Update: The use of a CDS tool to support the Radiology service by optimising demand and referrals remains a viable option and may be looked at again as part of the Scottish Strategic Network for Diagnostics review of realistic radiology.
Aim
Modern medicine is growing increasingly complex and there is a myriad of guidelines that clinicians need to follow when they make decisions. In radiology, there is international interest in Clinical Decision Support (CDS) systems to encourage appropriate use of radiology resources. This type of software is already being adopted in many European sites and has become a legal requirement for all radiology requests in the US.
The Clinical Decision Support (CDS) project was established to identify whether Clinical Decision Support software could increase efficiency in the referral of patients to radiology in Scotland and to help ensure that patients are referred for the right exam, first time.
Objectives
- To support clinicians in their decision-making about the most appropriate radiology scans for patients, based on guidelines from the Royal College of Radiologists.
- To streamline processes and improve patient safety through avoiding unnecessary procedures and radiation exposure.
- To increase productivity and identify opportunities for cost savings.
How
Completing and evaluating a pilot of MedCurrent’s Radiology iRefer CDS product to establish the true value of Clinical Decision Support within Scottish Radiology and pave the way for an effective Scotland wide solution.
The original pilot implementations were planned to take place in NHS Greater Glasgow and Clyde and NHS Tayside. SRTP funded a CDS System for a period of two years for the pilot Boards and the Royal College of Radiologists (RCR) iRefer guidelines were incorporated into MedCurrent’s iRefer CDS System. This was then to be integrated with the CliniSys ICE Order Communications System (OCS) in the two Boards.
A combination of the COVID-19 pandemic and technical issues with CliniSys ICE, led to significant delays and the pilots have yet to commence. However, the SRTP team has produced a comprehensive evaluation report demonstrating that CDS has the potential to deliver against all of the project’s objectives and outlining the pre-requisites to implementation. The report is based on data from deployments of iRefer CDS throughout NHS England and a readiness assessment of the technical landscape in Scotland.
The following recommendations are now being progressed, collaboratively, as part of the Digital Health and Care Delivery Plan:
- A National Radiology OCS strategy and deployment is required as a pre-requisite and should be done alongside other diagnostic disciplines, where there are similar requirements.
- Firm local and national, clinical and managerial support is vital for successful implementation.
- Due to other key IT dependencies in deploying CDS, it should form part of the wider national IT strategy, including a national Radiology Information System and recommendations coming out of the Target Operating Model for national radiology IT.
Although the national CDS project is now closed, piloting is expected to continue at a local Board level to realise local benefits, with the SRTP providing national clinical input, governance and secretariat support. MedCurrent remains committed to the pilot and is available to support the local Boards as required.
Who
The project team managing the delivery of the Clinical Decision Support project includes:
- Clinical Lead – Dr Raj Burgul
- Project Manager – Adam Pinner