CLINICAL DECISION   SUPPORT IMAGING   GUIDELINES   National Decision Support CompanyCONFIDENTIAL © 2012 National Decision ...
Who is NDSC?National Decision Support Company (NDSC) is theexclusive distributor of national standards clinical decisionsu...
What is the relationship with the ACR?In July 2012, the ACR entered into an exclusive agencyagreement with NDSC to provide...
What is ACR Appropriateness Criteria?ACR AC is a comprehensive national standards clinicaldecision support database with m...
OVERVIEW    Clinical Decision Support Imaging GuidelinesCONFIDENTIAL © 2012 National Decision Support Company
Overview•  The Imaging Challenge•  Imaging Management Solutions•  Industry Initiatives•  ACR Appropriateness Criteria•  Wo...
THE IMAGING    CHALLENGE    Utilization ManagementCONFIDENTIAL © 2012 National Decision Support Company
Diagnostic Imaging Challenges•  Diagnostic imaging growth rates of 8% to 16% annually•  Utilization driven by multiple fac...
IMAGING MANAGEMENT    SOLUTIONS    Current Market ApproachCONFIDENTIAL © 2012 National Decision Support Company
Traditional Imaging ManagementRadiology Benefit Managers (RBM’s)•  Work specifically on Outpatient imaging•  Manage pre-au...
INDUSTRY INITIATIVES    CMS Demonstration Project + Meaningful UseCONFIDENTIAL © 2012 National Decision Support Company
Regulatory ConsiderationsCMS    •  While no current mandate is in place, CMS launched a       demonstration project to eva...
CMS Demonstration Project•  CMS and Clinical Decision   Support for Imaging    •  Not enough data for CBO to score CDS    ...
Meaningful Use•  According to CMS, Clinical                           •  Stage 1 MU Core   Decision Support is defined as ...
ACR APPROPRIATENESS    CRITERIA®    OverviewCONFIDENTIAL © 2012 National Decision Support Company
History of ACR Appropriateness Criteria®•  Task Force formed late 1993•  Quality and Safety Commission•  Chair: Jeffrey Ne...
Current Status of ACR AC®•  Q1 2012- ACR makes decision to ‘commercialize’ the AC   in order to foster development.•  Obje...
ACR CDS SolutionRedesign the ACR Appropriateness Criteria    •  Complete criteria to cover the majority of clinic scenario...
CDS Advantages•  Reduce/eliminate unnecessary exams   •  Redirects ordering physicians to more appropriate exams   •  Impr...
CDS Advantages•  Standard rules set supported by national standards ‘body’   •  Evidence readily available   •  Criteria r...
WORKFLOW    EHR Technology IntegrationCONFIDENTIAL © 2012 National Decision Support Company
Integration/Workflow                                            ACR Appropriateness Criteria®                             ...
CDS VALUE PROPOSITION    Cost and Utilization ManagementCONFIDENTIAL © 2012 National Decision Support Company
What’s the Value Proposition?Inpatient/Emergency Department    •  Interface CDS into CPOE function to automate    •  Provi...
What’s the Value Proposition?Outpatient Department    •  Interface CDS into CPOE function to automate    •  Provides real-...
SUMMARY    ACR AC® Clinical Decision SupportCONFIDENTIAL © 2012 National Decision Support Company
SummaryMajor opportunity to use Radiology CDS    •  Improve quality of care    •  Decrease overutilization of imaging    •...
NEXT STEPS    National Decision Support CompanyCONFIDENTIAL © 2012 National Decision Support Company
Next steps…•  Contact National Decision Support Company to learn   more about ACR Select, the digitally consumable version...
