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MITA Medical Imaging and Technology Alliance November 27, 2007

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

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MITA Medical Imaging and Technology Alliance November 27, 2007

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  1. MITAMedical Imaging and Technology AllianceNovember 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

  2. 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

  3. 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

  4. Duke-ACC Think Tank DIMENSIONS OF CV IMAGING QUALITYJanuary 30, 2006 - February 1, 2006 Pamela Douglas Linda Gillam Harlan Krumholz Robert Hendel Ami Iskandrian Jamie Jollis Eric Peterson

  5. QUALITY METRICS FOR MEDICAL IMAGING • Appropriateness • Structure • Process (timeliness, pt-centered) • Reproducibility • Reproducibility • Accuracy • Sensitivity • Specificity • Timeliness • Interpretability • Clinical integration JACC, Nov 6, 2006

  6. 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

  7. 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

  8. PILOT PROJECT FOR THE EVALUATION OF APPROPRIATENESS IN SPECT IMAGINGPROJECT 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

  9. SPECT AC EVALUATION PILOT Data collection paper form

  10. Duke-ACC Think Tank IMPLEMENTING CV IMAGING QUALITYOctober 8-10, 2007 Pamela Douglas Linda Gillam Greg Hundley Robert Hendel Fred Masoudi Manesh Patel Eric Peterson

  11. 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’

  12. DUKE-ACC THINK TANK - IIImplementing Cardiovascular Imaging QualityOctober 8-10, 2007 • Critical issues • Creation, Endorsement, Dissemination • Supporting tools, Compatibility • Universal implementation • Industry and societies must work together • ACC/Societies to endorse mandatory use • DATA STANDARDS AND REPORTING

  13. DUKE-ACC THINK TANK - IIImplementing Cardiovascular Imaging QualityOctober 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

  14. DUKE-ACC THINK TANK - IIImplementing Cardiovascular Imaging QualityOctober 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

  15. NCDR is… Physicians Leading the Effort To Quantify Quality Ped. Registry Achieve NationalCardioVascularDataRegistry Building a true… ICD Long EP Registry Imaging Registry PracMgt Registry Congenital Registry PAD Registry IC3 CAD ACTION Registry HF Registry CARE Registry CathPCI Registry ICD Registry 1998….. 2004 2005 2006 2007 2008 beyond

  16. 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

  17. 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

  18. 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

  19. 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

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