, information exchange between referring physicians and radiologists, information exchange between institutions, patient engagement, clinical decision support for radiologists, clinical decision support for referring physicians and clinical quality measures.

Ramin Khorasani, MD, director of information management systems at Brigham & Women’s Hospital (BWH) in Boston, accepted the theoretical challenge of MU for radiologists and sought to determine whether these measures could be pulled from existing health IT at BWH.

Khorasani found existing BWH tools could capture the theoretical radiology MU measures. BWH’s approach to MU set the stage for success. BWH no longer has PACS workstations, said Khorasani. The hospital configured workstations so that the PACS application was embedded in a single sign-on to the clinical workstation—iConsult, an EMR view. This allows clinicians to access images. Thus, measures such as digital image storage and display across sites would work well for its larger practices. Smaller practices might struggle, Khorasani admitted.     

The health system uses computerized physician order entry (CPOE), which facilitates information exchange between referring physicians and radiologists. This approach has enabled clinical decision support and promulgated appropriate imaging. Specifically, BWH has cut duplicate head CT exams by 5 percent via the display of patients’ imaging histories. The hospital also has achieved a 20 percent reduction in inappropriate CT pulmonary angiograms for suspected pulmonary embolism by deploying decision support.

Other clinical quality measures, such as critical results communication, also can be tracked and reported with existing tools. Ultimately, the modified measures that radiologists identified as important can be measured, said Khorasani.

Levin concluded by suggesting that radiologist re-frame their thinking about MU. “MU should be viewed as an important national clinical initiative to improve quality and reduce waste health [despite its limited relevance.] More relevant MU measures can help accelerate the creation and adoption of important health IT solutions which can help improve quality and reduce waste. … Excluding ourselves from national discussions [about MU and quality] is not a wise decision.”