ACR Select: Clinical Decision Support Imaging Guidelines
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Integration-ready clinical decision support that guides providers when ordering medical imaging scans.
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ACR Select: Clinical Decision Support Imaging Guidelines
- 1. CLINICAL DECISION SUPPORT IMAGING GUIDELINES National Decision Support Company CONFIDENTIAL © 2012 National Decision Support Company
- 2. 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. CONFIDENTIAL © 2012 National Decision Support Company
- 3. 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 NDSC Appropriateness Licensing, Platform, Criteria (AC) and Support CONFIDENTIAL © 2012 National Decision Support Company
- 4. 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
- 5. OVERVIEW Clinical Decision Support Imaging Guidelines CONFIDENTIAL © 2012 National Decision Support Company
- 6. Overview • The Imaging Challenge • Imaging Management Solutions • Industry Initiatives • ACR Appropriateness Criteria • Workflow • CDS Value Proposition • Summary • Next Steps CONFIDENTIAL © 2012 National Decision Support Company
- 7. THE IMAGING CHALLENGE Utilization Management CONFIDENTIAL © 2012 National Decision Support Company
- 8. 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 CONFIDENTIAL © 2012 National Decision Support Company
- 9. IMAGING MANAGEMENT SOLUTIONS Current Market Approach CONFIDENTIAL © 2012 National Decision Support Company
- 10. 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 CONFIDENTIAL © 2012 National Decision Support Company
- 11. INDUSTRY INITIATIVES CMS Demonstration Project + Meaningful Use CONFIDENTIAL © 2012 National Decision Support Company
- 12. 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 CONFIDENTIAL © 2012 National Decision Support Company
- 13. 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 CONFIDENTIAL © 2012 National Decision Support Company
- 14. Meaningful Use • According to CMS, Clinical • Stage 1 MU Core Decision Support is defined as Measure: Clinical Decision HIT functionality that builds Support Rule upon the foundation of an EHR to provide persons • Objective: Implement one involved in care decisions clinical decision support rule with general and person- related to a high priority specific information, hospital condition along with intelligently filtered and the ability to track compliance organized, at point of care, to with that rule. enhance health and health • Measure: Implement one care. clinical decision support rule. • Exclusion: No exclusion. CONFIDENTIAL © 2012 National Decision Support Company
- 15. ACR APPROPRIATENESS CRITERIA® Overview CONFIDENTIAL © 2012 National Decision Support Company
- 16. 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 CONFIDENTIAL © 2012 National Decision Support Company
- 17. 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. CONFIDENTIAL © 2012 National Decision Support Company
- 18. 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 CONFIDENTIAL © 2012 National Decision Support Company
- 19. 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 CONFIDENTIAL © 2012 National Decision Support Company
- 20. 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 CONFIDENTIAL © 2012 National Decision Support Company
- 21. WORKFLOW EHR Technology Integration CONFIDENTIAL © 2012 National Decision Support Company
- 22. Integration/Workflow ACR Appropriateness Criteria® NDSC Services Platform (ACR Select) Provider Service Calls Payer Service Calls (3rd Party) Direct Service Calls (3rd Party) Result set will contain both Result set will contain ACR Result set will contain both ACR AC and site mandated AC indications/scores ACR AC and payer mandated indications and exam options indications and exam options EHR/ Ordering System 3rd party provided/supported interface NDSC provided/supported interface CONFIDENTIAL © 2012 National Decision Support Company
- 23. CDS VALUE PROPOSITION Cost and Utilization Management CONFIDENTIAL © 2012 National Decision Support Company
- 24. 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 CONFIDENTIAL © 2012 National Decision Support Company
- 25. 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 CONFIDENTIAL © 2012 National Decision Support Company
- 26. SUMMARY ACR AC® Clinical Decision Support CONFIDENTIAL © 2012 National Decision Support Company
- 27. 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 CONFIDENTIAL © 2012 National Decision Support Company
- 28. NEXT STEPS National Decision Support Company CONFIDENTIAL © 2012 National Decision Support Company
- 29. 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: info@acrselect.org • 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 CONFIDENTIAL © 2012 National Decision Support Company