The medical service order is more than just an instruction to provide a service like an MRI to a patient. It’s also more than just a scheduling document. The service order is (or should be) the basis for any follow-up steps involved in delivering the service and getting paid for it. Done right, the order management process will generate orders that are complete—with the right CPT codes and medically-sound procedures to ensure good patient care and as few time-consuming digressions for staff as possible. The addition of intelligence-based decision support contributes to these positive potential outcomes.
Intelligence-Based Clinical Decision Support Vs. Clinical Decision Support
There’s a distinction to make between intelligence-based decision support in a medical service order management system and standard clinical decision support. They’re similar, and sometimes overlap, but they are not the same thing. The iOrder solution offers both.
Clinical Decision Support (CDS) refers to order management capabilities that enact the requirements of the Protecting Access to Medicare Act of 2014 (PAMA) law. The regulations coming from that law mandate the use of a qualified clinical decision support mechanism (qCDSM) to ensure that physicians cite appropriate use criteria (AUC) when they order certain imaging services. This requirement is still in a roll-out phase, but is expected to be completely mandatory by 2021. iOrder meets the qCDSM criterion by integrating with an approved qCDSM resource.
Intelligence-based clinical decision support, in contrast, is broader in scope. An order management system with intelligence can be customized to guide the ordering physician through virtually any sequence of eligibility for a diagnostic test. It’s not just limited to radiological services.
An Example of Intelligence-Based Decision Support at Work
Should someone with diabetes be required to fast before a fasting blood glucose test? The simple answer is “no,” but a medical order management system with intelligence-based decision support can be customized to make sure this issue is properly addressed. The system will prompt the doctor to answer the question, “Is this patient a diabetic?” If the doctor answers yes, the system will generate specific instructions for the patient that explain that he or she does not have to fast.
Why is this important? The doctor already knows that a diabetic should not be required to fast for a blood test. The difficulty is that without intelligence-based decision support, the doctor could easily overlook the issue because he or she is in a rush or isn’t paying attention to the patient’s medical history when the order is placed. Or, the doctor could place the order but neglect to tell the patient not to fast. This will have one of three outcomes, neither of which is good for the patient or the hospital providing the service:
- The patient will fast and put himself at risk, in health terms, perhaps even requiring medical assistance as a consequence
- The patient will get confused and call the doctor’s office for clarification. This is not the end of the world, but it’s the kind of minor, manual task that adds up when it happens hundreds of times a year
- The lab will ask the patient if he has fasted. The patient will say “no,” and be told to reschedule for a time when he has fasted. This will likely trigger another round of calls, rescheduling and so forth.
This is just one example. iOrder can be extensively customized for almost any ambulatory service scenario. It can take into account factors like the patient’s medical history, allergies, medications he or she is taking, physical issues like weight and disabilities and so forth. The goal is to make the service fulfillment process go smoothly and then enable a streamlined billing process with a low chance of a payment review or denial.