The U.S. government dropped two bombshells on the healthcare IT community on Thursday. First, it announced the recipients of awards for an eagerly awaited project on the use of clinical decision support for ordering radiology studies. Then, it announced that David Blumenthal, MD, is leaving as chief of the agency charged with directing federal health IT policy.
In the first of the day’s developments, the U.S. Centers for Medicare and Medicaid Services (CMS) named the organizations it has selected to participate in a $10 million project to evaluate the efficacy of clinical decision-support systems for ordering diagnostic imaging studies.
The organizations include four hospital enterprises:
- Brigham and Women’s Hospital of Boston
- Henry Ford Health System of Detroit
- Maine Medical Center – Physician Hospital Organization of Portland
- University of Wisconsin-Madison
National Imaging Associates (NIA) of Avon, CT, a radiology benefits management firm, was also selected.
Participation by each organization is contingent on the acceptance of CMS demonstration terms and conditions prior to the start of the project, according to Don McLeod, a public affairs spokesman for CMS. CMS declined to state the total number of applicants considered for the project.
|Blumenthal to leave ONCDavid Blumenthal, MD, will be leaving his post as National Coordinator for Health Information Technology later this spring, the U.S. Department of Health and Human Services announced on February 3.|
In a memo, HHS secretary Kathleen Sebelius said that Blumenthal will be returning to his academic post at Harvard University. He has been head of the Office of the National Coordinator for Health IT (ONC), effectively the nation’s healthcare IT czar, since being appointed to the post in March 2009.
In announcing Blumenthal’s departure, Sebelius said that in the past two years the U.S. has “turned the corner in our critically important journey to the use of health information technology,” particularly the adoption of electronic health records (EHRs).
Sebelius said that HHS would conduct a national search for Blumenthal’s successor.
In an e-mail to ONC staff, Blumenthal cited the agency’s accomplishments since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, and the concept that “meaningful use” of the utility of healthcare IT must be demonstrated.
“I believe the key factor for success has been, and will continue to be, the concept of ‘meaningful use,’ ” Blumenthal said. “The HITECH Act recognized that EHR adoption alone would not bring about the transformative improvements that are possible with health information technology. Meaningful use provides, for the first time ever, a consensus goal on how information should be used to enhance care. To realize its promise also requires changes in the processes of care delivery.”
The Medicare Imaging Demonstration initiative is being undertaken to enable CMS to determine if the use of decision-support software can promote the ordering of diagnostic imaging procedures only when they are clinically appropriate. The demonstration will focus on the appropriate use of CT, MRI, and nuclear medicine (including PET) exams, representing a total of 11 imaging exams.
The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 authorized funding of up to $10 million for the 24-month demonstration project. It was scheduled to begin January 1, 2011, according to the proposal application document published in July 2010.
The 11 imaging exams were selected based on high levels of spending and utilization of the studies among Medicare patients, and the availability of relevant medical specialty appropriateness guidelines. The demonstration has no impact on Medicare coverage or payment policies and specifically excludes any approaches that would require prior authorization, according to CMS.
CMS is holding a meeting on February 5 in Baltimore to discuss the project with the selected participants. The starting date or dates for the demonstration are expected to be announced at that time.
The selected organizations will function as “conveners” used to recruit physician practices, to install decision-support systems that incorporate medical specialty society guidelines for the selected procedures, and to keep the systems updated to reflect any guideline changes. They also will be responsible for collecting and transmitting data and distributing payments to physician practices for reporting data.
Two of the organizations, Brigham and Women’s Hospital and Henry Ford Health System, currently use commercial decision-support systems (Medicalis of San Francisco and Nuance Communications of Burlington, MA, respectively) with computerized order entry for radiology exams.
The project is designed to include collection of six months of data without the use of decision-support systems, followed by 18 months of use with them. How the criteria will be met by these organizations has not yet been explained. Brigham and Women’s Hospital, which pioneered use of the first commercial decision-support system, has been using the software for many years.
Both the American College of Radiology (ACR) of Reston, VA, and the Medical Imaging and Technology Alliance (MITA) of Arlington, VA, were delighted by the announcement.
“We are extremely pleased with the CMS announcement,” Dave Fisher, MITA’s executive director, told AuntMinnie.com. “MITA helped develop this demonstration program along with physician and patient groups, and worked with congress to include it in MIPPA. We believe that the use of physician-developed appropriateness criteria in determining who will receive an imaging test drives our long-held goal of patients receiving the right scan at the right time.”
The ACR echoed these sentiments.
“Decision-support systems, based on ACR appropriateness criteria, help providers prescribe the most appropriate exam for a given indication; can help avoid unnecessary utilization; and do so without taking care decisions out of doctors’ hands,” said Shawn Farley, ACR director of public affairs. “We look forward to working with CMS, Congress, and other stakeholders to arrive at sensible medical imaging utilization and reimbursement policies moving forward.”
Because the organizations’ project organizers were en route to Baltimore, most were unavailable for comment.
However, Thomas Grist, MD, chair of the radiology department at the University of Wisconsin-Madison, expressed his department’s and the hospital’s delight at being selected. He told AuntMinnie.com that “our participation in this demonstration is based on the firmly held conviction that, implemented in the right way, a decision-support system has the potential to simultaneously improve care quality, improve imaging indication quality, educate ordering providers, and reduce duplicated and limited utility imaging for patients.”
Commercial software vendors MedCurrent of Los Angeles and Nuance Communications were equally enthusiastic. Stephen Herman, MD, president of MedCurrent, told AuntMinnie.com that he “anticipates that the results of the demonstration will solidify the clinical and economical value of imaging decision support for Medicare enrollees and that it will likely be a required practice standard for commercial and other healthcare payers as well.”
The sentiment was echoed by Scott Cowsill, senior product manager of diagnostic imaging solutions at Nuance Healthcare, and co-founder of the Imaging e-Ordering Coalition.
“Studies show that a third or more of scans may be unnecessary or repetitive,” Cowsill told AuntMinnie.com. “This jarring statistic alone supports the need for better utilization management of diagnostic exams. CMS’ recognition of the value that decision-support solutions can bring to the process of ordering diagnostic exams is a major achievement in elevating the value of a technology that in many scenarios has already proved to be valuable.”
By Cynthia E. Keen
AuntMinnie.com staff writer
February 3, 2011