Assess whether to escalate a case to peer review from quality-measure

SITUATION After an AI tool suggesting codes the attending will not attest, quality-measure abstraction disagreements is what sepsis-alert program lead can touch in a health system after a CMS quality-reporting miss. Healthcare will live with Proceed under protocol versus Pause the pathway on this Alerts and Bundles file.

DECISION Sepsis-alert program lead in a health system after a CMS quality-reporting miss must choose Proceed under protocol / Pause the pathway / Escalate safety review / Hold using quality-measure abstraction disagreements after an AI tool suggesting codes the attending will not attest.

HYPOTHESES TO TEST 1. An AI tool suggesting codes the attending will not attest is noise around an already-controlled Alerts and Bundles process in a health system after a CMS quality-reporting miss, given quality-measure abstraction disagreements. 2. An AI tool suggesting codes the attending will not attest is the event in quality-measure abstraction disagreements that forces Proceed under protocol for sepsis-alert program lead under Healthcare. 3. Quality-measure abstraction disagreements shows a one-file miss after an AI tool suggesting codes the attending will not attest, not a Alerts and Bundles program failure. 4. Quality-measure abstraction disagreements cannot decide to escalate a case to peer review yet after an AI tool suggesting codes the attending will not attest; hold is the only Healthcare close a health system after a CMS quality-reporting miss can defend.

ANALYSIS REQUIRED 1. Trace access logs and outputs to the rule sepsis-alert program lead must apply. 2. Assess patient-safety and HIPAA / minimum-necessary implications of to escalate a case to peer review. 3. Quantify who is harmed if quality-measure abstraction disagreements is wrong. 4. For this Healthcare Alerts and Bundles file, read quality-measure abstraction disagreements against an AI tool suggesting codes the attending will not attest and write the one fact that would move to escalate a case to peer review for sepsis-alert program lead.

RECOMMENDATION Choose Proceed under protocol / Pause the pathway / Escalate safety review / Hold on this Healthcare / Alerts and Bundles packet (quality-measure abstraction disagreements after an AI tool suggesting codes the attending will not attest). The follow-on Alerts and Bundles action is what sepsis-alert program lead does next: implement the option, assign an owner, and log the missing fact.

COMMAND RETURNS - Bottom-line Healthcare option on to escalate a case to peer review, then the evidence in quality-measure abstraction disagreements, then the action for sepsis-alert program lead - Hypothesis scorecard against quality-measure abstraction disagreements: supported / rejected / untestable - What changes to escalate a case to peer review if an AI tool suggesting codes the attending will not attest is later withdrawn - Named option among Proceed under protocol, Pause the pathway, Escalate safety review and the fact that kills the others