Transcript ACC-Structured Reporting-FINAL.ppt

MITA
Medical Imaging and Technology Alliance
November 27, 2007
STRUCTURED REPORTING
A 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
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
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
Duke-ACC Think Tank
DIMENSIONS OF
CV IMAGING QUALITY
January 30, 2006 - February 1, 2006
Pamela Douglas
Harlan Krumholz
Ami Iskandrian
Linda Gillam
Robert Hendel
Jamie Jollis
Eric Peterson
QUALITY METRICS FOR MEDICAL IMAGING
Patient
u
Patient
Selection
Appropriateness
Image
Interpretation
u
Structure
u
Process (timeliness, uAccuracy
pt-centered)
uSensitivity
Reproducibility
uSpecificity
u
JACC, Nov 6, 2006
Image
Acquisition
uReproducibility
Results
Communication
u
Timeliness
u
Interpretability
u
Clinical
integration
Improved
Patient
Care
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
APPROPRIATENESS CRITERIA
The 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
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
SPECT AC
EVALUATION PILOT
Data collection
paper form
Duke-ACC Think Tank
IMPLEMENTING
CV IMAGING QUALITY
October 8-10, 2007
Pamela Douglas
Greg Hundley
Fred Masoudi
Linda Gillam
Robert Hendel
Manesh Patel
Eric Peterson
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’
DUKE-ACC THINK TANK - II
Implementing Cardiovascular Imaging Quality
October 8-10, 2007
DATA STANDARDS AND REPORTING
• 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 - II
Implementing Cardiovascular Imaging Quality
October 8-10, 2007
DATA STANDARDS AND REPORTING
• 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
DUKE-ACC THINK TANK - II
Implementing Cardiovascular Imaging Quality
October 8-10, 2007
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
NCDR is…
Physicians Leading the Effort To Quantify Quality
Achieve
Ped.
Registry
Building a true…
ICD Long
National
CardioVascular
Data
Registry
CathPCI
Registry
1998…..
ICD
Registry
2004
2005
EP
Registry
Imaging
Registry
PracMgt
Registry
Congenital
Registry
PAD
Registry
CARE
Registry
2006
ACTION
Registry
2007
2008
IC3 CAD
beyond
HF
Registry
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
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
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
QUALITY IN CARDIAC IMAGING
Conclusions
• 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