‘‘(2) DEVELOPMENT AND MAINTENANCE OF IM-
AGING APPROPRIATENESS REGISTRIES BY MEDICAL 
SPECIALTY SOCIETIES.— 
‘‘(A) IN GENERAL.—Not later than April 
1, 2014, the Secretary shall qualify registries 
that are developed and maintained by national 
professional medical specialty societies. 
‘‘(B) REQUIREMENTS.—Registries quali-
fied under subparagraph (A) shall meet the fol-
lowing requirements: 
‘‘(i) The registry shall document— 
‘‘(I) the use of an approved elec-
tronic clinical decision support tool (as 
described in paragraph (3)) in connec-
tion with the ordering and perform-
ance of an applicable advanced diag-
nostic imaging service; 
‘‘(II) whether orders for applica-
ble advanced diagnostic imaging serv-
ices were consistent with related ap-
propriate use criteria (including an 
appropriateness score where available 
from the approved electronic clinical 
decision support tool); 
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‘‘(III) the clinical indication for 
the applicable advanced diagnostic im-
aging services ordered; and 
‘‘(IV) in situations where an 
order for an applicable advanced diag-
nostic imaging service is not con-
sistent with the related appropriate 
use criteria, the rationale of the order-
ing or furnishing supplier or provider 
(as the case may be) for such incon-
sistency. 
‘‘(ii) The registry shall be structured 
to allow access to data for future research, 
provide a centralized analysis of the data 
submitted, including the impact on utiliza-
tion changes for applicable advanced diag-
nostic services, and provide connections 
with existing medical society registries. 
‘‘(iii) The registry shall generate re-
ports on at least a quarterly basis pro-
viding feedback to suppliers and providers 
that order and furnish applicable advanced 
diagnostic imaging services on the ordering 
activity of the supplier or provider and re-
lated appropriate use criteria metrics. 
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‘‘(C) MULTIPLE QUALIFIED REGISTRIES.— 
In the case where more than one registry is de-
veloped under this paragraph, the Secretary 
shall ensure that each registry receives stand-
ardized data such that the data may be com-
bined and compared across registries. 
‘‘(D) PERIODIC UPDATING.—The Secretary 
shall periodically update the list of registries 
qualified under this paragraph. 
‘‘(3) LISTING OF QUALIFIED SUPPLIERS OF AP-
PROVED ELECTRONIC CLINICAL DECISION SUPPORT 
TOOLS.— 
‘‘(A) IN GENERAL.—Not later than July 1, 
2014, the Secretary shall publish a list of quali-
fied suppliers of approved electronic clinical de-
cision support tools, in accordance with the pro-
visions of this paragraph. 
‘‘(B) STANDARDS.— 
‘‘(i) IN GENERAL.—The Secretary, in 
consultation with the medical specialty so-
cieties described in paragraph (2)(A), shall 
establish standards for the approval of 
electronic clinical decision support tools 
provided by qualified suppliers. 
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‘‘(ii) STANDARDS.—The standards es-
tablished under clause (i) shall include the 
ability of such tool to— 
‘‘(I) use only standards and 
guidelines developed by national med-
ical specialty societies; 
‘‘(II) capture the clinical indica-
tion for the applicable advanced diag-
nostic imaging services ordered, se-
lected from the related appropriate 
use criteria; 
‘‘(III) accurately deliver to the 
ordering clinician appropriate use cri-
teria (and related guidelines) for ap-
plicable advanced diagnostic imaging 
services, regardless of the physician 
specialty (if any) from which the cri-
teria or guidelines originated or to 
which the criteria or guidelines are di-
rected; 
‘‘(IV) in the case where there are 
multiple standards or guidelines appli-
cable to a particular service or a spe-
cific set of clinical indications, indi-
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cate the standards or guidelines that 
are being applied; 
‘‘(V) determine the appropriate-
ness of orders for such services; 
‘‘(VI) submit standardized data 
to one or more registries qualified 
under paragraph (2) that is sufficient 
for such registries to meet their docu-
mentation 
obligations 
under 
that 
paragraph; 
‘‘(VII) be regularly and timely 
updated; 
‘‘(VIII) generate a unique elec-
tronic identifier (referred to in this 
subsection as a ‘Clinical Decision Sup-
port Number’) that documents the 
fact that the clinical decision support 
tool was consulted by the ordering 
supplier or provider in connection 
with the ordering of an applicable ad-
vanced diagnostic imaging service; 
and 
‘‘(IX) perform other functions 
determined to be necessary by the 
Secretary in consultation with the 
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medical specialty societies described in 
paragraph (2)(A). 
‘‘(C) DESIGN.—An approved electronic 
clinical decision support tool under this para-
graph— 
‘‘(i) may use a web-based portal, or be 
imbedded into an electronic health record 
system or other health information tech-
nology tool; and 
‘‘(ii) shall meet the privacy and secu-
rity standards under the regulations pro-
mulgated pursuant to the Health Insur-
ance Portability and Accountability Act of 
1996. 
‘‘(D) USAGE AND CONVENIENT ACCESS RE-
QUIREMENTS.—The Secretary shall only include 
in the list published under this paragraph ap-
proved electronic clinical decision support tools 
provided by suppliers who— 
‘‘(i) attest that they have obtained 
permission to incorporate appropriate use 
criteria (and related guidelines) developed 
by national medical specialty societies; and 
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