In recent years, the Centers for Medicare & Medicaid Services and private payers have put pressure on providers to order high-tech diagnostic imaging tests more appropriately. But the number of CT, MRI, PET and nuclear cardiology studies continues to soar, and these tests now cost the nation more than $100 billion a year.

An initiative by Minnesota's Institute for Clinical Systems Integration aims to do something about that. With funding from four insurers, the collaborative licensed RadPort, a clinical decision support tool from Nuance Communications, to reduce the amount of inappropriate high-tech imaging tests that are ordered. All health care providers in Minnesota and bordering areas of Wisconsin and the Dakotas now have free access to RadPort, whether or not they are ICSI members. Sixty medical groups, accounting for 85 percent of physicians in Minnesota, are a part of the collaborative.

A Web-based application that can be integrated with some electronic health records, RadPort incorporates around 15,000 clinical guidelines related to imaging tests, including the criteria of the American College of Radiology.

After entering a patient's demographic information, the type of test and the clinical indications for ordering it, the program evaluates whether the test is appropriate for that patient; if it isn't, RadPort may suggest an alternative study. Doctors are under no obligation to follow the recommendation, however.

From 2006 to 2007, ICSI tested a homegrown CDS tool for imaging tests. Five organizations encompassing a total of 4,000 doctors participated in the pilot. Four of the groups used the homegrown tool, and one used RadPort, which produced slightly better results, says Cally Vinz, vice president of clinical products and strategic initiatives for ICSI. All five continued to employ CDS after the pilot ended.

Together, these health care systems cut the growth rate in their imaging tests to zero, trimming health care costs by an estimated $28 million in 2007, and $84 million over the past three years, according to ICSI.

Boston's Massachusetts General Hospital, which has been using a similar system since 2004, cut its growth rate for CT and MRI to 1 percent and 7 percent, respectively, down from 12 percent.

Barry Bershow, M.D., vice president, quality, for Minneapolis' Fairview Health Services, which is an ICSI member, says, "We found that by giving doctors guidance about what was and wasn't useful, we improved their ordering quite a bit."

Another positive: Payers waived onerous prior notification requirements for providers in the pilot. The same will be true going forward. ICSI soon will employ a program to analyze data collected by RadPort and give feedback to providers, as well as correlate ordering patterns with patient outcomes, says Vinz.