ImageSmart™ is a clinical decision support (CDS) solution that provides real-time clinical guidance for determining which imaging test is most appropriate for your patient’s clinical presentation. ImageSmart™ connects you to the right information at the right time for the right ordering decision.

With proven efficiency, ImageSmart™ promotes clinical improvement, supports the Centers for Medicare & Medicaid Services Protecting Access to Medicare Act of 2014, and reduces unnecessary spending and increases patient and provider satisfaction. Working closely with physicians, Altarum designed ImageSmart™ with innovative and useful features:

  • All your tools in one place
  • Relevant clinical guidance
  • Place electronic orders
  • Know your performance
  • Experience positive impact

At Show

Ensuring Most Appropriate Use of High-Tech Imaging

Altarum is leading the effort to advance decision support in image ordering using clinical decision support (CDS) and health information exchange technology. In partnership with the American College of Radiology, the American College of Cardiology, United Physicians, and McLaren Physician Partners, the project promotes alternate care pathways by building referral relationships and guidelines to expedite care alternatives; holding providers accountable for imaging utilization by auditing physician behavior, providing feedback, and collaborating with existing incentive programs; reducing patient-induced demand through a comprehensive patient education program to improve patient understanding of costs, risks, and appropriate use; and promoting awareness nationwide by consolidating and disseminating tools, approaches, and lessons learned. 

To date, more than 500 primary and specialty care physicians have received CDS training and are using ImageSmart™. By allowing real-time access to each patient’s history, including past imaging studies, the entire process promotes patient safety and care while preventing unnecessary or duplicative tests. Doctors can also use the tool to manage patient expectations and demands and engage patients in shared decision-making.

Challenges include overcoming provider habit and routine and aligning ImageSmart™ into the physician workflow, given a diverse set of electronic health records. To further integrate the CDS tool within the clinician workflow, ImageSmart™ has been made available to physicians on mobile platforms, including iPad and iPhone, to facilitate usage concurrently with the electronic health record.

Keeping pace with the latest evidence-based guidelines and local best practices is essential. When doctors realize that ImageSmart™ supports their skills and leads to better patient outcomes at a lower cost, they are more willing to use it. Given the complexity of systems change, the program takes a multifaceted approach to this challenge. Components include routine peer comparison performance reporting and education that holds providers accountable. Another strategy aligns existing incentives for individual performance improvement.

Altarum Senior Product Manager Lindsey Ensley says,

“The work improves patient safety, reduces medical expenses, and leads to better health outcomes. More immediately, this project is reducing inappropriate use of advanced, high-tech imaging exams. Program results are positive, demonstrating that the providers who use the ImageSmart™ CDS tool order a more appropriate test or an imaging alternative nearly 20% of the time. Our partners have found that ImageSmart™ users experience over twice the utilization reductions than that observed for non-CDS users. The reduction in utilization has been so considerable that the organization not only achieved their utilization goals but also received a corresponding incentive payment from a major local insurance carrier for the first time.”

image smart

A Comprehensive Community-Based Approach to Reducing Inappropriate Imaging

Inappropriate use of high-tech imaging, including CAT scan and MRI technology, wastes financial resources and puts patients at unnecessary risk. With a 3-year, $8.4 million award from the Center for Medicare & Medicaid Innovation, Altarum worked with the Centers for Medicare & Medicaid Services to reduce unnecessary exposure to such imaging studies with ImageSmart™, a newly developed clinical decision support tool.

ImageSmart™ is interactive computer software designed to fit seamlessly into a physician’s workflow and easily accessible within the patient chart creating the imaging order with all relevant CDS output, allowing physicians to quickly finalize it within the electronic health record.

ImageSmart™ delivers up-to-date, evidence-based guidelines from multiple professional societies, and supports physician decision-making with important information regarding industry best practices, relative radiation exposure, and procedure cost. This helps doctors work with patients to understand whether a particular imaging test is really necessary or effective and to consider other available care options.

