Our recent article How Radiology Practices Can Drive True Quality of Care describes how the use of clinical data can be integrated with a business process to provide benefits for both patient care and practice value.  Expanding this concept to the next level triggers the imagination – what other types of cases in the practice need follow-up within specific time periods?  Thus came the idea for the second iteration of HAP’s clinical analytics solution deployment that involved patients with implanted inferior vena cava (IVC) filters.

Interventional radiologists routinely install IVC filters in patients who are at risk of pulmonary embolism.  These retrievable filters are intended to be removed once the patient’s risk has passed, but a 2011 study published in the Journal of Vascular and Interventional Radiology found that only about a third of them were actually removed.  The risk of leaving the filter in place longer than the recommended 29-54 days is great, and the complications of non-removal can even surpass the benefit of having the filter installed in the first place.  Repeated FDA warnings about this issue over several years seem to have had little effect on the rate of timely filter removal. 

As the physician who places the device, the interventional radiologist is in the best position to coordinate timely follow-up.  The American College of Radiology’s Practice Parameter for the Performance of Inferior Vena Cava (IVC) Filter Placement for the Prevention of Pulmonary Embolism section on Post-procedure Care states, “Patients in whom a retrievable IVC filter is implanted should undergo clinical reassessment for the appropriateness and timing of filter removal during the first 3 to 6 months after placement (depending on the device-specific time window for retrieval).”

Radiology practices can take a proactive role in this issue by adopting a process to:

• identify their patients with retrievable IVC filters,
  
  
• communicate to both the patients and their PCPs the presence of the filters and the need for a return visit to the interventional radiologist for evaluation, and
  
  
• track whether or not the patient returns for evaluation and removal of the filter within the same radiology group or health system.

We deployed such a process with a hospital-based radiology group shortly after the successful rollout of the lung-nodule process described in the article referenced earlier.  Our fully automated clinical analytics service can not only capture recommendations for follow-up that are entered at the time of the initial procedure, but it can also retroactively scan the practice’s database and identify patients with retrievable IVC filters that have been in place for longer than the recommended time, usually no more than 60 days.  The business component of the system then integrates this information to generate the letters to the patients and their primary care physicians, reminding both of them of the presence of the filter and the need for evaluation by the interventional radiologist of the filter’s continued efficacy or potential need for removal. 

Just as we found with the incidental lung nodule findings module, the use of this analytics and notification process had a measurable impact, with the practice realizing a 44% increase in average follow-up rates post-deployment. 

For radiology groups, pursuing such a solution prevents patient leakage, increases revenue, and establishes their value in the delivery of real, measurable quality. The referring physician community would welcome involvement in such a process to help monitor their patients in this manner.  Most importantly, an at-risk patient population is now receiving coordinated, potentially lifesaving care.  Everyone wins! 

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Sharon Taylor is the Chief Clinical Informatics Officer at Healthcare Administrative Partners. 

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