What is R-SCAN?R-SCAN™ is a collaborative action plan that brings radiologists and referring clinicians together to improve imaging appropriateness and streamline image ordering. R-SCAN delivers immediate access to Web-based tools and clinical decision support (CDS) technology that help you optimize imaging care, reduce unnecessary imaging exams and lower the cost of care. There is no cost to participate.
Who can participate?R-SCAN’s goal is to optimize imaging utilization in outpatient and emergent care settings. Radiologists, primary care physicians, emergency care physicians and other clinicians who order imaging exams in these settings are welcome to participate.
How does R-SCAN work?It all starts when referring clinicians and radiologists agree to form a collaborative care team to improve image ordering using R-SCAN. The team selects one or more Choosing Wisely® topics that best fit the team goal for clinical improvement. The R-SCAN team leader (either a referrer or radiologist) registers for free R-SCAN participation.
Facilities that already have CDS integrated in their order entry systems will be able to create R-SCAN reports using their CDS data. See the “What If I Already Have a CDS Tool Installed?” question below.
The R-SCAN team carries out the clinical improvement activity in three phases — typically over a three- to six-month period. See the R-SCAN Step-by-Step Guide for more information.
Phase 1: Collect and Rate Cases
- Radiology team members collect cases, either retrospectively or prospectively, that the referring clinicians’ practice ordered. The R-SCAN team determines how the cases will be reviewed — either by radiologists or, ideally, by a collaborative group of referring clinicians and radiologists.
- Using a free, customized version of the CareSelect™ CDS tool, the designated person or team reviews the cases, rates the appropriateness of each exam, and enters the case data into the R-SCAN Web-based CareSelect™ tool. Users may also opt to enter data using one of the topic-specific Excel templates, or if the practice already has CDS software installed they can report R-SCAN data automatically. For more information about the different methods of case data entry, see Generating R-SCAN Reports.
- CareSelect™ then generates a report of appropriate vs. inappropriate exams ordered. The R-SCAN team reviews the report to identify opportunities for improvement.
Phase 2: Conduct Educational Activities
- Based on the team’s recommendations for improvement, radiologists can propose and hold educational activities with referring clinicians and staff that guide appropriate imaging ordering.
- To support the educational program, the R-SCAN team can capitalize on R-SCAN’s Choosing Wisely resources along with other educational tools — some of which offer CME credit.
Phase 3: Assess Improvement
- After the educational program, radiology practice personnel repeat the collection and rating process from Phase 1 (with the same number of cases from the same Choosing Wisely topic).
- The R-SCAN team then reviews the results to determine overall improvement in image ordering.
How much time is required?Staff time dedicated to an R-SCAN project ranges from 15 to 30 hours over a three- to six-month period.
What are the Choosing Wisely imaging topics?The R-SCAN physician advisory panel selected Choosing Wisely® topics pertaining to outpatient and emergent imaging.
Topic selection criteria includes: potential impact for improving appropriate imaging utilization, the existence of associated ACR Appropriateness Criteria®, and the inclusion of indications and clinical scenarios in CareSelect. Additional topics will be added that meet the R-SCAN advisory panel’s criteria.
The list of Choosing Wisely imaging topics included in R-SCAN is available on the R-SCAN website.
How do I develop an educational program?A library of educational materials is available on the topic-specific resources page for each of the R-SCAN topics for participants to use as part of the educational intervention phase of an R-SCAN project. Participants can choose to incorporate those materials most appropriate for their setting and collaboration.
Participants can choose to incorporate the materials most appropriate for their setting and collaboration. In addition, participants are encouraged to develop their own educational materials and to share these via the R-SCAN website. For “practice-defined” R-SCAN projects, the participants will need to develop their own educational materials.
How is CDS used in R-SCAN?One of R-SCAN’s many free tools is a CDS product that delivers a digital version of the ACR Appropriateness Criteria® (or other certified appropriate use criteria) to participating clinicians’ desktops. R-SCAN participants use the Web-based CDS tool to rate the appropriateness of imaging exams ordered by referring clinicians who are collaborating with radiologists to improve the ordering of imaging exams.
The team uses CDS to rate the appropriateness of exams ordered for one of R-SCAN’s Choosing Wisely topics before and after a site-specific educational program is carried out. R-SCAN participants can select from presentations, case reviews, podcasts, videos and articles featuring the most current evidence to support clinicians ordering the right imaging exam for the right reason for patients.
Facilities participating in R-SCAN that do not already have CDS integrated into their order entry systems will receive free access to the customized CareSelect product available for R-SCAN use.
How can referring clinicians gain experience with CDS via R-SCAN participation?Referring clinicians participating in R-SCAN can gain CDS experience several ways:
- By registering for R-SCAN, referring clinicians gain free access to an CareSelect Web portal on the R-SCAN website. For each of R-SCAN’s Choosing Wisely topics, sample cases show how to enter patient and clinical information to view a list of possible imaging exams that could be ordered and the associated appropriateness rating. Referrers can explore recommended imaging for hundreds of other indications and clinical scenarios.
- R-SCAN participating referrers and radiologists can review cases ordered for their patients as a team and use CareSelect to guide the discussion about the most appropriate imaging option. R-SCAN’s Choosing Wisely imaging topics are among those with the most potential for improved ordering through joint case review and discussion.
- Referring clinicians can try CDS to experience how it facilitates selecting the best exam for their patients. As part of the education to improve the ordering of imaging exams for one of R-SCAN’s Choosing Wisely topics, a referring practice can opt to use CDS when placing an order for each exam.
What are the benefits for referring clinicians by using R-SCAN and CDS?Gaining experience with CDS now will help referring clinicians be prepared for the implementation of federal reimbursement requirements for CDS consultation prior to ordering advanced imaging. This alternative to pre-authorization reduces time and expense for practices and patients when imaging is the next step in the diagnostic process.
What if I already have a CDS tool installed?ACR will provide a reporting tool for R-SCAN participants to generate reports with no involvement from facility IT departments.
Is IT support required?No. Participants can easily use a standalone, Web-based version of CareSelect to rate case appropriateness in R-SCAN, so no IT support is required. However, some R-SCAN participating practices request IT support to collect retrospective case data.
Is MOC or CME available?Yes, radiologists who plan to claim MOC Part 4 credit for R-SCAN participation will need to demonstrate having played a meaningful role in carrying out one or more of the R-SCAN steps.
For many topics, referring clinicians can earn CME credits, and equivalent SA-CME is available for radiologists.