IOM Top Ten Touts Familiar Concerns, Puts Figure on Waste

Recommendations from the Institute of Medicine (IOM) earlier this month may have sounded familiar to radiologists and radiology practice directors. The 2,000-word report—entitled “Best Care at Lower Cost”—never mentions imaging, but the goals and sentiments have been on the radiology radar for a long time. In short, the IOM report contends that the health care system is drowning in data, and getting a handle on this information through better technology must be a top priority. IOM officials calculated that various inefficiencies in 2009 led to about $750 billion wasted on unnecessary services, excessive administrative costs, fraud, and other problems. This is one of the first times the IOM has issued a concrete dollar figure for waste. More importantly than the money wasted, on the patient care side, thousands of deaths routinely result from lack of optimal care. At the top of the IOM list is a recommendation to improve the “digital infrastructure” by boosting the capacity to capture clinical and financial data. The modern PACS has already organized massive amounts of digital information. Many practices are dealing with this bounty through vendor neutral archives (VNAs) that consolidate storage for the image data into a single archive. Once the data is there, it is neutralized and standardized. Recommendation #3 involves clinical decision support (CDS), a methodology increasingly embraced by radiologists. According to Dan Armijo, vice president, information and technology strategies, Altarum Institute, the idea is to someday do advanced CDS in the context of a whole community, using ACR guidelines to support evidence-based decision making. Recommendation #4—Patient-Centered Care—harkens back to strenuous industry efforts to adhere to basic quality measures that the ACR has outlined. Initiatives such as the Physician Quality Reporting System measurement set, and dose registries, serve as additional measures of quality. The IOM report follows a similar study from April 2012 in which nine physician groups released a list of 45 common tests and treatments thought to be unnecessary and even harmful. Items on that list included “X-rays or other scans for uncomplicated headaches.” “The threats to Americans' health and economic security are clear and compelling, and it's time to get all hands on deck,” adds Mark D. Smith, president and CEO, California HealthCare Foundation, in connection with with the IOM report. “Our health care system lags in its ability to adapt, affordably meet patients' needs, and consistently achieve better outcomes. But we have the know-how and technology to make substantial improvement on costs and quality.”