Clinical Decision Support Systems: Breaking ground for imaging referral guidelines in Canada

By Dr. Martin Reed

The Canadian Association of Radiologists (CAR) is advocating for the implementation of Diagnostic Imaging (DI) Clinical Decision Support (CDS) Systems in Canada. Access to updated medical imaging referral guidelines is crucial to ensuring the appropriateness of diagnostic imaging tests and quality patient care. The best way forward for appropriate imaging requires a multi-tiered stakeholder approach to implement DI CDS across Canada.

CDS systems are software platforms that are installed at the point of physician order entry – at the level of the electronic health record or patient digital medical record. CDS systems integrate current, evidence-based guidelines for imaging of various health conditions and symptoms into the regular workflow of a referring physician.

CAR is steadfast in its position that the right test should be given to the right patient, at the right time. Ensuring that all medical imaging examinations are the most appropriate for every patient will not mean less care. It will mean that health system resources used for DI are used as efficiently and effectively as possible to enable optimal outcomes. Enhanced appropriateness of imaging referrals will also mean more timely access to care in some cases, which can contribute to decreased wait times for Canadians.

We are collaborating with several national stakeholder organizations on the issue of medical imaging referral guidelines, including the College of Family Physicians of Canada, the Canadian Association of Emergency Physicians and Choosing Wisely Canada. Bringing together experts from these organizations has facilitated the sharing of information and insight about how best to ensure the appropriateness of medical imaging referrals and while fostering access to referral guidelines for front-line physicians and healthcare workers. CAR has also held consultations with various provincial health authorities. These discussions have underscored the desire to establish one centralized, national system of DI referral guidelines and associated CDS systems.

The CAR has approached the federal government and has asked that they take a leadership role in the implementation of a CDS System in Canada. The CAR to date has been at the helm of facilitating stakeholder consultations and would like to continue to be an active participant in this space: however, this initiative should be led by an independent collaborative body that can bring together affected groups.

In establishing a national set of DI referral guidelines, we improve the patient experience and save the healthcare system valuable time and money. A move to implementation of DI CDS systems nationally will help ensure better access for those who require medical imaging by appropriately meeting the needs of the patient and reducing the backlog.

CAR has hosted two stakeholder consultation meetings in 2018. The main objective was to receive expert guidance on integrating referral guidelines into CDS. Discussions focused on making clinical referral guidelines more accessible to front-line physicians: general practitioners and emergency physicians and integrating these guidelines into the Canadian health care landscape in a seamless and efficient manner. During that stakeholder consultation process participants reviewed examples from other jurisdictions and established recommendations for next steps.

It is our desire to continue in a guidance capacity in facilitating implementation of diagnostic imaging CDS systems in Canada. There will be challenges in introducing these into the Canadian healthcare market.  However, with all the stakeholders on board and the federal government taking a leadership role on a strategy for CDS integration is viable.

Dr. Martin Reed is Chair, Referral Guidelines Working Group, CAR.