InterQual 2013 release supports intelligent automation for better decision-making

As part of our commitment to incorporating client feedback and improving efficiency, we have enhanced automation and informed decision-making in this year's release.

Enhanced and Expanded Criteria

InterQual Acute Criteria continued expansion of "condition-specific" subsets, adding 10 new adult subsets and 12 new pediatric subsets as well enhancements to extended-stay and general subsets. The new subsets are:

• Acute Cholecystitis
• Carbon Monoxide Overdose
• Cellulitis (pediatric only)
• Cystic Fibrosis
• Diabetes Mellitus
• Diabetic Ketoacidosis
• Hyperglycemic Hyperosmolar Syndrome (adult only)
• Hypoglycemia
• Meningitis (pediatric only)
• Pancreatitis
• Pyelonephritis (pediatric only)
• Sickle Cell Crisis
• Tylenol Overdose

InterQual Acute Criteria books have a new binder with an 800-plus page capacity for improved ease of use

InterQual Outpatient Rehabilitation and Chiropractic Criteria have four new subsets. The new subsets are:

• Amputation Upper Extremity
• Amputation Lower Extremity
• Lymphedema
• Multiple Sclerosis

InterQual Procedures and Imaging Criteria have migrated from the nested decision tree format to a more user-friendly and intuitive "question and answer" (Q&A) model in which the criteria are presented in a series of simple, rules-driven questions. Other InterQual Criteria products have been delivered in this Q&A model, and client feedback has been positive. In addition, where appropriate, the best evidence-based recommendation is made based on the clinical scenario presented (e.g., MRI being superior to CT of the head in cases of evaluation for primary brain tumor), driving more value from your criteria investment. We've also added four new Imaging subsets, including adolescent imaging, and six new Procedures subsets. Based on client feedback, we are retiring a number of unused or rarely used Procedures subsets.

InterQual Specialty Rx Criteria received eight new non-oncology and 13 new oncology drugs since the March 2012 InterQual release. The new drugs are:

• Specialty Rx Non-Oncology
  • Omalizumab (Xolair)
  • Octreotide acetate (Sandostatin)
  • Octreotide acetate (Sandostatin LAR Depot)
  • Ustekinumab (Stelara)
  • Romiplostim (Nplate)
  • Agalsidase beta (Fabrazyme^®)
  • Palivizumab (Synagis)
  • Alpha 1 proteinase inhibitor (Prolastin-C)
• Specialty Rx Oncology
  • Aprepitant (Emend)
  • Bortezomib (Velcade)
  • Cabazitaxel (Jevtana)
  • Denosumab (Prolia)
  • Denosumab (Xgreva)
  • Filgrastim (Neupogen)
  • Palonosetron (Aloxi)
  • Pertuzumab (Perjeta)
  • Peg-filgrastim (Neulasta)
  • Rituximab (Rituxan)
  • Sipuleucel-T (Provenge)
  • Cabazitaxel (Jevtana)
  • Ipilimumab (Yervoy)

SIM plus™ will be retiring a number of unused or rarely used subsets; this will help us accelerate innovation in new clinical criteria areas.

InterQual Behavioral Health Criteria's Chemical Dependency & Dual Diagnosis product has been renamed to "Substance Use Disorders & Dual Diagnosis" to align with current medical literature.

InterQual Durable Medical Equipment Criteria will be released on a more frequent, quarterly basis to ensure alignment with CMS updates of LCDs and NCDs.

Improved Technology

CareEnhance^® Review Manager Enterprise now includes CriteriaView™, a new feature that helps primary reviewers with "online guidance," which means they can see all possible recommendations when they navigate down the criteria algorithm in the Q&A model. This approach helps reviewers understand at which question in the model a certain procedure, imaging study or service stopped being an option. The CriteriaView feature also allows clients to view all of the criteria associated with a procedure, imaging study or service at a glance.

To enable more frequent updates and increase client access to our technology, criteria enhancements will now be available via electronic download on Download Central, a secure website that uses a state-of-the-art method for distributing software and product updates. This new delivery method will be used in conjunction with current software delivery via DVD for the 2013 release. Starting in 2014, this software download delivery method will be the primary way to access your software.

Do you want to learn more about InterQual? Contact us at 800.782.1334 or MHS@mckesson.com to request more information.

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