The ImageSmart™ Dashboard analyzes imaging ordering trends and provides comparisons to your peers.

Altarum’s partners experience improved imaging appropriateness and reduced cost, allowing for greater incentive opportunities in preparation to meet upcoming regulatory requirements.

Altarum has also launched, a website that explains the cost, safety, and role of imaging in care decisions and provides guidance on helpful self-care activities that patients can do to improve their health outcomes.

Learn more about real-world experience with Imagesmart™ by United Physicians, an independent physician association located in southeastern Michigan.

This article for “A Comprehensive Community-Based Approach to Reducing Inappropriate Imaging” describes an Altarum project supported by Funding Opportunity Number CMS-1C1-12-0001 from the Centers for Medicare & Medicaid Services’ Center for Medicare & Medicaid Innovation. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

Altarum Receives $8.4 Million to Reduce Unnecessary Imaging

Over the past decade, the use of medical imaging has grown significantly, resulting in increased national spending and potential for unnecessary treatment and patient safety risks. Altarum has received an award of $8.4 million from the Center for Medicare & Medicaid Innovation (CMMI) to curb inappropriate medical imaging in Southeast Michigan over the next three years. While utilization has decreased in recent years, there is ongoing need to ensure appropriateness: the right scan for the right patient at the right time.

In partnership with United Physicians (UP) and the Detroit Medical Center Physician Hospital Organization (DMC PHO), Altarum will leverage health information technology to reduce unnecessary imaging. More than a million patients in Southeast Michigan who are seen by a UP or DMC PHO physician will be affected over the course of the three-year project. The project focuses on enrolling health care providers and offering them the support and tools necessary to improve patient care processes, as more than 25% of all imaging studies are not considered medically necessary and are ordered due to a lack of awareness about previous imaging studies or lack of alignment with guidelines.

The award was part of $1 billion in grants awarded by CMMI with the goal of implementing the most compelling new ideas from the field to deliver rapid improvements in health, care, and costs. CMMI fosters health care transformation by finding new ways to pay for and deliver care that improve care and health while lowering costs. CMMI is a new engine for revitalizing and sustaining Medicare, Medicaid, and the Children’s Health Insurance Program and ultimately improving health care for all Americans.

The project goals are threefold:

  • First, the project seeks to reduce cost by reducing utilization of targeted images and unnecessary care by more than 10%. This includes a reduction in the utilization of advanced or high-tech imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), over the 3-year period.
  • Second, the project seeks to improve care by emphasizing patient and provider education and promoting care that leverages awareness of previous patient images, improves care coordination, and reduces unnecessary delays in treatment.
  • Third, the project seeks to improve health by reducing patient radiation exposure, misdiagnosis, and unnecessary treatment.

According to Altarum Vice President Dan Armijo, this effort will give physicians the tools that they need to better understand when imaging studies are truly needed. “We demand a lot of our physicians. We expect them to stay abreast of rapidly evolving medical evidence and depend on them to address misinformation patients have obtained on their own. We also want them to take responsibility for the health of populations whose behaviors are outside of their control and to run their practices as efficient businesses. In essence, this project is about empowering physicians to provide better care by making it a little easier to decide when to order an imaging study.”

During the first year, the team’s goals include making the tools and systems widely available and then measuring the use of and satisfaction with these tools. By project end, Altarum expects to see significant reductions in ongoing operating costs based on economies of scale and lessons learned, demonstrated community-wide cost savings, and clear quality and health improvements.

This presentation for “A Comprehensive Community-Based Approach to Reducing Inappropriate Imaging” describes an Altarum project supported by Funding Opportunity Number CMS-1C1-12-0001 from Centers for Medicare & Medicaid Services Center for Medicare & Medicaid Innovation. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.


Project Leader

Amanda DeLandsheer

Amanda DeLandsheer

Program Coordination Lead, Health Innovations & Technical Assistance