Conducting an InterQual^® AutoReview automated review

Complete an automated review that met criteria

• Find an automated review.

  You find and select automated reviews either from your system’s case worklist or from the InterQual AutoReview dialog that displays whenever you start a new review. If a patient is admitted with more than one diagnosis, multiple reviews might be created. If multiple reviews are found, you can identify the review that is most appropriate for your patient and then delete the others.

• Select DELETE for a review you want to remove.

• Select OK in the warning message to confirm you want to delete the review.

  Note: If you close the InterQual AutoReview dialog or delete all the automated reviews, the Select Subset screen appears so you can begin a manual review.

• Select to open a review.

  The Medical Review screen appears.

• If the levels of care are collapsed, expand the level of care you want to focus on.

  The criteria appear as follows:

• Criteria points or rules in solid teal indicate that the EHR data satisfy the criteria.
• Criteria points with an EHR plus-sign icon indicate that EHR data are available and are being evaluated to determine whether they satisfy the criteria.
• Criteria points with an EHR ellipsis icon indicate that imaging narratives and other text-based EHR data are available, and that Natural Language Processing (NLP) is used to determine whether they satisfy the criteria.
• Criteria points or rules outlined in teal indicate that EHR data are available but require a reviewer to determine whether the data can be used to satisfy the criteria.
• EHR Updates status: AutoReview runs for 24 hours after the admission order is placed and updates every two hours. The EHR Updates status indicates whether the updates are still running or have completed. One of the following statuses displays to the left of the criteria status:
• Accepting EHR Updates: Indicates that AutoReview is still accepting updates because it is within the 24-hour period from the time the admission order was placed.
• EHR Updates Complete: Indicates that AutoReview is no longer accepting updates because the 24-hour period has expired. Additionally, the update process also stops if a reviewer saves or completes the review within the 24-hour period.

• To view the EHR data for a criteria point, select a plus-sign icon or ellipsis icon . The EHR Data dialog appears and displays the data that were extracted from the EHR.

  The data appear as follows:

• Clinical data for labs, medications, flowsheets, diagnoses and problems, and patient demographics are displayed in tables
• Systolic and diastolic blood pressure measurements are combined in a single table

• Clinical data elements from separate sources are displayed on separate tabs

  The EHR data that are displayed when you select the ellipsis icon have key terms identified by Natural Language Processing (NLP) highlighted in yellow.

• Select CLOSE when you finish viewing the data.

  Note: Depending on your organization's workflow, you can perform certain tasks such as add a reviewer comment or select a benchmark value without affecting the review's status as an automated review. However, if you select (or clear) criteria, it is converted to a manual review.

• If appropriate for your workflow, add a benchmark value and/or a reviewer comment.
• Optionally, select REVIEW SUMMARY so you can view and print the Review Summary. The Review Summary includes the following information:
• Title—InterQual Review Summary — Generated by InterQual^® AutoReview—indicates that the review was generated using data extracted from the EHR and no criteria were manually selected
• Check mark and EHR plus-sign icon next to a criteria point indicates that the EHR data satisfied the criteria.
• Plus-sign icon only next to a criteria point indicates that EHR data are available but do not satisfy the criteria.

• Letters (for example, (A), (B), (C) etc.,) that appear next to the EHR icons indicate where to find the corresponding information in the EHR Data section of the Review Summary. You can scroll to the EHR Data section to view the details.

  Note: The Review Summary presented in InterQual^® Connect may differ from the Review Summary that is available in your integrated case management system.

• Complete or save the review.
• Complete review — selecting COMPLETE stops the update process, locks the review, and prevents any future edits.

• Select COMPLETE.

  A message appears indicating that any data (criteria selections and EHR data) that did not contribute to meeting criteria will be removed from the review. This includes clearing irrelevant data from the level of care that was met and all other levels of care that have data.

• If your workflow includes electronically sharing the review with a payer who also uses InterQual, select Share this review.

• Select COMPLETE REVIEW.

  The review is locked and saved to your organization's system. If you chose to share the review, the Review Share dialog appears. Refer to Sharing an InterQual^® Review for directions on sharing a review.

