ACR Select: Clinical Decision Support Imaging Guidelines

CONFIDENTIAL © 2012 National Decision Support Company

CLINICAL DECISION SUPPORT IMAGING GUIDELINES National Decision Support Company


Who is NDSC? National Decision Support Company (NDSC) is the exclusive distributor of national standards clinical decision support (CDS) imaging guidelines. NDSC provides the technical platform, support, and licensing of digitally consumable CDS that continuously educates providers regarding the latest evidence-based approach to medicine without disrupting the doctor-patient relationship or delaying needed care.


What is the relationship with the ACR? In July 2012, the ACR entered into an exclusive agency agreement with NDSC to provide the technical platform, support and licensing of the ACR Appropriateness Criteria under the name ACR Select.

ACR Appropriateness

Criteria (AC)

NDSC Licensing, Platform,

and Support


What is ACR Appropriateness Criteria? ACR AC is a comprehensive national standards clinical decision support database with more than 130 clinical topics and 614 variant conditions that provide evidence-based guidance for the appropriate utilization of all medical imaging procedures. More than 300 volunteer physicians, representing more than 20 radiology and non-radiology specialty organizations, participate on the ACR AC expert panels, continuously updating these nationally transparent guidelines, and providing real-time access to the latest medical imaging procedure guidance.

CONFIDENTIAL © 2012 National Decision Support Company CONFIDENTIAL © 2012 National Decision Support Company

OVERVIEW Clinical Decision Support Imaging Guidelines


Overview •  The Imaging Challenge •  Imaging Management Solutions •  Industry Initiatives • ACR Appropriateness Criteria • Workflow • CDS Value Proposition • Summary • Next Steps


THE IMAGING CHALLENGE Utilization Management


Diagnostic Imaging Challenges • Diagnostic imaging growth rates of 8% to 16% annually • Utilization driven by multiple factors

ü  Introduction of new technologies (PET, MRA, CTA, etc.) ü  New uses for existing technologies ü  Self-referral ü  Patient demand ü  Defensive medicine

• Unnecessary exposure to radiation • Hospital inpatient and emergency departments

experiencing the same trends as outpatient


IMAGING MANAGEMENT SOLUTIONS Current Market Approach


Traditional Imaging Management Radiology Benefit Managers (RBM’s) • Work specifically on Outpatient imaging • Manage pre-authorization for payer organizations •  Inefficient for providers and facilities • But, they are effective in lowering utilization

Clinical Decision Support solutions recently developed •  Did not use nationally recognized clinical criteria •  Difficulty with EHR/EMR interfaces •  Have proven effective where deployed •  Only effective solution for hospitals


INDUSTRY INITIATIVES CMS Demonstration Project + Meaningful Use


Regulatory Considerations CMS

• While no current mandate is in place, CMS launched a demonstration project to evaluate the effectiveness of CDS to manage utilization in the Medicare population

• Numerous proposals to implement RBM pre-auth services in Medicare

•  eOrdering Coalition (http://radnet.com/eOrdering/) effective in promoting CDS as an alternative to RBM

Meaningful use • CDS fulfills Stage 1 MU Core Measure


CMS Demonstration Project •  CMS and Clinical Decision

Support for Imaging

•  Not enough data for CBO to score CDS vs. RBM

•  $10M Demonstration Project •  To determine the effect of CDS on

imaging utilization •  Five sites located throughout the

country •  Two Example Sites

•  University of Wisconsin •  EPIC Integration to ACR-AC Web Services

•  Henry Ford Health System •  Custom EMR to ACR-AC Web Services

•  Integration to site charge masters were seamless

•  CDS has been well adopted by clinicians •  Project to complete in 2013


Meaningful Use •  According to CMS, Clinical

Decision Support is defined as HIT functionality that builds upon the foundation of an EHR to provide persons involved in care decisions with general and person-specific information, intelligently filtered and organized, at point of care, to enhance health and health care.

• Stage 1 MU Core Measure: Clinical Decision Support Rule

•  Objective: Implement one clinical decision support rule related to a high priority hospital condition along with the ability to track compliance with that rule.

•  Measure: Implement one clinical decision support rule.

•  Exclusion: No exclusion.


