Healthcare in Quebec is seeing great returns on the implementation of digitized Clinical Decision Support (CDS) systems.

Santé Québec introduced the digitized system in 2024 and has since expanded to several different regions across the province.

“A CDS system was integrated into the existing computerized provider order entry (CPOE) and was deployed in Laurentides in April 2024, in Outaouais in November 2024, and Abitibi-Témiscamingue in February 2025,” explained Nathalie Bazylewicz, Project Manager for Santé Québec. “A total of 149 clinical indications and 1874 scenarios have been integrated using recommendations from the CAR Diagnostic Imaging Referral Guidelines, l’Institut National d’Excellence en Santé et Services Sociaux (INESSS), as well as custom entries.”

Bazylewicz acknowledged challenges during implementation, including the complexity of IT systems, resource allocation, competing priorities, and securing physician buy-in.

“As a French-speaking province, Quebec faced additional challenges in aligning the CDS with Canadian and Quebec-specific clinical practice guidelines,” she noted. “Support from the CAR and INESSS was instrumental in overcoming these hurdles.”

The project’s success is evident. “Clinical content coverage has grown from 90% to 95% since the first launch, thanks to ongoing updates from the CAR and INESSS. Additionally, 6% of orders have been canceled as ‘not the right test for the patient,’ resulting in estimated annual savings of $750,000 for a site processing 40,000 referrals,” said Bazylewicz.

A unified CDS system across Canada remains a priority for CAR, which has advocated for standardization with government officials and healthcare leaders. In November 2024, the CAR hosted the Conference on Digitizing Healthcare Referrals in Toronto, bringing together radiology experts, policy representatives, and other key stakeholders.

“Historically, CDS implementation has been led by local healthcare organizations, often with limited coordination,” Bazylewicz noted. “However, a more comprehensive approach, as demonstrated in Quebec, achieves greater success by addressing the complexities of policy frameworks, technical systems, clinical needs, and implementation efforts.” 

Despite Quebec’s progress, adoption across other provinces remains limited.

“Some provinces, like Alberta, have implemented CDS for advanced imaging (CTs, MRIs) however, they rely on American guidelines. Greater visibility of these initiatives and access to their outcomes would be invaluable for learning and collaboration,” Bazylewicz said. “In Quebec, embedding the CAR guidelines into our CDS has enhanced clinician engagement by aligning with local practices and positively influencing CDS usage.”

The CAR has continuously spearheaded efforts to implement digitized referrals across jurisdictions nationwide by conveying the benefits to radiology stakeholders at events like the Conference on Digitizing Healthcare Referrals. The day of insightful meetings featured expert speakers in front of an audience of radiology department and clinic directors, business managers, health human resource leads, health policy representatives, and other key radiology stakeholders.

“The conference provided an excellent platform to bring attention to the need for implementing CDS systems with important decision-makers in our field,” said Dr. Ania Kielar, CAR Past-President. “Streamlining referrals is proven to have a positive impact on physician health and patient care.”

At present, administrative burden siphons around 10 hours per week on tasks that don’t require the expertise of a physician, and innovative approaches are needed to reduce this burden. Key benefits of CDS systems include support for administrative functions, increased adherence to referral guidelines, and a streamlined referral process.

The sessions were broken into four topical categories, each with an element of group discussion and speakers specific to the topic: Current Status of Healthcare Referrals in Canada, Harnessing Technology to Improve Referrals and System Efficiency, Regulatory and Ethical Considerations, and Looking Forward.

The overall objectives of the day were to:

• Provide an overview of the current state of digitization efforts in Canada

• Create a discussion forum for shared challenges and barriers to implementation

• Develop an actionable and reproducible set of recommendations to facilitate implementation

The CAR also brought the issue to the attention of the federal government with our most recent advocacy efforts at Day on the Hill in October. Investing in the national integration of CDS systems into electronic medical records (EMRs) helps clinicians order the most appropriate test based on clinical need. The CAR recommended a federal investment of $50 million over five years. 

Quebec’s efforts highlight the potential for digitized referrals to improve healthcare efficiency and patient care nationwide. While other provinces such as Alberta and Ontario have implemented CDS systems and have also experienced success, there is more work required to achieve national implementation.