Decision support for concurrent utilization review using a HELP-embedded expert system

Utilization Review is the process of evaluating the efficiency of medical care, based on examination of the patient record. At LDS Hospital, the electronic patient record is in an advanced state. This paper describes the development and knowledge base verification of ASSURE (Automated Support System for Utilization Review), an application within the HELP hospital information system. ASSURE applies the Appropriateness Evaluation Protocol (AEP) Day of Care criteria to the electronic patient record, concurrent with the patient's stay. In blinded trials, an experienced Utilization Manager agreed with 92% of ASSURE's decisions on single AEP criteria for 560 acute care patients. Agreement was statistically significant, with kappa = 0.84, P < 0.0001.