The Imaging e-Ordering Coalition is calling for digital ordering and clinical decision support to ensure that the right tests are ordered for the right patients at the right time.

"Ordering tests is a very manual process," said Nancy Koenig, president of Milwaukee-based Merge Healthcare's Merge Fusion and a founding member of the coalition.

The coalition made its case Monday during a presentation at the Radiological Society of North America's annual meeting in Chicago.

Members of the coalition include the American College of Radiology, the Center for Diagnostic Imaging, the Connecticut State Medical Society-IPA (CSMS-IPA), GE Healthcare, Insight Imaging, lifeIMAGE, the MedCurrent Corporation, Medicalis, Merge Healthcare, Nuance Communications and SCI Solutions.

Koenig said the coalition has been successful in lobbying the Office of the National Coordinator for Health Information Technology, the Centers for Medicare and Medicaid and Congressional committees working on health reform legislation.

While pending legislation had initially focused on radiology benefits management as the way to prevent unneeded tests, said Koenig, that legislation now includes no mention of RBMs. Koenig said the RBM approach is a manual process promoted by insurance companies and not an effective way to ensure the right tests at the right time.

"It's difficult to administer, and there's no appeals process," said Elisabeth Quam, executive director of the CDI Quality Institute.

"There's no policy," she said. "It's just, 'Captain, may I.'"

"Appropriate utilization for diagnostic imaging exams is a consistent and important healthcare reform issue," said David D. Thompson, Jr., MD, president of the CSMS-IPA. "As the federal government works to identify ways in which the healthcare industry can bend the cost curve, eliminating medically unnecessary diagnostic exams remains a key area of interest."

Real-time guidance for physicians in ordering diagnostic tests is critical, Thompson said, and e-ordering simplifies the process of verifying physicians' decisions as medically appropriate and safe.

"The genesis of the Imaging e-Ordering Coalition was in response to developing healthcare regulation that exclusively identified prior-authorization as the solution to reduce unnecessary high-tech diagnostic imaging exams," said Cindy Dullea, senior vice president of marketing for SCI Solutions, based in Los Gatos, Calif. "Beyond improved patient care and physician satisfaction, e-Ordering is a healthcare IT solution that regulators and insurers can support, knowing that the patient is receiving appropriate care without adding unnecessary time or administrative expense."

The coalition's stated goals are:

• Promote existing HIT legislative concepts to inform policymakers on the value of e-Ordering to enable the appropriate use of imaging.
• Ask lawmakers to include e-Ordering in the development of healthcare system efficiency incentives.
• Act as a resource for the Centers for Medicare and Medicaid Services on its Medicare Imaging Demonstration Project, established by Congress in Section 135(b) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
• Work with policy makers to have the coalition's e-Ordering proposal for CMS scored to validate long-term value and savings for the healthcare industry.
• Work with stakeholders to establish standards to accelerate e-Ordering as a meaningful and valuable application with EHRs.