Change Healthcare unveiled InterQual 2018, the latest edition of the company’s flagship clinical decision support solution. InterQual 2018 delivers updated and enhanced clinical criteria as well as new technology such as InterQual AutoReview, providing real-time automation of the InterQual medical review using clinical data from the EHR.
InterQual is regularly updated with objective clinical criteria. This year’s release benefits from a new proprietary literature surveillance system that automatically analyzes over 3,000 medical literature sources daily and flags newly published information for the clinical team to critically appraise. As a result, nearly two-thirds of existing InterQual content has been updated to reflect the latest, best evidence. This helps ensure clinicians and workflow automation solutions—such as InterQual AutoReview and InterQual Connect—have the latest evidence to help support appropriate decisions.
InterQual 2018 includes hundreds of new content areas to maintain its emphasis on the most current and challenging aspects of healthcare such as:
- Addressing social determinants of health: The expansion of the Care Management information to include Admission Considerations helps organizations consider significant social or safety concerns that can help aid in decision-making.
- Battling the opioid crisis: To further enhance the collection of InterQual Criteria and tools that support the management of patients with opioid use disorder, Proactive Care Management Guidance has been added to the Substance Use Disorders criteria. This will help to ensure the most relevant evidence-based care is delivered to patients, across the continuum, caught up in this epidemic.
- Enabling Emergency Department (ED) case management: The expansion of the Initial Review Criteria to cover the most common conditions that account for >90% of the ED admissions1, and the introduction of InterQual AutoReview, helps to address one of the costliest decisions in healthcare: whether to admit a patient, and if so to what level of care.
- Supporting the aging population: The expansion of Medicare Advantage Plans means it is more important than ever to leverage InterQual evidence-based criteria to support clinical decisions. This year, staying current with changes to Medicare Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) required updating over 350 procedures and adding almost 50 new ones. Additionally, CMS’ decision to remove knee replacements from the Inpatient Only list of procedures led to the addition of evidence for the safe use of the outpatient setting for knee replacements to the Procedures Criteria.