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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. 1. CLINICAL DECISION SUPPORT IMAGING GUIDELINES National Decision Support CompanyCONFIDENTIAL © 2012 National Decision Support Company
  2. 2. Who is NDSC?National Decision Support Company (NDSC) is theexclusive distributor of national standards clinical decisionsupport (CDS) imaging guidelines.NDSC provides the technical platform, support, andlicensing of digitally consumable CDS that continuouslyeducates providers regarding the latest evidence-basedapproach to medicine without disrupting the doctor-patientrelationship or delaying needed care.CONFIDENTIAL © 2012 National Decision Support Company
  3. 3. What is the relationship with the ACR?In July 2012, the ACR entered into an exclusive agencyagreement with NDSC to provide the technical platform,support and licensing of the ACR Appropriateness Criteriaunder the name ACR Select. ACR NDSC Appropriateness Licensing, Platform, Criteria (AC) and SupportCONFIDENTIAL © 2012 National Decision Support Company
  4. 4. What is ACR Appropriateness Criteria?ACR AC is a comprehensive national standards clinicaldecision support database with more than 130 clinicaltopics and 614 variant conditions that provide evidence-based guidance for the appropriate utilization of all medicalimaging procedures.More than 300 volunteer physicians, representing morethan 20 radiology and non-radiology specialtyorganizations, participate on the ACR AC expert panels,continuously updating these nationally transparentguidelines, and providing real-time access to the latestmedical imaging procedure guidance.CONFIDENTIAL © 2012 National Decision Support Company
  5. 5. OVERVIEW Clinical Decision Support Imaging GuidelinesCONFIDENTIAL © 2012 National Decision Support Company
  6. 6. Overview•  The Imaging Challenge•  Imaging Management Solutions•  Industry Initiatives•  ACR Appropriateness Criteria•  Workflow•  CDS Value Proposition•  Summary•  Next StepsCONFIDENTIAL © 2012 National Decision Support Company
  7. 7. THE IMAGING CHALLENGE Utilization ManagementCONFIDENTIAL © 2012 National Decision Support Company
  8. 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 outpatientCONFIDENTIAL © 2012 National Decision Support Company
  9. 9. IMAGING MANAGEMENT SOLUTIONS Current Market ApproachCONFIDENTIAL © 2012 National Decision Support Company
  10. 10. Traditional Imaging ManagementRadiology 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 utilizationClinical 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 hospitalsCONFIDENTIAL © 2012 National Decision Support Company
  11. 11. INDUSTRY INITIATIVES CMS Demonstration Project + Meaningful UseCONFIDENTIAL © 2012 National Decision Support Company
  12. 12. Regulatory ConsiderationsCMS •  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 RBMMeaningful use •  CDS fulfills Stage 1 MU Core MeasureCONFIDENTIAL © 2012 National Decision Support Company
  13. 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 2013CONFIDENTIAL © 2012 National Decision Support Company
  14. 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. 15. ACR APPROPRIATENESS CRITERIA® OverviewCONFIDENTIAL © 2012 National Decision Support Company
  16. 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 yearsCONFIDENTIAL © 2012 National Decision Support Company
  17. 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. 18. ACR CDS SolutionRedesign 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 cliniciansCONFIDENTIAL © 2012 National Decision Support Company
  19. 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, RadiologistsCONFIDENTIAL © 2012 National Decision Support Company
  20. 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 careCONFIDENTIAL © 2012 National Decision Support Company
  21. 21. WORKFLOW EHR Technology IntegrationCONFIDENTIAL © 2012 National Decision Support Company
  22. 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 interfaceCONFIDENTIAL © 2012 National Decision Support Company
  23. 23. CDS VALUE PROPOSITION Cost and Utilization ManagementCONFIDENTIAL © 2012 National Decision Support Company
  24. 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 staffCONFIDENTIAL © 2012 National Decision Support Company
  25. 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 modelsCONFIDENTIAL © 2012 National Decision Support Company
  26. 26. SUMMARY ACR AC® Clinical Decision SupportCONFIDENTIAL © 2012 National Decision Support Company
  27. 27. SummaryMajor opportunity to use Radiology CDS •  Improve quality of care •  Decrease overutilization of imaging •  Increase departmental efficiency •  Reduce radiation dose •  Gain ordering physician loyaltyWell 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 RBMCONFIDENTIAL © 2012 National Decision Support Company
  28. 28. NEXT STEPS National Decision Support CompanyCONFIDENTIAL © 2012 National Decision Support Company
  29. 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/ACRselectCONFIDENTIAL © 2012 National Decision Support Company
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