Everything Every Radiologist Always Wanted (and Needs) to Know About Clinical Decision Support

Factors Driving Resistance to Clinical Decision Support: Finding Inspiration in Radiology 3.0

“…(3) psychological factors, including cognitive biases or habitual behaviors leading to inappropriate use of imaging; (4) clinician knowledge gaps or misinformation regarding EBGs; (5) perceived inconsistencies that may exist between available guidelines from the various professional societies; (6) skepticism or suspicion of the value of EBGs to guide patient care as opposed to clinician judgement; (7) defensive medicine practices leading to overuse in direct opposition to EBGs; or perhaps (8) other undiscovered or unanticipated factors. We sought to uncover which, if any, of these might be the primary drivers of the phenomenon of clinician resistance to CDS.…”

“…These systems are designed to combine ease of use with reliable, comprehensive evidence-based guidance. We have previously described the basic concepts and rationale for CDS [8]. CDS systems simplify the use of EBGs for clinicians at the point of care, and computerized applications for CDS have been developed to streamline its integration into the clinical workflow.…”

Increasing and disparate use of neuroimaging for adults and children with non‐traumatic headaches in the US emergency departments: Opportunities for improvement

“…52 Our results suggest that despite the existing evidence-based utilization guidelines, further work is needed to improve standardization and decrease currently existing disparities in imaging use for headache in the ED. Implementation of electronic clinical decision support systems 25 can serve as an additional tool assisting practicing physicians with navigating the complexities of imaging utilization in headache in the realities of busy EDs and multiple confounding factors.…”

“…[17][18][19] In the last two decades, overall imaging utilization, regardless of indication, has been on the rise in the United States, 20 including both the adult and pediatric ED settings [21][22][23][24] with up to 30.0% of currently performed medical imaging of dubious clinical necessity. 23,25,26 The scope and focus of prior studies investigating the use of imaging in headache were limited to outpatient settings, 1,27 ED settings before 2007, 23,28 single-institution cohorts, 6 short (1 year) study periods, 6,29 and single imaging modality, 29 or were based on patient-generated data obtained through household surveys. 22 Longitudinal population-level patterns of imaging utilization for headache in US EDs in the last decade remain unknown.…”

Handoffs in Radiology: Minimizing Communication Errors and Improving Care Transitions

“…Templates for structured reporting that also include auto-filling features as well as macros for adding comprehensive information or triggering alerts are other ways that standardization can be automated for greater reliability [41,[73][74][75]. Automated electronic decision support tools can then be applied to both orders and reports to automatically incorporate appropriateness criteria into handoffs and connect them to accurate patient information, examination indications, and evidence-based follow-up recommendations that guide and enhance communication [38,41,[76][77][78][79][80]. In a Thyroid Imaging Reporting and Data System study comparing structured templates to free-text formats, errors decreased by 10% when using a fully structured template that provided a guided impression section and reference to a Thyroid Imaging Reporting and Data System scoring algorithm.…”