The development team develops Appropriate Use Criteria (AUCs) sufficient to cover the entire Priority Clinical Area. AUCs sufficient to cover the required scope may be developed in one or a number of pieces using any of 3 AUC types. There are 3 types of Intermountain Imaging Criteria AUCs (image order guideline, diagnostic CPM, comprehensive CPM). AUC types, description of architectures, applicable scopes, and examples are given in the following table.
| AUC Type |
Architecture |
Applicable Scope |
Example |
| Image Order Guideline |
Specific clinical context (age, sex, reason for exam, etc.), exam code, appropriateness rating (y/n)
|
Well-defined clinical context, single imaging exam |
AUC designating appropriateness of non-contrast head CT use in context of chronic recurrent but uncomplicated headaches in an adult.
|
| Diagnostic CPM |
Broad clinical context, algorithms leading to context refinement and linkage to one or more imaging exams |
Broad context with diagnostic end-points |
Diagnostic CPM guiding clinician to choose appropriate imaging test for patient presenting to the ED with symptoms suspicious for pulmonary embolus. |
| Comprehensive CPM |
Broad clinical context, algorithms leading to context refinement and linkage to one or more imaging exams. Downstream logic leading to therapeutic interventions. |
Broad context with therapeutic and diagnostic end-points
|
Comprehensive standards for diagnosis and management of patients with low back pain. |
Architecture Iterations
In general, the architecture of the AUC(s) is defined up front in the project plan (step 1), but may be modified as the work of evidentiary review and AUC building proceeds. Results of evidentiary review form the foundation for building all three types of AUCs. CPM types also require significant attention to operational workflows and strategies for integration into clinical workflows and therefore require extensive vetting of flow diagrams and other content across multiple teams.
Prototypes are developed, input is received, and models are revised as needed. Rigorous attention to the evidentiary base is maintained and assured by the development team as successive versions are advanced. The degree of design iteration and required testing and validation is determined by the complexity of the AUC (the number of provider types and provider settings impacted for example).
Inadequate Evidence
Where there is inadequate evidence for the use of imaging within a specific clinical context encompassed within the Priority Clinical Area, the gap is discretely identified and no AUC is produced. These gaps serve as opportunities for further research and data gathering.