The Institute for Clinical Systems Improvement, a nonprofit health care improvement organization, launched a statewide initiative focused on reducing the number of unnecessary high-tech diagnostic imaging exams in Minnesota, ICSI announced Wednesday.

Participating medical groups and hospital-based clinics in the state will employ a clinical decision-support tool to assist physicians with selecting the most appropriate diagnostic imaging tests for patients.

ICSI licensed Nuance Communication's RadPort solution to be used in the statewide effort.

The initiative, launched after a highly successful yearlong pilot, is projected to save the state more than $28 million on an annual basis.

"Use of HTDI procedures such as MRI, CT, PET and nuclear cardiology tests has been increasing 8 percent annually in Minnesota, and more than $100 billion is spent each year on diagnostic imaging nationally. Yet there have not been enough studies to correlate this increase with improved patient outcomes," said Cally Vinz, VP of clinical products and strategic initiatives with ICSI, in prepared remarks. "Our goal with this initiative is to ensure the appropriate use of HTDI exams based on the medical evidence so that patients get better care, providers are more efficient and health care is more affordable."

During the yearlong pilot program, more than 4,000 physicians from the state's five medical groups, five largest payers and the Minnesota Department of Human Services, employed a decision-support tool to order HTDI scans. The pilot showed that using the technology increased medical appropriateness when compared to exams ordered without it.

Following an 8 percent increase in HTDI scans ordered in the state in 2006, using the tool contributed to a zero percent increase in the scans ordered the following year.

Burlington, Mass.-based Nuance Communications was chosen as the vendor for the state's decision-support application -- it signed the 374-page contract with ICSI just last month.

"[RadPort] is significantly going to redefine this industry niche and produce a new way of delivering clinical decision support for imaging as a tool," Scott Cowsill, senior product manager of diagnostic solutions with the company, told DOTmed News.

RadPort includes more than 15,000 clinical guidelines from the American College of Radiology and subspecialists with Massachusetts General Hospital, which maintains a close relationship with the company.

The decision-support tool can be accessed via a website or embedded directly into a physician's electronic medical record system. Using RadPort, providers can eliminate the hassles of dealing with radiology benefit management companies, removing the "brick and mortar" of the order process, said Cowsill.

The physician enters the clinical indications of a particular patient and RadPort runs the physician's order against its evidence-based guidelines. The system then returns a score ranging from one (low diagnostic utility) to nine (high diagnostic utility). If a physician chooses a low-utility exam option, RadPort offers a superior alternative.

"That process takes about seven to 10 seconds," said Cowsill.

Nuance is already working with a few facilities in Minnesota that are using RadPort, sites that will be encompassed in the statewide project.

The company is also currently working with providers looking to embed the tool into their EMR systems.

Cowsill, who is a co-founder and chair of the Imaging e-Ordering Coalition, said all eyes are on Minnesota, as states across the country are looking to emulate the initiative that can cut costs and enhance the appropriateness of diagnostic imaging exams for patients.

By relying on the support-decision tool in ordering HTDI scans, providers save time, cut costs and employ evidence-based guidance in making their decisions.

"It's a zero penalty approach, there's no barrier," said Cowsill. "It's actually educative in nature."