ACR APPROPRIATENESS CRITERIA® Overview


History of ACR Appropriateness Criteria® •  Task Force formed late 1993 • Quality and Safety Commission • Chair: Jeffrey Newhouse, MD •  11 expert panels

•  9 diagnostic •  2 therapeutic

• Criteria development over the last 20 years


Current Status of ACR AC® • Q1 2012- ACR makes decision to ‘commercialize’ the AC

in order to foster development. • Objective is to establish the AC as the national standard

guidance tool for medical imaging ordering. • ACR enters into an exclusive agency agreement with the

National Decision Support Company (NDSC) to provide the technical platform, support and licensing of the ACR AC under the name ACR Select.

• Efforts underway to integrate the AC into CPOE systems nationwide to ensure seamless and clinically relevant workflow.


ACR CDS Solution Redesign the ACR Appropriateness Criteria

•  Complete criteria to cover the majority of clinic scenarios •  Create discrete rules from massive text •  Map exam text to exam types to CPT codes •  Map clinical scenarios to indications to ICD9 codes •  Validate changes through the ACR AC Panels •  Create actionable web services and API’s •  Integrate with EHR/EMR systems •  Keeping whole system (rules, data and evidence) transparent •  Continuously updated via ACR AC Panels •  Actively take market feedback to improve the criteria by fostering

an inclusive relationship between the ACR, radiologists and ordering clinicians


CDS Advantages • Reduce/eliminate unnecessary exams

•  Redirects ordering physicians to more appropriate exams •  Improve safety by reducing radiation dose

• Select best protocol for patient and patient’s disease •  Capture essential clinical information

• Highly responsive to end user requests •  Continuous modifications to clinical indications (check boxes) •  Continuous addition of new exam types •  Changes to rules by consensus of PCP, Specialists, Radiologists


CDS Advantages • Standard rules set supported by national standards ‘body’

•  Evidence readily available •  Criteria readily acceptable by clinician community •  Proactive platforms to address clinician and market questions and

suggestions for improvement •  Government agencies looking for standards bodies to support

clinical guidelines to support utilization and quality initiatives •  Positioned well for meaningful requirements for clinical decision

support at point of care


WORKFLOW EHR Technology Integration


Integration/Workflow ACR Appropriateness Criteria®

NDSC Services Platform (ACR Select)

Provider Service Calls (3rd Party)

Result set will contain both ACR AC and site mandated

indications and exam options

Direct Service Calls

Result set will contain ACR AC indications/scores

Payer Service Calls (3rd Party)

Result set will contain both

ACR AC and payer mandated indications and exam options

EHR/Ordering System

NDSC provided/supported interface 3rd party provided/supported interface


CDS VALUE PROPOSITION Cost and Utilization Management


What’s the Value Proposition? Inpatient/Emergency Department

•  Interface CDS into CPOE function to automate • Provides real-time feedback to clinicians •  Lower utilization of capitated volume (DRG’s) • Results in significant cost savings to facility •  Lowers unnecessary exposure to radiation • Provides department heads with utilization profiles of

staff


What’s the Value Proposition? Outpatient Department

•  Interface CDS into CPOE function to automate • Provides real-time feedback to clinicians •  If accepted by payers, improves efficiency in obtaining

pre-authorizations • Reduces authorization staff (if used) • Provides for effective UM for ACO and other risk

bearing models


SUMMARY ACR AC® Clinical Decision Support


Summary Major opportunity to use Radiology CDS

•  Improve quality of care •  Decrease overutilization of imaging •  Increase departmental efficiency •  Reduce radiation dose •  Gain ordering physician loyalty

Well received by referring physicians •  Each exam ordered is a learning opportunity with just-in-time knowledge

delivery and point-of care decision support •  Consistent and reproducible •  Saves time– direct scheduling with no phone calls to the department or

RBM


NEXT STEPS National Decision Support Company


Next steps… • Contact National Decision Support Company to learn

more about ACR Select, the digitally consumable version of the complete ACR Appropriateness Criteria® (AC):

•  Phone: 855.475.2500 •  Email: [email protected] •  Website: www.acrselect.org Connect with us! •  Twitter: https://twitter.com/ACRselect •  Facebook: http://www.facebook.com/acrselect •  LinkedIn: http://www.linkedin.com/company/national-decision-support-company •  YouTube: http://www.youtube.com/user/ACRselect

ACR Select: Clinical Decision Support Imaging Guidelines

Health & Medicine

Transcript of ACR Select: Clinical Decision Support Imaging Guidelines