Leveraging Technology to Improve Appropriate Imaging Studies: There’s an App for That!



 

Peter Huynh, MD; Paymann Moin, MD; Michael Flores; Pamela Galvan; Steven Ethington

https://doi.org/10.7812/TPP/19-039-41

Abstracts from the Kaiser Permanente 2019 National Quality Conference

From Southern California

Background: The use of radiographic imaging has steadily increased over the years and has become a routine patient-evaluation component in health care delivery. Unnecessary medical imaging tests result in increased health expenditure and ionizing radiation exposure, and can lead to poor clinical outcomes. Given the increased popularity of mobile apps in health care, we sought to develop and implement a mobile app at our medical center that would provide appropriate, cost-effective imaging guidelines based on evidence-centered medicine. The aim is to deliver high-value health care by reducing health care waste and increasing patient safety through improved imaging appropriateness.
Methods: We used Guidebook.com as a platform to develop a mobile app called iMAGING APPropriateness App (iAPP), an easy-to-use application that provides high-value imaging recommendations based on health practitioner-encountered symptoms and diagnoses. iAPP uses validated and evidenced-based literature such as the Canadian Computed Tomography Head Injury Rules, the Pediatric Emergency Care Applied Research Network (PECARN) criteria, the HEART (history, ECG [electrocardiogram], age, risk factors, troponin) Pathway, and Choosing Wisely. The iAPP was made available as a clinical resource across the medical center in 2018. Practitioners were able to access the iAPP at the patient’s bedside to determine whether an imaging study needed to be ordered. We compared imaging utilization 3 months before and after implementation. We used the Healthcare Effectiveness Data and Information Set (HEDIS) low back imaging metric as a quality measure.
Results: Three months after implementation, iAPP was accessed 825 times by 114 unique health care providers. The average session duration was 33 seconds. Overall imaging utilization decreased from 40.75 (relative value units x order volume per 1000 members) to 35.63 (relative value units x order volume per 1000 members), a 12.6% reduction. HEDIS quality low back imaging metric improved from 90% to 90.7% compliance.
Discussion: iAPP, a mobile app based on evidenced-based imaging algorithms and guidelines, was successfully designed, developed, and implemented at our medical center. Health care practitioners were receptive to using this new technology. Leveraging health information technology using a mobile app for imaging guidelines resulted in a reduction in overall imaging utilization and improvement in a HEDIS quality metric.

Abstracts from the Kaiser Permanente 2019 National Quality Conference

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