mita medical imaging and technology alliance november 27, 2007 structured reporting a critical need...
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MITAMedical Imaging and Technology Alliance
November 27, 2007
STRUCTURED REPORTINGA Critical Need in Cardiac Imaging
Robert C. Hendel, M.D., F.A.C.C.
Clinical Cardiologist
Midwest Heart Specialists
Fox River Grove, Illinois
Chairman, ACCF/UHC SPECT MPI Appropriateness Criteria Evaluation Pilot Study
Member, Working Group for ACC Appropriateness Criteria
Co-Chairman, Quality in Imaging Task Force of the Cardiovascular Imaging Collaborative, ACC
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WHY DO WE NEED QUALITY-BASED IMAGING INITIATIVES?
• Marked growth in procedural volume, cost
• Inconsistent use
• Inadequate definition of “quality in imaging”
• Poor quality imaging can do harm
• Limited evidence of impact on outcome
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AMERICAN COLLEGE OF CARDIOLOGY Imaging Initiatives
• Cardiovascular Imaging Consortium (CVIC)• Duke/ACC Think Tank I and II• ACC/AHA guidelines• Appropriateness criteria• Evaluation of imaging appropriateness (“Pilot”)• ACC/AHA data standards for imaging • NCDR imaging registry• Integration with other key ACC committees
–PAR3–Advocacy–QSDC–BOT
• Collaboration with other organizations–Subspeciality societies, radiology organizations–Participation with AQA–Alliance with ICA
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Duke-ACC Think Tank
DIMENSIONS OF CV IMAGING QUALITY
January 30, 2006 - February 1, 2006
Pamela Douglas Linda Gillam
Harlan Krumholz Robert Hendel
Ami Iskandrian Jamie Jollis
Eric Peterson
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QUALITY METRICS FOR MEDICAL IMAGING
Patient Patient Selection
Image Interpretation
Results Communication
Improved Patient Care
Image Acquisition
Appropriateness Structure
Process (timeliness, pt-centered)
Reproducibility
Reproducibility
Accuracy
Sensitivity
Specificity
Timeliness
Interpretability
Clinical integration
JACC, Nov 6, 2006
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WHY APPROPRIATENESS?Right Test, Right Patient, Right Time
• Unprecedented focus on assessment and improving quality
• Explosive growth of CV imaging
• Substantial regional variation
• True nature of utilization unknown–Overuse/ Under-use/Appropriate
• Clinicians, patients, and especially payers seeking guidance
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APPROPRIATENESS CRITERIAThe ACC Queue
√ Nuclear cardiology (SPECT)October, 2005
√ Cardiac CT/CMR September, 2006
√ Echocardiography (TTE, TEE)
–July, 2007
• Echocardiography (Stress)–Fall/Winter, 2007
• Percutaneous coronary intervention–Winter, 2007-8
• CV imaging cross modality (efficiency) evaluation
• Revised SPECT Criteria
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PILOT PROJECT FOR THE EVALUATION OF APPROPRIATENESS IN SPECT IMAGING
PROJECT GOALS
• Quality improvement–Effective patient care–Efficient care
• Assess validity of appropriateness criteria–Provide data for revisions/updates–Determine threshold levels of performance
• Assess practice patterns–Feedback to practice & individual physician–Identify areas for improvement
• Analysis of decision making–Correlation of level of appropriateness and image findings/patient outcome
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SPECT AC EVALUATION PILOT
Data collection
paper form
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Duke-ACC Think Tank
IMPLEMENTING CV IMAGING QUALITY
October 8-10, 2007
Pamela Douglas Linda Gillam
Greg Hundley Robert Hendel
Fred Masoudi Manesh Patel
Eric Peterson
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Duke-ACC Think Tank
Broad Stakeholder Representation
• Professional societies
• Academics - ‘quality mafia’
• Government- CMS, FDA, NHLBI, VA
• Payers- UHC, Aetna
• Accrediting organizations- IAC, IHE
• Industry
• We acknowledge ‘special interests’
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• Critical issues–Creation, Endorsement, Dissemination–Supporting tools, Compatibility–Universal implementation
• Industry and societies must work together–ACC/Societies to endorse mandatory use
DUKE-ACC THINK TANK - IIImplementing Cardiovascular Imaging Quality
October 8-10, 2007
DATA STANDARDS AND REPORTING
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DUKE-ACC THINK TANK - IIImplementing Cardiovascular Imaging Quality
October 8-10, 2007
• Data elements and standards– In progress, anticipated completion 12/07
• Structured reporting–Collaboration with equipment manufactures and software vendors
–Recommend mandatory use by 2010 (?)
• Imaging databases and registries–Proposal for feasibility of imaging registry completed
– Integration with other registries
–Potential to provide true outcome data
DATA STANDARDS AND REPORTING
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IMAGING REGISTRY PRINCIPLES
• Ultimate goal; May be needed for reimbursement
• Data elements embedded in software
• Central certification
• Interface with disease and procedural registries
• Claims data for outcomes
• ?? Workflow
• ?? Business model
DUKE-ACC THINK TANK - IIImplementing Cardiovascular Imaging Quality
October 8-10, 2007
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National CardioVascular
Data
Registry
1998….. 2004 2005 2006 2007 2008 beyond
CathPCICathPCIRegistryRegistry
ICDICDRegistryRegistry
CARECARERegistryRegistry
ACTIONACTIONRegistryRegistry
IC3 CADIC3 CAD
ImagingRegistry
HFRegistry
PracMgtRegistry
PADRegistry
EPRegistry
Ped.Registry
Congenital
Registry
Building a true…Building a true…ICD LongICD Long
AchieveAchieve
NCDR is…Physicians Leading the Effort To Quantify Quality
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A PROPOSAL (1)
• Using data standardization and structured reporting, facilitate the design, creation, implementation, dissemination of resources supporting imaging quality
• Examine the possible integration of structured reporting into a national cardiac imaging registry
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A PROPOSAL (2)
• Create working group of industry and MD/society leadership – Industry leaders: Technical, marketing, Decision makers
• PACS, reporting, IT, equipment, IHE/DICOM, NEMA/MITA
– MD/societal leadership • ACC, ASNC, ASE, SCMR, SCCT, ACR
• Develop resources, potentially include branded commercial products – Reporting software, educational materials, etc. – Capable of supporting QA and QI efforts (appropriateness criteria evaluation,
lab accreditation and imaging and other registries)
• Explore funding challenges and opportunities
• Advocate for use of structured reporting and registry data to improve the evidence base supporting the value of CV imaging
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A PROPOSAL (3)
• Initial steps
–Kick off meeting in winter ‘08–Review of lessons learned from DICOM and IHE regarding collaboration, consensus
–Evaluate economic potential including branded/accredited products
–Discussion with NCDR regarding registry integration–Project plan, timeline and budget
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QUALITY IN CARDIAC IMAGINGConclusions
• A critical ACC priority–Large allocation of resources (“Think Tank”, data standards, appropriateness
criteria, evaluation pilot, registry development)
• Data standards structured reporting EMR/PHR databases/registries
• Collaboration with MITA/NEMA, IHE/DICOM, allied societies, and industry to develop structured reporting and image registry.
–Same audience, same market
• Overall goal of improving patients outcomes with a consciousness of cost