"As a vendor, we want to see the project succeed for business reasons, to take care of patients, and to be leaders in health information technology," Cowsill says. "We are doing our part to reduce radiation exposure. On the Coalition side, we have worked long and hard to get to the stage that we are now in the country and our health care delivery system. We can see that we have made strides in the health care reform bill. What we don't want to see are steps backward just because of things that may have worked in the past, but aren't necessarily how health care will be handled in the future."

Cowsill says the future lies in electronic clinical decision support rather than RBS "...because we have the technology, the know-how and the support to have electronic clinical decision support embedded in EMRs, and embedded in CPOE workflows. We want to move forward and work with the federal level and the private payers and try to show them the benefits."


Cowsill points out the one missing piece in moving forward is data. In this regard, the CMS project provides a great opportunity because it's an all-electronic format. The success of the project may go a long way to show that e-CDS is as effective or more effective than the RBM approach, plus having features attractive to clinicians, like being user-friendly, making patients more comfortable by eliminating the third-party, and offering Medicare and Medicaid an efficient and cost-effective solution. Cowsill says e-CDS also conforms with the HIT goals of the nation--interoperability and interconnectivity, through making electronic documentation as opposed to a phone call.

While the members of the Coalition are aware of the benefits of e-CDS, any positive data from the project will show those outside the industry, a necessary step. For example, a few years ago the GAO had issued a report suggesting that if CMS wanted to manage high-tech utilization of diagnostic imaging, it should contract with an RBM. Cowsill says, "We saw that they did not know about us. So we formed the Coalition and went to the federal government and the legislators. They did not know that there were electronic decision support tools that were ready for prime time. Now that we have an opportunity to prove the data and the tools, we are just thrilled. The Coalition has been pushing for some time to get the demonstration off the ground, because the sooner it got started the sooner we could show from the data that it was successful."

Cowsill explains that an important aspect of the project is that CMS has said it's not about whether one clinical decision support system is better than another; rather, the intent is to determine if clinical decision support is effective in managing high-tech imaging.

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