Duke Health Implements ACR Select

By: Kal Clark MD, Raj Gondalia MD, Christopher Roth MD.

Duke Health is proud to announce the successful implementation of ACR Select, a new tool to help clinicians and their patients get the most appropriate and up-to-date expert recommendations when ordering radiology exams.

ACR Select is a decision support tool, produced by the National Decision Support Company and licensed by the ACR. The tool has been integrated into the Duke Health enterprise wide electronic health record, which provides real-time targeted imaging recommendations to clinicians based on expert guidance from the American College of Radiology.  The goals of the tool are to improve diagnostic accuracy and reduce unnecessary imaging, as well as to comply with requirements from the 2014 Protecting Access to Medicare Act federal legislation.

Diagnostic accuracy is a problem because with the proliferation of imaging technologies and imaging guidelines, it can be a complicated task for an ordering clinician to match 3000 clinical scenarios with 15,000 different imaging criteria to ensure that the right patient receives the right imaging test. ACR Select’s ability to automate this process using extracted information from the patient’s medical record allows a physician to pick from a scorecard which displays which test is most likely to aid in diagnosing the patient’s condition. When a radiology exam is being ordered, the clinician will be guided through the process of choosing the best test for the patient. The tool is intended to maximize the diagnostic accuracy of a radiology test by suggesting optimal parameters such as imaging modality, contrast timing, anatomic coverage, etc. based on patient history and other available data.

In some states, information from ACR Select clinical decision support has been used to streamline a process known in the medical industry as “pre-certification.”  Traditionally, pre-certification is a resource intensive and potentially time-consuming manual cost-containment process where an insurance company approves or denies an imaging test based on its judgement of medical appropriateness. This is problematic for two main reasons: 1) the information available to an insurance company can be different than the information available to the patient’s doctor, and 2) due to its manual nature the process can introduce delays into patient care.  We hope ACR Select will simplify the patient’s experience for getting advanced medical imaging at Duke and maximize the impact of radiology exams on patient care.