• Save review — selecting SAVE REVIEW stops the update process and saves the review so you can edit and complete it later.

• Select SAVE REVIEW. Note that saving does not clear irrelevant data from the review.

  The review is saved to your organization's system.

Edit an automated review that met criteria

If appropriate, you can edit the criteria selections in an automated review that met criteria. You might do this in cases where the review automatically met criteria for a lower level of care, but when additional clinical information is evaluated, you find that the patient is appropriate for a higher level of care.

Note that editing an automated review converts it to a manual review and it is no longer considered a fully automated review.

• Find an automated review.

  You find and select automated reviews either from your system’s case worklist or from the InterQual AutoReview dialog that displays whenever you start a new review. If a patient is admitted with more than one diagnosis, multiple reviews might be created. If multiple reviews are found, you can identify the review that is most appropriate for your patient and then delete the others.

• Select DELETE for a review you want to remove.

• Select OK in the warning message to confirm you want to delete the review.

  Note: If you close the InterQual AutoReview dialog or delete all automated reviews, the Select Subset screen appears so you can begin a manual review.

• Select to open a review from the list.

  The Medical Review screen appears.

• If the levels of care are collapsed, expand the level of care you want to focus on.

  The criteria appear as follows:

• Criteria points or rules in solid teal indicate that EHR data satisfy the criteria.
• Criteria points with an EHR plus-sign icon indicate that EHR data are available and are being evaluated to determine whether they satisfy the criteria.
• Criteria points with an EHR ellipsis icon indicate that imaging narratives and other text based EHR data are available, and that Natural Language Processing (NLP) is used to determine whether they satisfy the criteria.
• Criteria points or rules outlined in teal indicate that EHR data are available but require a reviewer to determine whether the data can be used to satisfy the criteria.
• To view the EHR data, selecta plus-sign icon EHR plus sign icon or ellipsis icon EHR ellipsis icon. The EHR Data dialog appears and displays the data that were extracted from the EHR. The data are presented as follows:
• Clinical data for labs, medications, flowsheets, diagnoses and problems, and patient demographics are displayed in tables
• Systolic and diastolic blood pressure measurements are combined in a single table

• Clinical data elements from separate sources are displayed on separate tabs

  The EHR data that display when you select the ellipsis icon show key terms identified by Natural Language Processing (NLP) highlighted in yellow. Select CLOSE when you finish viewing the data.

• If there is additional information in the medical record or information that became available after the EHR updates were completed, you can record that information.

  Note: Depending on your organization's workflow, you can edit certain items such as add a reviewer comment or select a benchmark value without affecting the review's status as an automated review. However, if you select criteria, it is converted to a manual review.

• If appropriate, select or clear criteria points.

  A message alerts you that changing criteria selections converts the automated review to a manual review.

• Select CONTINUE in the message if you wish to continue selecting or clearing criteria. Otherwise, select CANCEL.

  If you select continue, the review changes as follows:

• Criteria points or rules in solid teal change to green and criteria points with an EHR plus-sign icon EHR plus sign icon or EHR ellipsis icon EHR ellipsis iconcontinue to display the icon, indicating that the EHR data are retained.
• Criteria points outlined in teal change as follows:
• If you manually select a criteria point outlined in teal, it changes to green. The associated EHR data are retained and indicated by a solid green folder icon .
• If you do not select criteria points outlined in teal, they change to white and appear as unselected criteria. The EHR data are retained and indicated by the plus sign or ellipsis icon.
• Criteria points you clear (includes outlined in teal and solid teal) change to white and the associated EHR data are removed.
• If you select a criteria point that results in meeting a higher level of care, a message appears indicating that the criteria selections in the lower level of care will be removed.
• If the level of care message appears, selectOK to select the criteria point. Otherwise, selectCANCEL. The criteria status changes to reflect the higher level of care.
• If appropriate, for your workflow, select a benchmark value and add any relevant reviewer comments.

• Optionally, select to view and print the Review Summary.

