Clinical Decision Support


Q: How is ACR Select delivered?

A: The ACR Select platform includes an integration layer such that the content can be incorporated into health care IT platforms and clinical workflows. The ACR Select platform includes a web portal to access the content and augment the workflows of health care IT platforms as required.

National Decision Support Company provides the licensing and technical support of the ACR Select platform into the market so that health care providers can improve the delivery of imaging services and access ACR Select in their clinical workflows.

Q: Why does ACR Select use all available evidence rather than only evidence from controlled trials?

A:Highest quality evidence may be scarce in some areas of medicine for a variety of reasons. Researchers may not have studies for some diagnostic procedures for specific clinical conditions. If a high-quality study exists, it may not be repeated. Or research may never be performed to study the value of examinations that are unlikely to be appropriate for given conditions.

The ACR includes expert, consensus-driven content in addition to the evidence that exists in ACR Select for these circumstances to ensure a complete and useable Imaging CDS.

Q: Can ACR Select use decision trees and deep algorithmic logic?

A: The greatest benefit from CDS is in the initial presentation of patients and that is what ACR Select has chosen to focus on. Experience and feedback from users of early Imaging CDS platforms has led the ACR and NDSC to focus on a single-layer, single-question model for the presentation of the CDS logic to the users. Adding clicks and additional questions at the point of order does little to improve the quality of result, and unnecessarily burdens the ordering physician.

The platform and presentation state are, however, decoupled. The platform is multilayered; the presentation model has been purposely “flattened” to make the content useable at CPOE.

Physician adoption is critical to achieving the kind of health care outcomes the ACR believes are possible with ACR Select and CPOE. Creating additional overhead for already busy physicians in the form of decision trees is not conducive to physician adoption.

Q: Should a CDS system be able to provide expert consensus guidance as well as evidence-based guidance?

A: A CDS system should be able to provide the ordering clinician all information available at the time of order, provided that it also exposes the source and quality of all guidance, including the distinction between evidence-based and expert, consensus-based content. ACR Select can also limit the presentation of CDS based on quality of evidence. Experience has dictated that presenting the most complete set of guidance possible improves the physician experience with CDS.

Practical experience with CDS systems has dictated that presenting the most complete set of guidance possible improves the physician experience.

Q: Why is ACR Select important to me as a radiologist?

A: When used in the CPOE workflow, ACR Select ensures the most appropriate imaging procedure based upon a structured set of clinical indications.

The rule set is evidence-based and reflects more than 20 years of the ACR’s expertise and collaboration with other medical societies.

The forces at work within the current health care delivery model are moving away from volume-based models towards value-based payment models. Furthermore the reimbursement for imaging services continues to decline without regard to the value of imaging on patient care.

By using ACR Select to guide the ordering physician towards more appropriate imaging, radiologists can be at the forefront of the dialogue regarding how best to utilize imaging in the care cycle and collaborate on new value-driven models for the delivery of imaging services.

ACR Select allows radiology to demonstrate the value of properly delivered imaging services on improving the quality of care. CDS can help drive radiology as a consultative service when clinicians encounter moderate to low level of appropriateness scores.

Copyright © American College of Radiology