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Radiology is a powerful tool for physicians when diagnosing a patient's condition. "Best first test" helps to create conditions where the fewest number of imaging studies generate the most definitive diagnosis for the patient and the physician. Best first test is one of the most important radiology management steps that MedSolutions takes to support the physician, the patient, and the health plan when a study is ordered. For physicians Radiology is critical when helping physicians work through a differential diagnosis. "We find many physicians conduct radiology using a shotgun technique," said Jennifer Meko, M.D. "They conduct multiple tests at the same time to arrive at a diagnosis." Dr. Meko said MedSolutions consults with physicians to determine the most logical sequence of tests based on the differential diagnosis. "It's important to point out that the physicians' differential diagnosis still drives the process," Dr. Meko said. Dr. Meko cited an example of a patient with neck and shoulder pain. In this case, the diagnosis could involve the cervical spine or the shoulder. Without best first test standards, Dr. Meko said the patient could undergo multiple imaging studies - some of which would ultimately prove unnecessary. For patients Best first test ensures that patients have to undergo the fewest number of radiology studies to achieve the most definitive diagnosis. For example, a physician differential diagnosis may require an MRI of the spine. MedSolutions would recommend avoiding an open MRI, even if the patient is uncomfortable with closed spaces, because the weaker magnets in open MRIs produce poor quality spine studies. If the study is performed in an open MRI, the patient would likely have to undergo a second MRI in a closed unit, especially if she is referred to a specialist for additional care. Best first test prevents patients from being exposed unnecessarily to radiation. For example, a CT of the abdomen delivers the equivalent radiation of performing 300 chest x-rays. For health plans Best first test improves quality by targeting imaging studies to a differential diagnosis and improves utilization by eliminating studies that do not contribute to the differential diagnosis. MedSolutions works with health plans to decide the exact guidelines for its radiology management program. Dr. Meko said MedSolutions creates its extensive guidelines through evidence-based medicine to the extent possible. When large prospective studies are not available, the company uses consensus statements from specialty medical societies as well as recommendations from consulting physicians who are actively practicing.
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