Your facility may be gearing up to integrate Appropriate Use Criteria (AUC) into your existing physician order workflow, which is the program established to increase the rate of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries. The mandate from CMS is that the program needs to be fully implemented by January 2021.
Under this program, practitioners will be required to consult with a Clinical Decision Support Mechanism (CDSM) when placing certain orders (CT, PET, Nuclear Medicine and MRI) for Medicare beneficiaries. This adds an additional layer to the ordering process to help the practitioner confirm they are ordering the most appropriate procedure for the patient.
How it Affects the Workflow:
After each order is placed, the CDSM application uses the information provided about the patient and reason for exam/order to provide the practitioner with a list of recommended procedures. Each procedure is typically scored (weighted) to reflect a confidence level for the procedure using the information known about the patient at that point in time. The user may then elect to keep the original procedure or may select one of the recommended items to replace the original procedure.
The CDSM system may also collect an override reason in the event the user chooses to override a procedure. Upon return from the CDSM application, the procedure's score, CDSM vendor information, and override comment are returned to the ordering system to be filed as part of the order.
The procedure selection ultimately comes down to the practitioner (or their staff) but the CDSM application is used to help ensure the most accurate procedure is being ordered for the patient with the information at hand.
What is the technical impact to your current process?
If you are using an interface to electronically process and file applicable orders from physician practices, review with your hospital HIS vendor to confirm if any interface changes will be needed to support the new AUC fields. These changes may entail additional cost and scheduling lead-time. Also, to ensure a smooth AUC transition, these changes need to be added and thoroughly tested for all relevant procedures.
Please review this link for additional information about the Appropriate Use Criteria (AUC) Program.