Clinical Decision Support: Building a Standardized Process for the 2017 Deadline
It’s no secret that IT standards in healthcare are changing rapidly. In addition to the evolving rules for meaningful use of HIT in the EHR incentive program, several current and proposed legislative actions are also mandating changes. The mandate on the use of Clinical Decision Support (CDS) is particularly important to imaging providers. It's critical to stay informed about the changes so your imaging business can successfully meet the new Clinical Decision Support (CDS) market requirements.
In March 2014, as a part of the Protecting Access to Medicare Act, new legislation was enacted to mandate the use of CDS for advanced imaging. CDS provides the ordering clinicians with evidence-based guidelines to enhance decision-making on which imaging exam to order. Because the act also delayed ICD-10 and the SGR, this component may have been overlooked. However, it will have a dramatic effect on current imaging order processes.
It is important to understand both the legislation itself and the progress made to date to ensure that providers are ready to implement it. We are at a critical point in this process, as the proposed workflow standards are currently out for public comment.
Michael Bohl, CEO of Radiology Group, and I co-hosted a webinar for RBMA members to shed some light on these inevitable changes. I also co-chair an eOrdering Coalition Work Group on standardizing the imaging order and would like to outline three key areas of work underway to help ensure that the new legislation can be implemented smoothly:
- Define order and process – the group is working with IHE to define the standards whereby CDS data can move from an order to a claim in a consistent manner so time isn’t wasted having to write, copy or scan information
- Make order more consistent through data exchange – the group is reaching out to technology experts to determine the most efficient and least costly way to send and receive order information and reports
- Standardize for dictionaries and informatics – there is much work underway in organizations to establish standard dictionaries for key elements wherever possible
Michael Bohl, CEO Radiology Group, who is spearheading efforts with IHE on CDS, weighs in to share his views from a radiology practice representative’s perspective.
“There is a perception that the majority of orders we get today are electronic. The reality is that a minority, a significant minority of orders actually come in electronically. I would say, generally speaking, between 5 and 15%, maybe a little higher depending on the practice.”
Starting in 2017, the government will collect CDS data and assess outliers in imaging ordering, and in 2020 they will require prior-authorization on those outlier physicians for everything they order – all advanced imaging. Teamwork between referring providers is going to be necessary.
“We are going to need a CDS number for every Medicare outpatient CT, MRI, Nuclear Medicine, and PET study starting January 1, 2017 and other payers will likely follow. Everyone uses different systems and we need to ensure information goes from the order, through the location where the imaging exam is performed, and through to my billing system in such a way that I know exactly who the patient is and when they were seen so I can get my claim out the door. In order to make this happen, we have a lot of work to do,” Bohl says.
The clinical decision process needs to be efficient, which means, in essence, a standard must be developed to define what that CDS is, what it looks like, and how it’s shared so one-off solutions don’t have to be created for every facility and physicians get reimbursed as soon as possible.
Download this free webinar to educate yourself on the rule and add your voice to the dialogue.
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Julie Pekarek is Vice President of Solutions Management at Merge Healthcare. Visit Merge on Linkedin or Twitter.