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System Helps Doctors Pick The Right Tests

Business intelligence moves into the examining room.

Minnesota is home to the first statewide effort to use business intelligence to reduce inappropriate diagnostic testing of patients.

The Institute of Clinical Systems Improvement (ICSI), a nonprofit comprising 60 medical groups, 9,000 physicians, and six payers and health plans, is expanding a pilot program launched about a year ago that uses e-ordering and decision-support tools from Nuance Communications to help doctors choose the most appropriate diagnostic imaging test--tests such as MRI, CT, and PET scans--for patients. With the pilot's success, ICSI is rolling out the tools to all its members.

The group's members represent 80% to 90% of Minnesota's healthcare providers. They range from small doctor practices to large organizations, including the Mayo Clinic, the state's Medicaid programs, and Blue Cross Blue Shield of Minnesota.

ICSI is licensing Nuance's RadPort, an e-ordering system that incorporates evidence-based clinical decision-support tools, and Nuance's RadCube software, which analyzes physician ordering trends, correlating them with patients' clinical outcomes.

During the yearlong pilot involving more than 2,300 ICSI-member physicians, ICSI saw no growth in the number of high-tech diagnostic imaging tests ordered. In previous years, the number of tests ordered grew about 8% annually, says Cally Vinz, VP of ICSI clinical products and strategic initiatives. The lack of growth translates to a savings about $28 million for the year, she says.

The system doesn't steer physicians to the least expensive tests, but rather recommends the most medically appropriate test based on the patient's information, says Peter Durlach, Nuance's senior VP of product marketing. Doctors can override the RadPort recommendations. On the back end, RadCube's clinical BI tools analyze whether the tests that were ordered resulted in best patient outcomes.

The Nuance tools integrate with electronic medical record and computerized physician order-entry systems, including Epic's platform, which is used by many Minnesota hospitals and other healthcare providers, Durlach says. Doctors that don't have EMRs can order tests using RadPort over the Web, he says.

RadCube uses natural language processing technology to extract data such as diagnoses, positive findings, and recommended treatment from radiologists' dictations and reports.

The technology used in RadPort and RadCube was developed by Massachusetts General Hospital for use by its physicians. The software was licensed to Commissure, which Nuance acquired in 2007.

The criteria the tools use to determine the appropriateness of tests are based on more than 15,000 clinical guidelines that are continuously updated in accordance with patient demographics, imaging procedures, the American College of Radiology, and input from Massachusetts General and other clinical organizations.

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