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QUESTIONS & ANSWERS FOR IMAGING FACILTIES
Q. What is Premerus? How does Premerus improve diagnostic accuracy? How is Premerus different from other teleradiology companies?
A. Premerus is a quality initiative designed to improve patient outcomes through utilizing diagnostic imaging subspecialist to deliver precise and accurate interpretations to referring physicians. It consists of a platform that directs high-tech images only to subspecialists with additional qualifications to interpret images of those particular body systems or modalities. The governing principle of Premerus is that the more experience a diagnostician has for a specific condition, the more likely he/she will deliver an accurate diagnosis. Although Premerus may utilize “teleradiology” to ensure that a qualified subspecialist is reading a particular study, it is the only comprehensive, imaging-specific, quality management program in the industry. We have a rigorous peer review process as well as a clinical outcome feedback loop for quality assurance and continuous improvement
Q. Is there really a problem with misdiagnosis?
A. Studies indicate misdiagnosis is prevalent:
Autopsy studies have uncovered frequent clinical errors and misdiagnoses, with error rates as high as 47%. 1
A study of autopsies of patients in the intensive care setting, published in the Mayo Clinic Proceedings, comparing clinical diagnoses with postmortem diagnoses revealed that in 26% of cases a diagnosis was missed clinically. In most of these cases, knowledge of the true diagnoses might have resulted in a change in the patient’s therapy and prolonged survival. The researchers concluded that “The number of missed major diagnoses remains high, and despite the introduction of more modern diagnostic techniques and of intensive and invasive monitoring, the number of missed major diagnoses has not essentially changed in the past 20 to 30 years” 2
Medical imaging has become a vital component in modern diagnosis. There have been multiple articles published over the past several years discussing radiologic errors. Most of these described failure to detect abnormalities in 25-32% of cases where disease was present and falsely diagnosing diseases in 1.6-2% of cases that were actually normal. 3
Q. How has Premerus addressed the issue of misdiagnosis?
A. To measure impact, Premerus conducted a study comparing the medical interpretations of general radiologists to subspecialty radiologists. The study consisted of 160 patients from a single health plan in 2 states who underwent MR and/or CT imaging. Cases were distributed to sub-specialists based on their expertise; they were provided with the original clinical history and images, but not the original interpretation results. Interestingly, 44% of the original and subsequent subspecialists’ reports were found to be non-concordant. Examination of insurance claim data for these non-concordant cases, along with clinical outcomes data gathered from patient records identified unnecessary procedures and erroneous treatments that were the result of these original interpretations.
Q. Does Premerus have a Peer Review/QA Process in place?
A. For additional questions about the Peer Review/QA Process, please contact
Premerus at
(866-600-3016).
Q. How are Premerus patients identified?
A. When an imaging provider receives an authorization for an imaging procedure, the documentation will include clear identification that it is a Premerus case and will provide instructions regarding workflow.
Q. If an imaging facility already has a professional services agreement with an existing local group of radiologists, how will the Premerus model co-exist with that relationship?
A. If the radiologists in the local practice has subspecialty experience,
they may likely qualify as a Certified Premerus Expert and will be invited
to participate in the program. If there are no subspecialists available
in your area, the study will be forwarded on to Premerus for interpretation
by an appropriate Certified Premerus Expert.
Q. Why do facilities need to make some modifications to their workflow to be part of Premerus? How does this provide any benefit to the imaging facility?
A. Premerus is first and foremost a quality initiative. One of the key
components of Premerus is to ensure subspecialist radiologists are reading
only studies within his/her specialty. In order to accomplish this, Premerus
needs to receive certain information from the imaging facility related to
the study. In addition, in order to follow the Premerus Peer Review process,
we must receive images and clinical information from the imaging provider.
We recognize that a change in workflow can be an inconvenience, but the
result of higher quality diagnoses, we feel, is a reasonable tradeoff. With
a new focus on image acquisition, interpretation and reporting excellence,
Premerus implements quality measures which create the only comprehensive
approach to imaging quality management in the market today.
Premerus is marketed and viewed by health plans as a quality program. Consequently, imaging facilities in the program will be more sought after and will benefit from increased volumes due to preferred status with health plans.
