CAR project promotes evidence-based imaging
December 16, 2020
OTTAWA – The Canadian Association of Radiologists (CAR), with support from the Canadian Medical Association (CMA), has launched a national project to integrate diagnostic imaging referral guidelines into digital Clinical Decision Support (CDS) systems in Canada. Canada’s radiology community will co-develop national referral guidelines for medical imaging, helping to support referring physicians in selecting the best imaging test for their patients.
These evidence-based, peer-reviewed guidelines will be made freely available to guide healthcare professionals in their implementation of CDS systems to enhance care and enable better communication among physicians.
“Imaging referral guidelines should be collaborative, non-punitive tools, designed to improve quality, safety and appropriateness. Collaboration with all stakeholders, including patients and ordering providers is needed to create comprehensive Canadian guidelines, designed to improve care for Canadian patients and families,” says Dr. Ryan Margau (pictured on left), co-chair, CAR Referral Guidelines Working Group and chief and medical director, Medical Imaging, North York General Hospital.
Starting in January 2021, the CAR will be working with a team of epidemiologists to take the lead on the development of these evidence-based guidelines using the GRADE methodology, ensuring all guidelines are context-specific to the Canadian healthcare system. CAR will also seek input from the full breadth of the radiology community. Drs. Ryan Margau and Paul Pageau, CAR Referral Guidelines Working Group Co-chairs, will provide leadership and oversight of this project.
“We need to work collaboratively with the broad spectrum of referring medical professions to make informed decisions regarding the selection of medical imaging tests and treatments. Having easily accessible Canadian guidelines will help us achieve this.” says Dr. Paul Pageau (pictured on right), co-chair, CAR Referral Guidelines Working Group and director, Point of Care US, Department of Emergency Medicine, The Ottawa Hospital and assistant professor, University of Ottawa.
The goal of this project is to promote evidence-based medicine as well as improve access to care and better health outcomes for patients.
For its part, Canada has lagged behind the rest of the industrialized world when it comes to e-referrals. CDS systems for medical professionals referring to radiology have been implemented with considerable success in other countries.
The Royal College of Radiologists in the United Kingdom, for instance, is working to pilot the delivery of radiological referral guidelines through CDS software. In the US, as of January 1, 2020 the Protecting Access to Medicare Act (PAMA) requires referring providers to consult appropriate use criteria prior to ordering advanced diagnostic imaging services (CT, MR, Nuclear Medicine and PET) for Medicare and Medicaid patients.
While these developments have not gone unnoticed in Canada, only a few Canadian hospitals and jurisdictions have started implementing CDS. North York General Hospital, in Toronto, has implemented a CDS system that is integrated into the ordering module of their hospital electronic medical record (EMR) system. Alberta Health Services has also begun to implement a similar electronic referral system.
The CAR intends to build on these successes and look at best practices for the development of a national electronic referral system for radiology. This is not limited to medical imaging. In fact, once developed, this system could act as a blueprint for other specialties in Canada.
Working in consultation with national medical bodies such as the Canadian Association of Emergency Physicians and the College of Family Physicians of Canada, the CAR plans to begin the development of evidence-based national referral guidelines. Choosing Wisely Canada and the Nurse Practitioner Association of Canada will also be key stakeholders in the process and validate that the focus is centered on safeguarding patients and advocating for optimal care for Canadians.
The implementation of national diagnostic imaging referral guidelines that can be integrated into CDS systems in Canada will help bring the latest evidence-based guidelines to ordering medical professionals. Ensuring that patients receive the medical imaging referral that provides the most clinical value at the right time while also reducing risks as much as possible is the goal.
Widespread adoption of CDS tools allows for referring medical professionals to have access to latest evidence-based knowledge as part of their regular workflow – taking some of the unknowns out of ordering medical imaging. Such a system in Canada could improve outcomes and reduce backlogs, ensuring that Canadian patients receive the right test at the right time.