Justification: gain or game

Abstract

Like legal justice, which is an absolute necessity but not always fair or timely, justification has its limitations. Prior studies have documented a decline in the utilization of imaging tests after the implementation of a CDS system (4-7) . Weilburg et al. reported a 28% decline in the use of high-cost imaging tests from 2007 to 2013, after a utilization management program was instituted in an outpatient setting (6) . However, some studies have suggested that those initial reductions in imaging utilization are temporary (8,9) . Other investigations have raised concerns about the substantial lack of consistency between the clinical indications specified in the CDS system and the symptoms, signs, and diagnoses described in the EHRs (10) . Gupta et al. found a 4.2% error rate in CDS system orders for computed tomography pulmonary angiography (10) . Such inconsistencies do not necessarily suggest malicious intent and might stem from errors in the EHR, a complex clinical presentation, or patient expectations or demands. The Brazilian College of Radiology and Diagnostic Imaging has initiated efforts to create referral guidelines for imaging in Brazil.