RADPEER™ Hani Abujudeh MD, MBA, FSIR Associate Professor of Radiology Massachusetts General Hospital Harvard Medical school

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RADPEER™ RADPEER™ is a simple tool developed to allow physicians to do peer review during the course of a day’s work. When a new study is interpreted with an prior study for comparison, a peer review of the accuracy of the interpretation of the previous examination occurs.

RADPEER™ Piloted RADPEER™ in 2001 Offered to members in 2002 e RADPEER ™ developed in 2005 Scoring changes implemented in 2009 4

Signal events American Medical Accreditation Program by the AMA in 1998 The publication of the, Institute of Medicine report To Err Is Human in March 2000. An ABMS task force on the maintenance of certification, Competence Initiatives: A Status Report   Listed four components of maintenance of certification, which will be required by all specialty boards These components are professional standing, commitment to lifelong learning and periodic self-assessment, cognitive expertise, and the evaluation of performance in practice. 6

ACR RADPEER In response to the interests of the public and the health care community, the ACR convened a patient safety task force. The task force concluded that to meet the fourth requirement of maintenance of certification a successful peer review program must be national, uniform in structure and function across practices, accurate, facile, nonpunitive, and able to be integrated into a facility’s quality assurance program. The task force concluded that no existing programs met these criteria 7

RADPEER ™ Four point scoring system: 1. Concur with interpretation 2. Discrepancy in Interpretation/not ordinarily expected to be made (understandable miss) a. unlikely to be clinically significant b. likely to be clinically significant 3. Discrepancy in Interpretation/ should be made most of the time 4. Discrepancy in Interpretation/ should be made almost every time - misinterpretation of finding Scores of 2b, 3 or 4 should be reviewed through the facility’s internal QA process prior to submission to ACR 9

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RADPEER could be expanded and used as a means to The median number of cases reviewed in RADPEER is 776 each year, which translates into 3 to 4 cases reviewed per working day. The RADPEER system is not designed to be a sole OPPE measure, but it can be incorporated into such programs. The committee discourages the use of scores as a means of competency assessment and encourages the maintenance of the nonpunitive nature and anonymity in scoring. RADPEER could be expanded and used as a means to collect data on other aspects of quality and safety in radiology. 14

Improving the performance of the system as a whole is far more beneficial than eliminating the outliers (Deming, W.E., Out of the Crisis2000, cambridge: MIT Press.) ( assessing competence vs improving performance)

Over 1,170 participating groups RADPEER™ April 2014 Over 1,170 participating groups Over 17,500 physicians 16

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RADPEER™ Data submitted to ACR via website Reports for individuals and group available electronically ABR MOC Reports 19

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RADPEER™ as a PQI Project Radiologists can select RADPEER™ to be used as one of their projects for Maintenance of Certification for the ABR (American Board of Radiology) The MOC process includes: Evidence of professional standing (license) Lifelong learning and self-assessment (SAMs, CME) Cognitive expertise (exam) Practice quality improvement (PQI project such as RADPEER™) 22

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Cost of RADPEER™ Participation Annual fee for participation in RADPEER™ is based on the number of physicians in the group # Physicians Annual Fee 2-5 $800 6-15 $1,500 16-25 $2,200 26-35 $3,000 36-45 $3,800 46-55 $4,600 56-65 $5,400 66-75 $6,200 76-85 $7,000 86-95 $7,800 96-105 $8,600 106-115 $9,400 116-125 $10,200 24

https://radpeer.acr.org habujudeh@partners.org 25