Demand Optimisation (CDS) Workshop Dr Raj Burgul What is - PowerPoint PPT Presentation

Demand Optimisation (CDS) Workshop Dr Raj Burgul

What is Clinical Decision Support (CDS)? Referrer: “Does my Clinical IT Appropriate patient need guidelines Solution test & treatment medical imaging?”

The Aim The CDS project will explore what impact the use of CDS can have as a demand management tool on the Radiology Service in Scotland

Guidelines • Available guidelines: – iRefer (Royal College of Radiologists; developed with ) – iGuide ( European Society of Radiology; based on the American College of Radiology appropriateness test) – SIGN – NICE

'Pull’ resources iRefer

European Council Directive 97/43/Euratom requires Member States “to ensure that recommendations concerning referral criteria for medical exposures, including radiation doses, are available to the prescriber of medical exposures” The Protecting Access to Medicare Act (PAMA) The Protecting Access to Medicare Act of 2014 mandates that starting January 1, 2019, physicians ordering advanced diagnostic imaging exams must consult qualified, evidence-based appropriate- use criteria, namely through a Clinical Decision Support Mechanism.

How has CDS performed elsewhere? CDS installed 2015 – initial silent mode Appropriateness Score categorization for 6754 cases Pre intervention 16909 cases post intervention University of Virginia, Charlottesville, Virginia. J Am Coll Radiol 2018;

How has CDS performed elsewhere? Pilots have been ongoing across Europe using iGuide by the European Society of Radiology Their latest report has shown that once CDS is introduced: • number of unnecessary/duplicate exams goes down • number of avoidable referrer-radiologist consultations reduce • diagnostic yield of exams actually carried out is increased

How has CDS performed elsewhere? • Pilots in Hillingdon and North West London using RCR’s iRefer guidelines: • Pilots are ongoing. • There have been delays due to integration issues and no results are available yet.

SRTP CDS Pilot – The story so far • Additional funding was made available through the Scottish Government to fund a CDS pilot • There has been a PIN notice via NHS GGC • The Scottish Government is testing CDS software in a national pilot. The SRTP is currently exploring if the contracted provider is able to support a Radiology CDS solution in Scotland. • Boards have been approached to note their interest to participate in the pilot. Further discussions to be held.

SRTP CDS Project Objectives Use the experience Run CDS pilot Depending on of the pilot to within one or outcome of pilot, to inform a national more NHS implement a national approach in this boards CDS solution area

Group Discussion

Group Discussion 1. CDS will only be as good as the guidance. What guidance should we use? 2. Should we try to standardise guidance across Scotland? If so how? 3. Are there existing Scottish audits and guidance we can use? 4. Should DGH guidance be aligned with their tertiary centre?

Group Discussion 5. Structured Requests? 6. How to assess a CDS project? What metrics and balancing metrics should be used? 7. Do we think CDS will reduce demand? 8. Is there an educational benefit?

Group Discussion 9. How do we utilise the data CDS will provide regarding clinician requesting behaviour? 10. Pilot sites? 11. Are there any other ways to manage demand? What is the role of Vetting? 12. Is there any current way to quantify the number of unjustified requests?

Thank you