Clinical Quality Framework (CQF)- Pilot: National Decision Support Company

Pilot background: HR4302 passed into law April 2014, which requires ordering physicians consult appropriate use criteria when placing orders for high tech diagnostic imaging (HTDI) exams. This pilot was designed to use the CQF Service Based Evaluation use case in order to provide a standard means for physicians to access AUC in EHR systems. This standard can be adopted as part of Meaningful Use Certification Criteria and adopted by CMS to define the mechanism to access and deploy AUC per HR 4302. 

Pilot Goal: Provide ordering physicians Point of Order access to Appropriate Use Criteria for Imaging orders. Appropriate Use Criteria provides feedback as to the appropriateness score for an imaging order. Each imaging order is assigned a unique decision support identifier and appropriateness score and users are presented feedback in the form a score and suggested alternate exams. This decision support data is recorded within the EHR. This data and activity is also recorded in the CDS service for Quality Measurement. The appropriateness score, structured reason for exam and associated imaging order can be used to track impact of AUC on care, identify overall ordering patterns and be incorporated into Clinical Quality Measures. The pilot  also demonstrated how this data can be used in such a report and example eCQM. The pilot also demonstrated how the data generated (appropriateness score, physician behavior etc) during a service-based evaluation can be incorporated into Clinical Quality Measures through generation of reports from both the EHR and cloud based service. In the case of an EHR, appropriateness data was incorporated into an example CQM calculation and physician activity reports. In the case of a cloud based service, the pilot demonstrated how data from multiple health care providers accessing the service can be aggregated, in effect demonstrating a registry. During the pilot, user interaction within CPOE during an imaging order, selection of exam and structured indication and other data elements (eg Service Requestor), generates a query to a cloud based DSS containing National Standard Appropriate Use Criteria published by the American College of Radiology. The pilot demonstrated how an existing integration model deployed in the market can be adapted to the CQF.