ACR wants CPOE to incorporate appropriateness-guided CDS

The American College of Radiology on April 24 submitted comments on the Office of the National Coordinator for Health IT's proposed rule containing voluntary electronic health record technology certification criteria for 2015.

In it's comments, ACR said it supports ONC's proposal to separate the order types in previous computerized physician order entry (CPOE) certification criteria into three distinct criteria encompassing medications, lab-tests and radiology/imaging.

"A standardized certification criteria from CPOE of radiology/imaging will allow more specialized, robust order entry software to achieve modular certification for use in the EHR Incentive Program without having to add unrelated medication and lab-test functionality," said Paul Ellenbogen, chair of ACR's board of chancellors, and Keith Dreyer, chair of ACR's IT and informatics committee.

ACR also recommended that ONC require radiology/imaging order functionality to integrate appropriateness-guided clinical decision support, pointing out that such systems reduce inappropriate ordering and reduce costs, eliminate waste and improve patient care and safety. The recently passed SGR fix, ACR pointed out, will require healthcare providers to use clinical decision support to get reimbursement for imaging services.

The comments went on to suggest that it would be "helpful to ordering providers if ONC's related certification criteria ... explicitly require CPOE/CDS to include/enable this functionality."

While ACR said it understands that radiology/imaging CPOE in the EHR incentive program now focuses on documentation within certified EHR technology, and not transmission of orders to "referring providers," it suggested that in the future, CPOE systems should be able to provide those providers with structured reasons or indications for orders.

ACR also responded to questions for the 2017 Edition EHR certification criteria related to imaging.

For example, as to whether medical images being supplied to patients need to be of diagnostic quality, ACR replied that while those images don't need diagnostic quality if they are for a patient's personal use, they should be of diagnostic quality if they are being transmitted to a physician or provider third party.

ACR also suggested that ONC should examine the recent recommendations of the HIT Standards Committee clinical operations workgroup to get a look at standards and methods relating to enabling imagine sharing in various use cases.

To learn more:
- read the ACR's comments (.pdf)

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