  The Review Summary includes information about the review and, for criteria points that have EHR data, displays the EHR details.

• Check mark and plus-sign icon next to a criteria point indicates that the EHR data satisfied the criteria.
• Plus-sign icon only next to a criteria point indicates that EHR data are available but did not satisfy the criteria.
• Check mark and green folder icon next to a criteria point indicates that you manually selected a criteria point that was outlined in teal.

• Letters (for example, (A), (B), (C) etc.,) that appear next to the EHR icons indicate where to find the corresponding information in the EHR Data section of the Review Summary. You can scroll to the EHR Data section to view the details.

  Note: The Review Summary presented in InterQual^® Connect may differ from the Review Summary that is available in your integrated Case Management System.

• Finish the review workflow by completing or saving the review:
• Complete review — selecting COMPLETE stops the update process, locks the review, and prevents future edits.

• Select COMPLETE.

  A message appears indicating that any data (criteria selections and EHR data) that did not contribute to meeting criteria will be removed from the review. This includes clearing irrelevant data from the level of care that was met and all other levels of care that have data.

• If your workflow includes electronically sharing the review with a payer who also uses InterQual, select Share this review.

• Select COMPLETE REVIEW.

  The review is locked and saved to your organization's system. If you chose to share the review, the Review Share dialog appears. Refer to Sharing an InterQual^® Review for directions on sharing a review.

• Save review — selecting SAVE REVIEW stops the update process and saves the review so you can edit and complete it later.

• Select SAVE REVIEW.

  The review is saved to your organization's system.

Complete an automated review that partially met criteria

As you work with automated reviews that partially met criteria, you can edit the criteria selections as you complete the workflow. Note that editing the criteria selections in an automated review converts it to a manual review.

Editing a review that partially met criteria might involve:

• Selecting additional criteria that results in a review that meets criteria, or
• Clearing EHR data and criteria selections that do not align with the patient’s level of care before completing the review to Criteria Not Met. Clearing data ensures the review contains only relevant clinical data before you share it internally or with a payer organization.

• Find an automated review.

  You find and select automated reviews either from your system’s case worklist or from the InterQual AutoReview dialog that displays whenever you start a new review. If a patient is admitted with more than one diagnosis, multiple reviews might be created. If multiple reviews are found, you can identify the review that is most appropriate for your patient and then delete the others.

• Select DELETE for a review you want to remove.

• Select OK in the warning message to confirm you want to delete the review.

  Note: If you close the InterQual AutoReview dialog or delete all automated reviews, the Select Subset screen appears so you can begin a manual review.

• Select to open a review.

  The Medical Review screen appears.

• If the levels of care are collapsed, expand the level of care you want to focus on.

  The criteria appear as follows:

• Criteria points or rules in solid teal indicate that the EHR data satisfy the criteria.
• Criteria points with an EHR plus-sign icon indicate that EHR data are available and are being evaluated to determine whether they satisfy the criteria.
• Criteria points with an EHR ellipsis icon indicate that imaging narratives and other text-based EHR data are available, and that Natural Language Processing (NLP) is used to determine whether they satisfy the criteria.
• Criteria points or rules outlined in teal indicate that EHR data are available but require a reviewer to determine whether the data can be used to satisfy the criteria.
• To view the EHR data for a criteria point, select an EHR plus-sign icon or EHR ellipsis icon . The EHR Data dialog appears and displays the data that were extracted from the EHR.
• Clinical data for labs, medications, flowsheets, diagnoses and problems, and patient demographics are displayed in tables
• Systolic and diastolic blood pressure measurements are combined in a single table

• Clinical data elements from separate sources are displayed on separate tabs

The EHR data that are displayed when you select the ellipsis icon have key terms identified by Natural Language Processing (NLP) highlighted in yellow. Select CLOSE when you finish viewing the data.

If there is additional information in the medical record or information that became available after the EHR updates were completed, you can record that information.

Note: Depending on your organization's workflow, you can edit certain items such as add a reviewer comment or select a benchmark value without affecting the review's status as an automated review. However, if you select or clear criteria, it is converted to a manual review.

