Participation on the Quality Quest High Tech Diagnostic Imaging Team proved to be a valuable personal experience that has significantly influenced aspects of my professional practice behavior.  I have long appreciated the invaluable diagnostic benefits derived from high-tech imaging (HTI) studies and the skill of those who provide expert interpretation.  However, from my experience with this team, I discovered there was much for me to learn and revisit regarding several of the adverse considerations associated with HTI studies.  

What I would come to learn regarding the burden associated with HTI radiation exposure (properly ordered and administered or not) and the estimated frequency of inappropriate (suboptimal test selection, unnecessary testing and duplicity of testing, etc.) test ordering was enlightening and sobering.  It became clear to me very early in the process that (ouch) “I am part of the problem!”  In truth, it is the sometimes misguided stroke of my pen constitutes a root cause of this considerable industry-wide, elephantine problem.

Through participation on this team, I became much better acquainted with the enormity of the burden imposed on all citizenry by the improper ordering of HTI studies.  Specifically, the financial burden of HTI testing (properly selected or not) to all parties, when quantified, is colossal.  When confronted with national data describing the frequency of testing duplicity, inappropriate test selection, and needless patient exposure to potentially injurious radiation, I felt humbled, admonished, and challenged to improve my skill regarding HTI test consideration and selection. 

A review of the morbidity/mortality inflicted on patients by radiation exposure served to dispel any “casual” attitude of approach I may have possessed when writing an order for any given HTI test.  I found myself motivated to review the fundamentals of the orthopedic and neurologic physical examinations to better justify any specific test I may consider ordering.  I more commonly now pause to consider the cost (it matters not to who-the point is it costs!) prior to ordering each and every HTI test.  I remembered anew my responsibility to “get it right”for the sake of all who are stakeholders in my decision to order an HTI test.

The good news is there is seemingly a potential remedy.  Quality Quest, serving our region as a catalyst, was able to craft a team that was successful in identifying a point of care evidence-based decision support software program that, in the possession of a conscientious practitioner, may serve well to reduce the adverse impact of improper HTI test selection.  As well, with implementation of this system, the burden to all parties of pre-authorization is relieved.  The program is able to provide objective metrics, allowing health plans and practitioners to recognize quality, cost-effective care- the end result is optimal-caliber, responsible patient care with a favorable economic outcome.  My hope is that all parties able and necessary to implement this option can unite effectively and secure this option for the greater good of all who serve, and are served by the medical community.

Project  Background

Project Objectives

1. Identify or craft a means to assure that, on each occasion, the “right” high tech imaging test is ordered for the “right” reason(s).. every time- if in fact any imaging test was rightfully needed.

2. Prevent duplicity of testing.   

3. Prevent the patient risk associated with improper testing.

4. Educate all relevant participants regarding the risks associated with HTI studies. 

5. Improve physician access to, and awareness of, testing performed at additional points of service.

The Team

The High Tech Diagnostic Imaging Team was lead by the skillful Dr. Carter Young.  The makeup of the committee reflected a diverse group of stakeholders: patient(s)/ advocates, Quality Quest 6 Sigma specialists, major local employers, hospitals, insurance plans, and physicians of various specialties.  The unifying, unanimously shared theme of the participants was an unwavering commitment to serve the best interest of the patient and the commitment to comply with best practices.

Click here to learn more about the project.