The Basics

This standard deals with the subject of "automated review,” which is defined as "a computerized process whereby a validated algorithm is used for drug management."

The standard imposes two requirements on the organization's automated review process. 

• First, the organization must define the algorithmic protocol.  This involves identifying the evidence-based guidelines and parameters contained in each algorithm.
• Second, your organization must validate the algorithm.  In this process, the organization ensures consistent responses to the same set of data inputs.

Management Tips

Naturally, a clear policy and procedure is the best start to addressing this standard.  However, your policy and procedure also should set forth a method of documenting the algorithm definition and validation processes.  This no doubt will involve" nation with the information management staff assigned to the maintenance of the automated review process.

URAC Accreditation Tips

Both elements of the standard are mandatory.

Initial documentation should include the appropriate policy and procedure as well as documentation of the process of validating the automated algorithms.  In addition, your pharmacy provider manual section that describes minimum requirements for submission of requests to the automated review system should be submitted.

For the on-site review, make sure you have ready to show the reviewer documentation of recent validation of the algorithms.  In addition, make sure that your information management staff members associated with the automated review process are up-to-date on algorithm definitions and validation.