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Evidence-Based Referrals

Referring a patient for a diagnostic test such as an imaging procedure should be accomplished efficiently and capture the physician's knowledge of the unique signs and symptoms to ensure a timely and accurate diagnosis. Until now, manual processes, inadequate documentation, and interference from medical management groups have instead encouraged inefficient processes that discourage best medicine and increase the potential for medical errors.

Sage HMS applications — like RadWise® — remove the barriers to communication so timely, accurate, and complete orders are as simple as point and click.

Many organizations aspire to use evidence-based criteria for appropriate referrals, especially to manage high tech imaging via appropriateness criteria. To view a Criteria page example, go to Imaging Clinical Decision Support. Sage HMS has compared the following representative organizational goals to what RadWise offers. Note: "High tech" may be defined by each organization to include different procedures.

Use of Evidence-Based High Tech Imaging Appropriateness Criteria What RadWise Offers
  • Appropriateness criteria must be established for the most frequent indications, cumulatively adding up to the top 90% (by volume) for each scan type, (e.g. MRI, CT, PET, Nuclear Cardiology) of outpatient, elective, high tech imaging
  • Appropriateness criteria for ALL imaging including MR, CT, PET and Nuclear Cardiology, would be available for outpatient, elective imaging for an estimated 95% of all diagnostic radiology.
  • Requests can be made for specific content additions to be included as high priority.
  • Sage HMS will work with each organization and any additional payers or providers to improve the coverage of the appropriateness criteria to meet the population's health care needs.
  • 100% of high tech imaging orders must be processed through the decision support using the appropriateness criteria.
  • All high tech imaging can be processed through the RadWise system using decision support to place the order electronically with the rendering physician or radiologist.
  • New indications for imaging or new imaging technologies must have appropriateness criteria developed before they are put in use.
  • RadWise is a very flexible tool and can support the changing landscape of imaging technology — both new uses and new devices.
  • As new clinical evidence is available it is incorporated into the RadWise system using criteria and recommendations based upon patient-centric signs and symptoms.
  • As long as the new imaging technologies have assigned CPT codes, they can be easily handled in RadWise.
  • RadWise may be used as part of clinical research to assure standardization of ordering for studying new indications or new technologies.
  • The criteria must be created by a body that strives to be free of conflict of interest (e.g., professional organization, imaging management vendor, internal committee).
  • Sage HMS has developed the appropriateness criteria in an objective process and because the criteria are copyrighted they can be made transparent to the clinical users online.
  • The clinical content development process is two-fold using both a review of the scientific evidence and then a multidisciplinary consensus panel review to assure that a recommendation is objective, evidence-based, and practical.
  • Sage HMS welcomes participation by each organization's constituents and offers a stipend to the panel participants for their time and contribution to the process.
  • Sage HMS has several feedback access points on the RadWise website for end-user comments on the content regarding the usefulness and appropriateness of the criteria.
  • The criteria must be available to all clinicians at the point of ordering — as decision support.
  • RadWise criteria are available to all clinicians as part of the process.
  • RadWise does not, however, require a specific review of the criteria to place an order.
  • Most clinicians will only need to "point and click" on signs and symptoms to document and communicate the order to the rendering physician or radiologist.
  • If the ordering physician does not agree with the RadWise recommendation, he/she is asked to document the "exception" to make sure of the situation and to provide feedback to Sage HMS about issues that may be integrated into the criteria.
  • The RadWise process provides a "safety-valve" for getting the most appropriate order for each specific patient, while making sure a standard process is being used for selecting the appropriate imaging procedure.
  • The criteria must be used in all sites for 100% of providers.
  • Not only could the RadWise criteria be used in all sites by 100% of the providers, but the RadWise process for ordering and decision making could be used for 100% of the imaging procedures ordered.
  • RadWise covers approximately 95% of all content that would result in an imaging procedure, but the RadWise system has all ICD9 and CPT codes with "generic signs and symptoms" for documentation of an order even if there is no specific criteria or content developed for that diagnosis.
  • Providers can use the RadWise Web site to place all orders and standardize the ordering process as well as locate the results in one database for improved patient care.
  • The criteria must be reviewed and updated as often as needed but at least annually.
  • RadWise content is reviewed by clinicians annually and also updated as information in the medical literature, data from use of Radwise, or user feedback suggests the content should be reviewed.
  • Daily data set feed of orders to be sent to health plan or vendor for claims payment.
  • RadWise data would be provided electronically to approved parties in appropriate standard formats and as frequently as needed.