Step 5: Testing and Validation
Appropriate Use Criteria (AUCs) are tested and validated using classical PDSA (plan-do-study-act) cycles or other similar methodology within a controlled clinical environment. Steps 4 and 5 are really iterative, with feedback from a testing/validation cycle being used in refinement and improvement of the AUC.
After clinical and operational viability of the AUC is demonstrated in the controlled environment, Intermountain expands implementation to a broader group of providers, ultimately resulting in enterprise-wide implementation and validation of the CPM.
Step 6: Publish AUC to Public Website
AUCs that have been 1) developed using this evidence-based methodology and 2) validated clinical and operationally are approved by Imaging Services and Clinical Program leadership for publication to the Intermountain Imaging Criteria website. This public-facing website includes the following information for each AUC published:
- AUC/CPM guideline
- Names, credentials, institutional affiliation, and a designation of disciplinary expertise for development team members.
- Designation of Priority Clinical Areas
- Key evidence sources and an evidentiary rank for each source.
- The aggregated Fryback & Thornbury level and required Fryback & Thornbury level determined using the Gazelle framework.
- Date AUC last reviewed
- A disclosure of parties external to Intermountain who participated in AUC development.
- A designation as to whether AUC was derived from an AUC produced by another qualified Provider Led Entity.
- A unique identifier for the AUC that includes versioning information.
Step 7: Annually Review Process
On an annual basis, Intermountain Imaging Services and associated Clinical Programs review published AUCs. In the event that new information is available that requires revision/updating of the AUC, the AUC is revised and, as needed, tested and validated.
The degree of re-work is managed and Intermountain does not “build from scratch” every time new versioning is required. However, any revising of an AUC requires that revisions be developed by a properly constituted multi-specialty team (step 2) and adhere to the same evidentiary rigor defined in step 3. AUCs that are updated are given a new unique identifier and published to the website (step 6).