The Joint Commission standards for diagnostic imaging, which recently went into effect, are designed to help prevent duplicate and unnecessary medical imaging of patients, and reduce potentially harmful exposure to radiation when patients need CT scans, MRI or a combination of these and other diagnostic tests. Beginning July 1, 2015, these standards require protocols, documentation and data collection, staff education and other criteria that raise the bar for quality and safety at ambulatory imaging sites, critical access hospitals and accredited hospitals. What do these standards really mean to the patient?
The new imaging standards focus primarily on the radiation dose index. There are a number of uncertainties tied to the long-term impact of imaging on patients, but researchers agree it impacts patients differently depending upon sensitivities to radiation, age, body parts being tested, absorption rates and other factors and these are still being studied. In the meantime, to prevent undue risk, The Joint Commission has put a stake in the ground with these specific standards to help improve patient safety. The Joint Commission joins other accredited healthcare organizations, such as the American College of Radiology (ACR) and other clinical associations that are releasing new quality-focused recommendations, enhanced education tools and technologies to make it easier for healthcare teams to keep you safe from unintended risks while you receive diagnostic imaging that could shed light on serious health conditions.
As a patient and someone who has worked in healthcare technology for more than 20 years, I believe the combination of diagnostic imaging, evidence-based medicine and expert medical oversight that exists today will help organizations big and small better manage radiation exposure and protect patients today and in the future. These efforts provide great improvements in reducing unnecessary testing and putting safeguards in place to generate important results, while mitigating the long-term risks to patients when they need different exams.
The Joint Commission’s imaging standards were initially intended for release last year, but they were postponed due to lack of detail and clarity. In conjunction with imaging guidelines provided by the American College of Radiology’s “Body Imaging Commission” and other clinical associations, they help providers focus on the right testing, at the right time, to improve quality of care when radiologists face a flurry of different kinds of patient cases every day.
The Joint Commission’s report explains that knowledge of a patient’s previous imaging exams helps prevent duplicate imaging examinations and further radiation exposure, and they recommend considering a patient’s age and recent imaging studies when deciding the most appropriate exam. The same precedent exists for surgery today so it makes sense that something similar would apply to diagnostic imaging. The fundamental part of medicine is based on “do no harm.”
Obstacles to accurate and reliable imaging
While The Joint Commission’s standards will ultimately benefit hospitals, there are a few challenges they face in complying with these new regulations based on healthcare delivery today. Compliance becomes difficult when a patient is seen by multiple healthcare providers – especially in different geographic regions – and when the patient’s journey spans different facilities, specialists and time zones as they strive to get well.
Today, many hospitals keep a record of a patient’s medical images in their facility, and they typically provide a CD of relevant images to the patient to take with them when being treated somewhere else. However, too often the CD will end up damaged or unreadable when transferred to the next physician, and even if it works, the CD will not contain a complete story of the patient’s health including their medical imaging history. Incomplete or missing information creates doubt and risks that are not welcome in healthcare. The patient is looking for certainty in his or her diagnosis, the radiologist is looking for certainty in recommending next steps and the referring physician wants to ensure that he or she is providing the right treatment for the best outcome. Without accurate and reliable imaging information, everyone may not have the answers and assurances they need. The result? Repeat medical imaging.
Repeat exams are particularly problematic for patients who are most at risk because of the cumulative effectives of overexposure to radiation, such as the elderly and children. Concerns over unnecessary use of medical imaging and unnecessary costs of these tests have been around for years, but despite concerns recent statistics show it is still a common practice. A study published in the Journal of Emergency Medicine in March 2015 shows 97% of ED physicians order unnecessary imaging because of worries that they will miss something and be sued. Half of these physicians identify that improved education on advanced diagnostic testing would help cut down on this practice of over-ordering tests.
This all goes back to certainty. With regulations changing, clinical guidelines evolving, patient volumes growing and information access ranging from hard to get to hit or miss, the implications are clear. When physicians are unfamiliar with the appropriate diagnostic tests or the clinical best practice for a specific symptom, or they can’t see the complete patient story such as prior radiation dosing for the patient, they try to do what’s best and that often leads to repeat medical imaging.