Type:
Educational Exhibit
Keywords:
Radioprotection / Radiation dose, Management, Computer applications, RIS, PACS, Radiation safety, Audit and standards, Health policy and practice, Workforce, Economics
Authors:
D. Remedios1, S. Herman2, C. J. Williams3, R. Taiwo 4, P. Johnson4; 1Harrow/UK, 2Toronto/CA, 3Uxbridge/UK, 4London/UK
DOI:
10.1594/ecr2018/C-0543
Background
Estimates indicate that 10-40% of imaging procedures performed are inappropriate with limited or no benefit to patients or healthcare systems [5-10].
Strategies to improve justification include awareness of the issue,
evidence-based guidance for appropriate imaging and monitoring through clinical audit and quality improvement.
Clinical decision support (CDS) systems are accepted in clinical medicine for uniform,
safer and value-added prescription and clinical referral.
Fitting naturally into requesting workflow,
CDS provides efficient access to guidelines. Although measures using referral guidelines in the UK halve inappropriate imaging requests,
this is labour-intensive for the vetting radiologist and slows process.
For successful implementation of a CDS system,
it is important to ensure that all stakeholders will enjoy benefit from the innovation.
In order to demonstrate this,
buy-in of stakeholder groups at an early stage would need to be reinforced by metrics to show value at an individual level,
both to patients and healthcare professionals; for the system to provide the intended innovation; and for value to the purchasers (Table 1).
Implementing high value innovation funded by reduced spending on lower value intervention addresses both sporadic underutilisation and overutilization to provide uniform resource allocation.
The CDS project had to be appropriately pitched as behavioural change rather than purely a software innovation.
Allocative value
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To allocate resources to different groups equitably and in a way that maximises value for the whole population.
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Technical value
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To improve the quality and safety of healthcare to increase the value derived from resources allocated to particular services.
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Personalised value
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To base decisions on the best current evidence,
careful assessment of an individual's clinical condition and an individual's values.
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Table 1.
Value Based Healthcare: the principles.
From Value Based Healthcare Programme,
Oxford.
https://www.phc.ox.ac.uk/research/value-based-healthcare [2]