News & Insights

Clinical decision support (CDS) is a tool that aims to increase appropriateness and decrease unnecessary utilization. Although the Medicare Appropriate Use Criteria Program, which mandates consultation of appropriate use criteria (AUC) via electronic CDS for advanced imaging orders, doesn’t begin until 2020, many organizations have moved forward with implementation in order to experience the benefits of CDS.

Members frequently ask our research team if imaging CDS “works.” In other words, does this tool positively affect ordering behavior? A research study from University of Virginia Health System (UVA) sheds new light on the tool’s effectiveness.

Starting Jan. 1, 2020, the Protecting Access to Medi­care Act (PAMA) will require referring providers to consult Appropriate Use Criteria (AUC) prior to ordering advanced diagnostic imaging services (including CT, MR, nuclear medicine exams, and PET scans) for Medicare patients. Providers can access imaging AUC via stand-alone electronic clinical decision support (CDS) systems or software embedded in a physician’s EHR.

The ACR and the National Decision Support Company (NDSC) have developed CareSelect Imaging®, which uses the ACR Appropriateness Criteria® (AC) to guide providers ordering imaging for patients. Not only does such a system aid providers in selecting the correct care path for patients, but some practices have worked with their payers to use CDS in place of prior authoriza­tion by radiology benefit managers (RBMs).

Clinical decision support (CDS) software designed around the ACR Appropriateness Criteria assists health care providers in choosing appropriate imaging studies at the time of order entry. The goal of this study was to determine the impact of commercially available CDS on the ordering habits of inpatient and emergency providers.

University of Virginia researchers found that radiology trainees benefit the most from a commercially available clinical decision support (CDS) program being implemented into an electronic health record, which overall improves the appropriateness scores of ordered imaging studies significantly.

The healthcare industry is riddled with opportunities to automate clinical processes.

Part of this opportunity stems from the growing prevalence of EHRs over the past decade. As of 2017, 80 percent of U.S. hospitals had adopted EHR systems through CMS’ Meaningful Use program.

“EHR adoption has moved technology forward in the healthcare arena, especially when it comes to clinical data,” said Nilo Mehrabian, vice president of product management at Change Healthcare.

However, Ms. Mehrabian noted there is room for improvement. She identified utilization management in the emergency department as one such area that could benefit from automation, as the current process is both time-consuming and costly.

Position your practice for success in the transition to value-based care. Learn how American College of Radiology Appropriateness Criteria supports Choosing Wisely recommendations to help reduce unnecessary tests and procedures.