Vice Chair of Clinical Operations and Informatics, Division Chief of Musculoskeletal Imaging and Intervention, and Associate Chief Medical Information Officer, Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia.
Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia.
J Am Coll Radiol. 2021 Jun;18(6):857-863. doi: 10.1016/j.jacr.2021.01.009. Epub 2021 Jan 29.
The aim of this study was to determine if a clinical decision support (CDS) tool could be used in partnership with a private payer to successfully expedite the prior authorization process for advanced (ie, MRI, CT, PET, nuclear medicine) imaging requests.
A single academic institution integrated a commercially available CDS tool utilizing the ACR Appropriateness Criteria into the ordering process for outpatient advanced imaging tests within the electronic health record. Ordering providers could elect to use the CDS tool or ignore the available technology. In partnership with a health care insurance company and a contracted radiology benefits management company, orders deemed as "usually indicated" by the CDS tool underwent expedited prior authorization in a pilot program from June 2018 to October 2019.
Providers used the CDS tool for 15% (1,453 of 9,640) of outpatient advanced imaging orders. Of these orders with elective CDS scores, 69% (n = 997) qualified for an expedited prior authorization process.
Under specific circumstances, a commercially available CDS tool was used in partnership with a private payer and a radiology benefits management company to expedite prior authorization of outpatient advanced imaging examination orders deemed likely to be appropriate by multispecialty professional guidelines.
本研究旨在确定临床决策支持 (CDS) 工具是否可以与私人支付方合作，成功加快高级（即 MRI、CT、PET、核医学）影像请求的预先授权流程。
一家学术机构将一种商业上可用的 CDS 工具整合到电子健康记录中的门诊高级影像检查的订单处理中，该工具利用了 ACR 适宜性标准。订单提供者可以选择使用 CDS 工具或忽略可用的技术。在医疗保险公司和合同放射学福利管理公司的合作下，CDS 工具认为“通常适用”的订单在 2018 年 6 月至 2019 年 10 月的试点项目中进行了加速预先授权。
提供者在 15%（9640 个中的 1453 个）的门诊高级影像订单中使用了 CDS 工具。在这些有选择性 CDS 评分的订单中，有 69%（n=997）符合加速预先授权流程的条件。
在特定情况下，一种商业上可用的 CDS 工具与私人支付方和放射学福利管理公司合作，加快了多专业指南认为可能适当的门诊高级影像检查订单的预先授权。
