ACR Appropriateness Criteria Available in Digital Format

July 12, 2012

The ACR selected National Decision Support Company to make the guidelines available for EHR integration, which could signal a shift in image ordering decisions.

The American College of Radiology is making the Appropriateness Criteria available in a digital format to be incorporated into computerized ordering and electronic health record systems.

Through an agreement with the National Decision Support Company, which will provide the technical platform, support and licensing, the guidelines will be available for integration into daily practice, the ACR announced this week.

The move aims to make the criteria available at the point of imaging ordering, and could signal a major shift away from the use of radiology benefit management companies.

“Using guidelines to control when imaging does and doesn’t get done is happening today, but it’s not being done by the doctors; it’s being done by the payers, the RBMs,” said Michael Mardini, CEO of NDSC. “This really puts control back into what the efficacy of imaging is and what should be ordered.”

The Appropriateness Criteria is a database with more than 130 topics and 614 variant conditions that provides evidence-based guidance for the appropriate use of medical imaging. Until now, the continuously updated criteria weren’t available in a platform that could be easily searched or integrated.

The digital platform, called AC Select can be integrated into a wide variety of solutions for payers and providers, and major EHR vendors have committed to integrating, according to the ACR.

It will be up to the payers to decide whether providers using this platform will still need to call a radiology benefit management company, Mardini explained. “It’s a huge cost for payers to hire RBMs. If they can keep the market happy and reduce costs, the perception is that using this does as much to control utilization as an RBM, [so] why wouldn’t they, but it will just take time.”

Michael Bettmann, MD, FACR, chair of the ACR Appropriateness Criteria Oversight Committee, called the development “very important.”

“It’s a perfect time to try to make more rational use of imaging and this is, I think, the best possible approach,” he said. “I think it has a potential to really change the way imaging is used and make it much more appropriate and rational and effective.”

Bettmann said he doesn’t know if the approach will replace RBMs, but added, “That certainly is a possibility…. It’s not ideal to use a radiology benefit manager; it’s not ideal to have a doctor or health care provider stop what they are doing and contact someone and wait for an answer.”

Bettmann noted that there have been other similar systems implemented, some successfully, but the strength of the Appropriateness Criteria methodology makes them the best set of guidelines on which to base imaging ordering decisions.