ACR Select FAQ

What if I can’t find the structured indication(s) (i.e., checkbox entry) relevant to my patient?

No problem! The hard stop requirement is really just that you put in an indication, not that you always mark a checkbox. If you enter a free text “reason for exam” in the second box, you will get credit for entry and be allowed to place the order. The first free text box is simply a search field to help you filter through the available structured indications.

Because there are numerous clinical scenarios for thousands of exams, you will certainly encounter patient scenarios which have not yet been evaluated and scored by consensus physician panels and translated over to our EHR. Though many scenarios are covered, we also have holes to fill in the future.

You are strongly encouraged to select any and all indications which are appropriate to your patient’s scenario. This provides radiologists with important clinical information for “more informed reads” and will ultimately lead to more accurate appropriateness scores for such orders. Marking a checkbox also provides the opportunity to give you real-time electronic feedback on exam appropriateness, relative cost, and relative radiation dose. This feedback loop will be activated in January 2015.

If you find that you commonly place orders in certain clinical scenarios which are blatantly missing from our content, you can forward these insights to our decision support vendor (ACR Select, National Decision Support Company) so that they may be incorporated into the site. To share this information, please contact feedback@nationaldecisionsupport.com.

Why do I need to select a checkbox?

These types of structured indications are necessary in order to query a database and provide objective, standardized, real-time, point-of-care feedback to you at time of order entry.

What is decision support for radiology order entry?

This is electronic point-of-care real-time feedback to you regarding your imaging orders. Based upon the structured indications (checkboxes) you have entered, you will receive instant objective feedback regarding exam appropriateness, relative cost, and relative radiation dose. Then, during the ordering process, you can use your own professional judgment to proceed with or change your order.

Why is UVA implementing decision support for computerized radiology order entry?

“Decision support for computerized radiology order entry” means that an order and its indication can be used to query a database of consensus standard appropriateness criteria provided by medical societies in order to receive real-time, point-of-care feedback to ordering providers. This mechanism provides opportunity for guidance on order selection based upon medical indication and potentially on relative cost and radiation dose.

The Senate passed the Protecting Access to Medicare Act of 2014, also known as the Sustainable Growth Rate (SGR) patch legislation. Notably, it delays a significant cut to Medicare physician payment. However, the fine print of this legislation also mandates the use of decision support software to show that ordered tests and procedures (such as radiology exams) meet appropriate use criteria (AUC) set by medical societies in order to get full Medicare/Medicaid reimbursement.

The UVA Health System is implementing decision support for radiology order entry via our Epic electronic health record (EHR). The first step in this implementation requires a change toward the use of structured orders, which means that providers will need to choose coded categorical choices for indications in order to receive decision support feedback at order entry. The feedback will come from integration of our Epic EHR with ACR Select software (National Decision Support Company) using the Appropriateness Criteria® of the American College of Radiology.

In short, this technology will help meet new federal requirements; improve appropriate utilization of imaging studies (the right exam, lower costs, less radiation); and provide requested real-time support to providers at order entry.

What kind of feedback can you get?

Highly indicated studies are green (scores 7-9). Marginally indicated studies are yellow (scores 4-6). Weakly or non-indicated studies red (scores 1-3). Relative cost and relative radiation dose are indicated by number of dollar signs or radiation symbols. The provider can use the feedback and checkboxes to easily modify or replace their order (bottom of screen).

Tips

Providers are strongly encouraged to select any and all indications which are appropriate to their patient’s scenario. This provides radiologists with more clinical information for “more informed reads” and will ultimately lead to more accurate appropriateness scores for such orders.