Electronic Health Reporter

Guest post by Karen Holzberger, vice president and general manager, diagnostic solutions, Nuance Healthcare.

A few years ago, there was a witty car commercial advertising an alert feature that took the guesswork out of filling your tires by gently beeping to signal the appropriate pressure had been reached. It featured a series of vignettes where the car horn would beep, cautioning the owner to reconsider just as he was about to overdo something (for instance, betting all of his money on one roll of the dice). The concept of getting a reminder at the point of a decision is a compelling one, particularly if it can save you time or aggravation and guide you to do the right thing. In healthcare, any technology that can provide that level of support will have a profound impact on patient care.

Albeit humorous, that car commercial wasn’t far off the mark with healthcare challenges. Unnecessary medical imaging exposes patients to additional radiation doses and results in approximately $12 billion wasted each year, but it has also has another unintended downstream effect. It has fueled a culture of medical certainty, where tests are ordered in hopes of shedding light on some of the grey areas of diagnostic imaging, including incidental findings. The reality is that incidental findings are almost always a given, but not always a problem. So how do you know what to test further and what to monitor? And while one radiologist may choose the former option with a patient who has an incidental node finding, another might decide to go with the latter option, so who is right?

Beep! It’s important
It is important that when a radiologist sees a nodule and it has certain characteristics, he or she makes recommendation for follow-up imaging, which is why the American College of Radiology (ACR) has released clinical guidelines on incidental findings. By offering standard clinical decision support on findings covering eleven organs, the ACR is helping radiologists protect their patients through established best practices for diagnostic testing.

This is a great step forward for the industry, but some hospitals are taking it one step further. Massachusetts General Hospital (MGH) is using its radiology reporting platform to provide real-time quality guidance at the point-of-care to drive better patient care. Now, when a radiologist is reading a report and notes an incidental finding, the system will automatically ping her with evidence-based recommendations for that finding. For instance, if the node is a certain size, it should be tested further.

The results of having this information at the radiologists’ fingertips are impressive. In fact, studies show that when these clinical guidelines are built into existing workflows, 90 percent of radiologists align with them, as opposed to alternative methods, such as paper print outs, which result in 50 percent concordance.

The evolution of health IT is comparatively slow relative to the science of medicine itself — a field where our knowledge base is growing every minute of every day. And what good is knowledge if it is neither shared nor accessible? In addition to smoothing out a previously clunky and manual look-up process, these automated clinical guidelines are updated constantly to ensure radiologists are using the most current information when treating their patients so they can make the most informed decisions based on industry best practices.

Patients deserve and need to have the best and most thorough care; however, this shouldn’t put them at risk for unneeded radiation exposure. It is neither safe, nor financially sustainable. Health IT innovations like these — that can ping clinicians in real-time with the latest in quality guidance — will be the tipping point in the shift to value-based care. They will forever change the standard of patient care and the landscape of the healthcare industry, and that is exactly what we need.