Not quite there: Rad focus groups perceive few benefits—but also few hassles—with CDS

In a study sponsored by CMS as part of the Medicare Imaging Demonstration project, four focus groups of radiologists heaved a collective yawn over computerized decision support (CDS).

The 26 rads, all participants in the demo project, shared a general sense that CDS has neither improved appropriate utilization of advanced imaging nor substantially changed their workflows or their interactions with referring physicians.

The good news for CDS proponents was that the groups didn’t register strongly negative perceptions of the technology, either—they just felt it didn’t make much difference one way or the other to the quality or quantity of their work.

The results of the study, led by Christoph I. Lee, MD, MSHS, of the University of Washington, appear in the November edition of the American Journal of Roentgenology.

The research team recorded and transcribed all four focus-group discussions, which were moderated by a guide asking open-ended questions.

The team used qualitative data-analysis software to code input according to various themes and to identify representative verbal expressions. The 26 participants also filled out a related survey.

Interestingly, the rads tended to agree that CDS’s potential benefits will be realized over time and, at some point, will justify its widespread adoption.

The consensus was that, in order for CDS is to make an impact on both patient care and the profession of radiology, radiologists must be given—or must assert—a greater role in future education, development and implementation.

The authors include in their study report a number of direct quotes from the focus-group sessions. Examples:

• “I think decision support is good. I think you'd refer to it as an entry-level sort of advice. And then, on top of that, layer on radiologists' consultation for the cases where the decision support is not answering all the clinicians' questions or concerns. So I'd see it as a kind of a multitiered approach.”
• “We were expecting to perhaps get calls with questions about CDS [from referring physicians]. You know, ‘This doesn't make sense to me.’ Or ‘I think I have a special case here that this doesn't apply.’ But I for one have not gotten a single call about questions about the decision support advice.”
• “I think the quality of the clinical information is significantly improved, compared to before [computerized physician order entry (CPOE)]. I’m not sure that the decision support piece of it has changed ordering as much as the change we have seen just from using [CPOE]. I think we’re getting a little more quality clinical information, but I would say we still have to go into the electronic medical record very often to look up clinician notes, even with the amount of information that we're provided.”

Commenting on participants’ optimism over the future of CDS adoption, the authors cite the potential financial benefits to radiologists of widespread adoption.

“CDS may eventually eliminate the need for radiology benefit managers and prior authorization programs,” write Lee and colleagues. “These programs have typically caused workflow burdens and shifting of costs from payers to practices, sometimes increasing overall costs.”

Regardless of perceptions—good, bad or indifferent—CDS is here to stay. The authors highlight laws encouraging the rapid adoption of CPOE and accompanying CDS.

For one, the Health Information Technology for Economic and Clinical Health Act of 2009 promotes the use of CDS by offering financial incentives for meaningful use.

For another, the Protecting Access to Medicare Act of 2014 mandates CDS for specific ambulatory imaging exams as a requirement for radiology reimbursement beginning in January 2017—“likely accelerating the rapid diffusion and adoption of CDS,” the authors note.