At ECR 2014, the ESR announced an ambitious project to introduce a Clinical Decision Support (CDS) system for imaging referral guidelines – a software tool to aid referring physicians in recommending the most appropriate radiological examination for patients – on the European market. After evaluating different possibilities to address the lack of use of imaging referral guidelines and concomitant inadequacies in the use of imaging procedures, as well as to ensure the availability of guidelines throughout Europe, the ESR decided to look across the pond and learn from the implementation of ACR Select in the United States.
ACR Select is a CDS system developed jointly by the American College of Radiology (ACR) with the health IT firm National Decision Support Company (NDSC). Since its launch two years ago, ACR Select boasts an impressive track record of enabling radiologists and referring physicians to utilise imaging technologies in a more targeted way, thereby reducing unnecessary exposure to radiation and improving diagnosis and treatment for patients, to say nothing of additional benefits such as greater clinical workflow and cost efficiency. The ESR has partnered with ACR and NDSC to replicate this success in Europe.
The partnership with ACR and NDSC allows the ESR to build on their work and experience. Rather than reinventing the wheel, ESR experts will ‘Europeanise’ the ACR Appropriateness Criteria, i.e. adapting them into imaging referral guidelines tailored to the European setting. Nine organ-based expert groups will conduct a scientific review of the American guidelines overseen by a dedicated methodologist, and ensure that European standards of practice and scientific literature are duly taken into account. Further to this Europeanisation, localisation of the recommendations is possible for end users based on regional or institutional requirements such as the availability of imaging equipment, while the software can be integrated into hospitals’ existing IT infrastructure.
Presentation of a prototype of the ‘ESR iGuide’ is planned for the next European Congress of Radiology in March 2015, with rollout of the final product to start from summer 2015. In addition to this European project, the ACR and the ESR have concluded a Memorandum of Understanding that includes a commitment to work towards a global solution to make CDS and evidence-based imaging referral guidelines available in all parts of the world. Cooperation on establishing a common terminology and standards will start during the ESR’s European review.
CDS has the potential to revolutionise the way medical imaging is used in Europe, especially at a time where healthcare costs are on the rise and concerns about the effects of exposure to ionising radiation are increasing. Successfully introducing a CDS system in a market that includes dozens of distinct healthcare systems seems a daunting challenge – but the promise of achieving better healthcare for less money certainly makes it worth the effort.