I250] Implementing clincial imaging guidelines

Abstract

Clinical imaging guidelines are the most practical format to provide referring doctors with guidance on appropriate imaging based on clinical indications. But, while they have been available for decades, guidelines are hardly used in clinical practice, and study after study shows that medical imaging is utilised inappropriately to a significant degree. The best way to increase the use of guidelines in clinical practice without significantly disrupting or delaying the referral workflow are clinical decision support (CDS) systems. Implementing guidelines through integrated CDS has several benefits compared to text-based guidelines or stand-alone, static applications. The guidelines can be updated continuously, and updates can be deployed to users in very short intervals. Updating comprehensive guidelines is an extensive process, and for entire guideline sets, updated editions are often only released every five years or less. Integrated CDS provides users with guideline-based recommendations within their native workflow, so they do not have to use a different system, or even open a separate browser window. Anonymous patient parameters like patient age and sex are automatically sent to the order entry system so that users need only select the reason for exam. Implementation not only depends on technical aspects and a streamlined user experience, there are other factors to consider. In Europe, the availability of referral guidelines is a requirement for EU member states according to the Basic Safety Standards Directive (2013/59/Euratom). This directive is a welcome driver to increase the adoption and use of referral guidelines in clinical practice. While this applies across the EU, the healthcare systems, utilisation of medical imaging, and incentives at work are very different, requiring a tailored strategy for promoting the implementation of guidelines in each country. This is why the ESR’s EuroSafe Imaging campaign has established a working group to promote the implementation of guidelines through clinical decision support this year. Working with national radiology societies, radiation protection campaigns, national authorities and other stakeholders, the group’s purpose is to identify strategies for maximising the adoption of evidence-based guidelines, and their application in clinical practice.