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ARL VAN MOORE, JR, MDACR CHAIR’S MEMO

© 2009

etrics and NRDR: What Is “Near Dear” and

ow Will It Affect Radiology’s Future?

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his month, I want to take the op-ortunity to introduce you to onef the ACR’s metrics initiatives: theational Radiology Data Registry

NRDR), also known colloquiallys “Near Dear.”

I think we can agree that mostadiologists want to control theirwn destiny as well as how we prac-ice our profession. However, in theurrent practice and economic cli-ates, maintaining control is be-

oming more challenging for all ofedicine. Previous ACR board

hairs have asked whether we are inanger of becoming a commodity.nfortunately, the answer is yes.

ncreasingly, the government, in-urance companies, and purchasersf medical care—large corpora-ions, small corporations, smallusinesses, and patients—are look-ng for metrics to which they canelate and that help quantify thealue of the medical services theyrovide or receive. The pay-for-erformance train has left the sta-ion, and the key question now is,

ho will develop the metrics thatre used to judge radiologists?

I have no doubt that it is in theest interests of our patients, ourembers, and medicine as a whole

hat radiology create meaningfuletrics for all aspects of medical

maging and imaging-related treat-ent. Such metrics can serve to im-

rove patient care while showinghe value we add to the health carerocess. Once again, if we aren’tilling to do it, others will do it for,r to, us. These others standing byo impose their own ideas of met-ics are the payers, such as Medi-are, United HealthCare, Blueross, the hospitals at which the

ajority of imaging care is pro- h

006 American College of Radiology1-2182/06/$32.00 ● DOI 10.1016/j.jacr.2006.09.001

ided, and the utilization manage-ent companies. They will either

evelop metrics internally, usingheir own resources and data, orutsource this task to others. Oncehis happens, we will effectivelyease being medical consultantsnd simply become passive partici-ants in the medical care system,esponding to measures set byther, less qualified, parties.

In response, the ACR has beenorking to develop meaningful andsable metrics for radiologists.ost recently, the Intersociety

ummer Conference in July andhe Sun Valley Summit on Metricsn August focused on the metricsevelopment process. Once suchuantifiable metrics are established,he next step will be determiningow to integrate them into ouraily practice. The final step will beo find a way to collect these metricsn a database so that they can benalyzed and reported back to indi-idual practices.

To this end, the ACR has beeneveloping the NRDR relationalatabase to incorporate the manyuantifiable functions of a radiolo-ist’s practice. The college alreadyas the core software written forhis project. It is an ideal platformor storing and analyzing the met-ics data that are being developedor both diagnostic and therapeuticadiologic procedures.

So what is our vision for theRDR? First of all, NRDR is the

erm for our overall benchmarkingroject of developing a unified da-abase to support the underlying ac-ivity of demonstrating the addedalue that radiologists bring to theealth care enterprise. The concept,

owever, is more than just a data- t

ase. It is really a data warehouse inhich multiple databases can func-

ion independently. In technicalerms, it is a user-extensible foun-ation with snap-in interfaces forommercial, analytical, and onlinenalytical processing tools. Writtenn structured query language with

icrosoft’s .NET interface, it is aast and robust database that is ex-andable to meet both current anduture needs and developments.

Let me review some currentxamples. This data warehousepproach allows input on indica-ions for positron emission to-ography (PET) scanning to an-

lyze data in unique ways acrosseveral databases. Currently,RDR is being used for the fully

unctional National OncologyET Registry and will be used forhe carotid stent registry that wille online shortly. When theCR’s National Mammographyatabase was conceived years ago,

t was never implemented becauset was ahead of its time. It is noweing rewritten to be part of theRDR project. e RADPEER™ill also be “plugged in” to thearehouse. Perhaps most impor-

ant, we are in the process of de-eloping the Global Radiologynformation Database, which willllow practices to enter data onerhaps 15 quality parameters,uch as instances of contrast-nduced nephropathy or patientait times. It is a good platform

or entering outcomes data forherapeutic procedures. This willllow individual practices to viewnd mine their own data and theno benchmark those data againstggregated data from like institu-

ions in the same state, same re-

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724 ACR Chair’s Memo

ion, or nationally as part of theireer review activities.In summary, the ACR is work-

ng on several fronts to help our

embers deal with the challenges m

hat pay for performance and simi-ar initiatives pose for their prac-ices. I believe that NRDR has theotential to become a key tool for

embers seeking to prove their a

alue to both payers and patients.s we move forward, I welcomeour input on other ways the col-ege can create and use such tools to

ssist you.

rl Van Moore, Jr, MD, Charlotte Radiology PA, 1701 East Boulevard, Charlotte, NC 28203; e-mail: vanmoore@aol.com.