• Select criteria or clear criteria selections as follows:

  Select criteria

• Select criteria points.

  A message alerts you that changing criteria selections converts the automated review to a manual review.

• Select CONTINUE in the message if you wish to continue selecting criteria. Otherwise, select CANCEL.

  The review is changed as follows and is no longer considered a fully automated review:

• Criteria points or rules in solid teal change to green.
• Criteria points with a plus-sign icon or ellipsis icon continue to display the icon, indicating that the EHR data are retained.
• Criteria points outlined in teal change as follows:
• If you manually select a criteria point outlined in teal, it changes to green. The associated EHR data are retained and are indicated by a green folder icon .
• If you do not select criteria outlined in teal, it changes to white and appears as unselected criteria. The associated EHR data are retained and indicated by a plus-sign icon or ellipsis icon .
• Criteria status changes to CRITERIA NOT MET.
• If appropriate, continue to select criteria. If you select enough criteria points to satisfy the criteria, the criteria status changes to CRITERIA MET.

Clear criteria point data

Note: We do not recommend using the Clear All option for automated reviews as it clears all criteria selections and EHR data from the review.

• From the CLEAR menu, select Clear Criteria Point Data.

  A message alerts you that changing criteria selections converts the automated review to a manual review.

• Select CONTINUE in the message.

  The Clear Criteria Point Data dialog appears. A selected box indicates there are underlying EHR data and criteria selections, while a clear box indicates there are no underlying EHR data or criteria selections.

• Clear criteria selections as follows:
• Optionally, expand (+) or collapse (-) the criteria so you can see all the underlying criteria.
• Clear the box to remove all underlying EHR data and criteria selections from the review.
• If you clear any selections in error, before saving your changes, select CANCEL and repeat the steps starting at A above.

• When you are finished clearing criteria, select OK to save your changes.

  The review is changed as follows:

• Criteria you cleared (includes solid teal and outlined in teal) change to white and any associated EHR data are removed.
• Criteria points or rules that remain selected, change from solid teal to green and any associated EHR data are retained as indicated by the EHR plus-sign icon or the EHR ellipsis icon .
• Criteria points outlined in teal that you did not clear, change to white and appear as unselected criteria. The EHR data are retained.
• Criteria status changes to CRITERIA NOT MET.

• Optionally, select to view and print the Review Summary.

  The Review Summary includes the following information about the review and, for criteria points that have EHR data, displays the EHR details:

• Check mark and plus-sign icon next to a criteria point indicates that the EHR data satisfied the criteria.
• Plus sign icon only next to a criteria point indicates that EHR data are available but did not satisfy the criteria.
• Check mark and green folder icon next to a criteria point indicates that you manually selected a criteria point that was outlined in teal.

• Letters (for example, (A), (B), (C) etc.,) that appear next to the EHR icons indicate where to find the corresponding information in the EHR Data section of the Review Summary. You scroll to the EHR Data section to view the details.

  Note: The Review Summary presented in InterQual^® Connect may differ from the Review Summary that is available in your integrated case management system.

• Finish the review workflow by completing or saving the review:
• Complete review — selecting COMPLETE stops the update process, locks the review, and prevents future edits.
• Select COMPLETE.
• If the review resulted in CRITERIA MET, a message appears indicating that any data (EHR data and criteria selections) that did not contribute to meeting criteria will be removed from the review. This includes clearing irrelevant data from the level of care that was met and all other levels of care that have data.
• If the review has a criteria status of PARTIAL (that is, no changes were made to the criteria) it changes to CRITERIA NOT MET.
• If your workflow includes electronically sharing the review with a payer who also uses InterQual, select Share this review.

• Select COMPLETE REVIEW.

  The review is locked and saved to your organization's system. If you chose to share the review, the Review Share dialog appears. Refer to Sharing an InterQual^® Review for directions on sharing the review.

• Save review — selecting SAVE REVIEW stops the update process and saves the review so you can edit and complete it later.

• Select SAVE REVIEW.

  The review is saved to your organization's system.