Four expert multispecialty panels will convene to build consensus based on available evidence (see right) on recommendations for diagnosis and management of findings that may lead to a diagnosis of lung, prostate, pancreatic or adrenal cancer. We will utilize a Modified Delphi process1 or nominal group technique (Expert Panel)2 to generate agreement on recommendations that will be implemented as CDS across MGB. The recommendations will be discussed as units of evidence. Guidelines, for instance, may contain more than 1 (often >10) units of evidence, or specific recommendations.
Evidence to be represented as CDS and evaluated by units of evidence
As part of the consensus process, surveys will be administered to panel members. Evidence will be assessed for consensus.
CDS development and implementation: We will represent the units of evidence derived from consensus as CDS.
PROTECTING ACCESS TO MEDICARE ACT (PAMA)
- PLAW-113publ93 Section 218(b)
This is the section of PAMA entitled “Promoting Evidence Based Care” that requires the use of Appropriate Use Criteria.
- Recommendations to CMS for PAMA Feb 13, 2015
This letter presents the PAMA implementation recommendations from institutional and radiology leaders from Brigham and Women’s Hospital, University of California Health System (UCLA and UCSF), New York-Presbyterian Hospital-Weill Cornell Medical Center and Geisinger Health System.
- Implementing PAMA Summary of Approach
This is a slide set summarizing the recommendations of the BWH, UC, NYPH-WCMC, Geisinger letter.
- MID Report to Congress
This is CMS’ report to Congress describing the results of the Medicare Imaging Demonstration, which was the largest ever experiment testing the delivery imaging clinical decision support based on professional society guidelines.
- Advisory Board document
Why you should think twice about the Medicare Imaging Demonstration. This document describes some of the lessons of the MID, concluding that the MID shows “how not to implement CDS.”
- CEBI Book of Evidence Dec 5, 2014
This document provides a primer on imaging CDS and summarizes peer reviewed research done at BWH showing the impact of targeted interventions using high quality evidence. a. Consider posting links to the list of publications as a separate document so people can link to the journals. This list could then be updated regularly, and could be expanded to include articles that are not generated by CEBI.
- Sistrom et al – 2009 (Radiology), and Ip et al – 2013 (American Journal of Medicine)
These articles use data gathered contemporaneously in response to the same Partners Healthcare System pay-for-performance initiative with local Massachusetts payers. The Sistrom article attributes changes in imaging utilization to the use of imaging CDS, while the IP article attributes changes to the multi-faceted radiology medical management program, physician and institutional incentives and other factors.
- HMS eLibrary of Evidence Website
- Final AUC Rule
This is the Final AUC Rule published by CMS in November 2015, describing the requirements to become a Qualified Provider Led Entity and the process a QPLE must follow to create or modify Appropriate Use Criteria
- Discussion of Final AUC RuleThis is the contemporaneous discussion of the Final AUC Rule published by CMS in November 2015, discussing the comments received on the proposed AUC rule, the changes made by CMS and providing guidance for the interpretation of the Final AUC Rule