As many as 30% of diagnostic imaging procedures deemed unnecessary

Canadian Association of Radiologists helps physicians choose best test first

OTTAWA, Sept. 27 /CNW/ - The Canadian Association of Radiologists (CAR) recently contributed to a report produced by the Health Council of Canada (HCC) entitled “Decisions, Decisions: Family Doctors as Gatekeepers in the Use of Prescription Drugs and Diagnostic Imaging in Canada.” This report, which was released today, supports one of the CAR’s main objectives: to implement medical imaging guidelines at a national level to guide physicians in selecting the most effective diagnostic imaging exam the first time.

As many as 30% of diagnostic imaging procedures are deemed inappropriate or contribute no useful information. According to Dr. Ted Lyons, President of the CAR, “Reducing the amount of unnecessary imaging is essential in maintaining patient safety, reducing wait times, and reducing the strain on the financial and health human resources of our healthcare system.” The operational costs for diagnostic imaging in Canada now exceed an estimated $2.2 billion; reducing the amount of unnecessary tests by as little as 10% would represent a savings of $220 million to the healthcare system.

The CAR is currently redeveloping its Diagnostic Imaging Referral Guidelines, originally produced in 2005, to reflect the ever evolving technologies and considerations surrounding these guidelines to provide physicians with this much needed support in ordering the most appropriate diagnostic imaging exam. The new guidelines are expected to be completed later this year.

Physicians are increasingly facing challenges in their workplace. Not only do they have heavier workloads, but they are also expected to keep up with copious amounts of research and new medical developments. The CAR is facilitating the use of the Diagnostic Imaging Referral Guidelines by making them available in an electronic format through computerized clinical decision support (CCDS) systems, which can be incorporated into physicians’ daily routine when ordering diagnostic imaging tests.

As outlined in the HCC report, family physicians are considered “gatekeepers” because of their decision-making authority. Dr. Martin Reed, Chair of the CAR Guidelines Working Group, notes that “giving physicians the proper tools to select the appropriate tests is vital in ensuring all Canadians receive the highest quality of care.” The CAR will continue to provide support and cutting edge information to help physicians make the most effective choices, and in turn, help patients get the care they need more efficiently.

About the CAR
The Canadian Association of Radiologists is the national voice of radiology committed to promoting the highest standards in patient-centered imaging, lifelong learning and research. Our physician members are respected as the experts in using diagnostic and therapeutic interventional imaging technology to promote safe, efficient and quality health care for Canadians. Radiologists are integral members of the healthcare team.

For more information on the CAR’s initiatives, please refer to the attached backgrounder.

Backgrounder

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Canadian Association of Radiologists Helps Physicians Choose Best Test First

OTTAWA, ON (September 27, 2010)

The CAR
The Canadian Association of Radiologists (CAR) is the national specialty society for radiologists in Canada. It is dedicated to maintaining the highest standards of care, promoting patient safety and helping radiologists contribute to the very best health care for patients.

The CAR is particularly active on three fronts:

• working with governments, health professionals and technology leaders to make optimal use of diagnostic imaging (DI) to ensure the right tests are performed the right way and interpreted the right way
• serving as the voice of Canadian radiology so that governments, the public and the media are fully informed about the benefits and risks of DI, the challenges faced and the solutions proposed
• creating, accrediting and promoting opportunities for continuing medical education and research, to help radiologists stay at the leading edge of DI health care

Best Practices in Radiology
The CAR is committed to providing solutions in providing quality DI services to Canadians. Initiatives of the CAR address critical healthcare concerns:

• to ensure quality patient care through the use of referral guidelines for DI services
• to make the best use of DI equipment through appropriate use of current and new technology
• to significantly reduce wait times for DI by ensuring the appropriate use of equipment
• to promote patient safety through radiation awareness and the provision of the best test for patient needs

The CAR Diagnostic Imaging Referral Guidelines
In 2005, the CAR developed a set of evidence-based guidelines entitled Diagnostic Imaging Referral Guidelines: A Guide for Physicians in order to assist healthcare professionals in making the most appropriate diagnostic imaging referrals. The CAR will have a redeveloped version of these guidelines available later in 2010. This redevelopment is necessary in order to reflect newly emerging technologies, the ongoing research, and considerations surrounding these guidelines.

The CAR guidelines help physicians order the most appropriate imaging exam for the clinical problem. When physicians choose the best test first it results in more effective and efficient use of DI equipment and health human resources and fewer tests for patients, which in turn improves patient care and safety and reduces DI wait times.

Computerized Clinical Decision Support (CCDS) System
Although the CAR DI referral guidelines are available in a booklet or PDF format, and through numerous physician websites, the CAR recognizes that for maximal effect its guidelines must be made seamlessly available as part of the clinician’s regular workflow. To achieve this, the CAR guidelines have been integrated into a computerized physician order entry (CPOE) system for diagnostic imaging with attendant computerized clinical decision support (CCDS). This is believed to be the most effective way of implementing guidelines to ensure that diagnostic imaging is used appropriately and that the human resources dedicated to diagnostic imaging (radiologists, technologists and others) are being used effectively.

This initiative can also serve as a prototype and the lessons learned can assist in the integration of other types of decision support into electronic health records, one of the 2015 priorities identified by Infoway to “unlock additional quality and safety benefits by enabling decision support and communication across the care continuum” in its Electronic Health Records: 2015 Canada’s Next Generation of Healthcare at a Glance.

To order a copy of the Diagnostic Imaging Referral Guidelines: A Guide for Physicians, please contact the CAR at 613 860-3111 or visit www.car.ca.

Manitoba Projects
Health Canada and Manitoba Health and Healthy Living joined with the CAR to organize two studies in Manitoba to study the effectiveness of providing the CAR referral guidelines through CCDS and CPOE.

The first study, which was completed in 2007, focused on specialist paediatricians at Children’s Hospital Winnipeg. The second study, which was completed in 2009, involved a group of family and general practitioners at the Steinbach Family Medicine Clinic in Steinbach Manitoba.

Results of the two first studies suggested that 10 to 20 per cent of imaging requests were inappropriate. They also clearly indicated that there is a need for more research into the use and acceptance of guidelines by ordering physicians, as well as the value of initiatives to improve physician ordering behaviour. The reports also indicate the potential to achieve reductions in costs and wait times for diagnostic imaging by cutting inappropriate and unnecessary ordering. For more information on these studies, please visit http://www.car.ca/en/about/reports/appropriateness.aspx.

The CAR has a third study currently underway at a children’s hospital in Winnipeg to study how to improve compliance with the best practice guidelines. Several other provinces are separately undertaking or exploring guidelines implementation initiatives.

Where do we go from here?
The CAR commitment continues.

• Improve the guidelines – the CAR commits to continuing to keep guidelines for Canada current
• Improve the software – the CAR will continue consultations with software producers to build in advice that is effective and efficiently placed in the clinical decision stream
• Other venues – the CAR will undertake projects focused on general practitioners (typical Canadian patient contact with the healthcare system), secondary hospitals and rural/remote settings, as well as projects with high throughput users (i.e. busy emergency rooms) and high volume DI clinical users (i.e. orthopaedics)
• Improve physician uptake of guideline recommendations – the CAR will develop and test interventions with physicians (specialists and generalists) to facilitate their behaviour change
• Increase guidelines utilization – the CAR is actively seeking other regional, provincial and federal partners to explore further possibilities of reducing inappropriate DI demand

For further information:

To coordinate an interview with a spokesperson from the Canadian Association of Radiologists, contact:
Josée Roy-Pilon, Director of Communications and Events
613 860-3111, ext. 203 or by email at [email protected]