Intermountain Healthcare, through its Proven Imaging initiative is dedicated to the development, maintenance, and deployment of evidence-based standards for imaging in support of its mission of helping people live the healthiest lives possible. The appropriate use of imaging must be defined and understood within the specific clinical context in which it occurs. This context can be very complex and include factors such as demographics, prior medical history, signs and symptoms, prior diagnostic test results and current therapies.

Further, a full understanding of context includes the anticipated downstream impacts of the imaging service result on therapy and ultimately on outcome. The Proven Imaging guidelines are framed within a population health management model where evidence-based preventative, diagnostic, therapeutic, and palliative standardized care processes are interwoven to form evidence-based care pathways across the continuum of care.

Proven Imaging Leverages Clinical Programs and Care Process Models

Multidisciplinary clinical teams called Clinical Programs are organized within Intermountain to develop and oversee implementation of evidence-based standards of care for defined sub-populations. Current Intermountain Clinical Programs include the following:

  • Behavioral Health
  • Cardiovascular
  • Intensive Medicine
  • Musculoskeletal
  • Oncology
  • Pediatric
  • Primary Care
  • Surgical Services
  • Women and Newborn

Experts in imaging including radiologists and cardiologists serve within the Clinical Programs as domain knowledge experts in imaging. The main work of the clinical programs is to develop Care Process Models (CPMs) for the key processes of care provided within their clinical domain. Imaging services are component services within the CPMs. This architecture allows for very complex clinical context to be specified for the imaging service and very importantly links the outcome of the imaging service to other downstream diagnostic and/or therapeutic services.

In addition to providing guidelines for care, CPMs also include the collection and analysis of data metrics that allow objective assessment of CPM impacts on outcome and on the total cost of care. CPMs functionally serve as a portfolio of dynamic Quality Improvement initiatives that are the essence of a Learning Healthcare System.

Creation of Imaging Appropriate Use Criteria

The Proven Imaging initiative leverages the Clinical Program infrastructure to develop Imaging Appropriate Use Criteria (AUC), generally in a CPM architecture. The steps to AUC development include:

  1. Identification of Priority Clinical Areas as defined by CMS, and assignment to the most appropriate Clinical Program and development of a project plan.
  2. Constitution of a development team to build and maintain the AUC.
  3. Performance of an evidentiary review.
  4. Creation of AUC in the most appropriate format.
  5. Testing and validation. 
  6. Publishing AUC to Intermountain’s Proven Imaging website.
  7. Review on an annual basis of published AUC.

Details of how each step will be carried out can be found by using the directory below or the "Intermountain Healthcare: Proven Imaging Process" PDF link above.

Intermountain's Proven Imaging AUC

heart-rhythm-program

Coronary Artery Disease

For each clinical scenario (e.g., known or suspected coronary artery disease (CAD) in ambulatory or inpatient care setting), there is an algorithmic presentation of the care pathway context for the imaging decisions made. This pathway contains not only the appropriate use criteria (AUC) and evidence-based advanced imaging recommendations but also what constitutes significant positive imaging results and downstream care recommendations.
Woman-with-hand-on-head

Headache

For each clinical scenario (e.g., headache plus suspected infection), there is an algorithmic presentation of the care pathway context for the imaging decisions made. This pathway contains not only the appropriate use criteria (AUC) and evidence-based advanced imaging recommendations, but also what constitutes significant positive imaging results and downstream care recommendations.

hip-orthopedics

Hip Pain

For each clinical scenario (e.g., chronic hip pain plus proximal hamstring tendinopathy), there is an algorithmic presentation of the care pathway context for the imaging decisions made. This pathway contains not only the appropriate use criteria (AUC) and evidence-based advanced imaging recommendations, but also what constitutes significant positive imaging results and downstream care recommendations.
A doctor explains and teaches an exercise to his patient.

Low Back Pain

For each clinical scenario included (e.g., low back pain plus suspected cancer), there is an algorithmic presentation of the care pathway context for the imaging decisions made. This pathway contains not only the appropriate use criteria (AUC) and evidence-based advanced imaging recommendations, but also what constitutes significant positive imaging results and downstream care recommendations.
neck-pain

Neck Pain

For each clinical scenario (e.g., neck pain and suspected cancer), there is an algorithmic presentation of the care pathway context for the imaging decisions made. This pathway contains not only the appropriate use criteria (AUC) and evidence-based advanced imaging recommendations, but also what constitutes significant positive imaging results and downstream care recommendations.
pulmonary-emphysema

Pulmonary

For each clinical scenario (e.g., suspected pulmonary embolism in non-pregnant patients), there is an algorithmic presentation of the care pathway context for the imaging decisions made. This pathway contains not only the appropriate use criteria (AUC) and evidencebased advanced imaging recommendations, but also what constitutes significant positive imaging results and downstream care recommendations.
shoulder-orthopedics

Shoulder Pain

For each clinical scenario (e.g., chronic shoulder pain and avascular necrosis or osteochondral lesion), there is an algorithmic presentation of the care pathway context for the imaging decisions made. This pathway is not only the appropriate use criteria (AUC) and evidence-based advanced imaging recommendations, but what constitutes significant positive imaging results and downstream care recommendations.