The EU Council Directive 2013/59/Euratom states in article 58c that referral guidelines for medical imaging, taking into account radiation doses, shall be available to referring physicians by February 2018 in all member states. Currently clinical decision support (CDS) for referral physicians does not exist in Sweden. The main purpose of a CDS system is to improve the appropriateness and justification of referrals for radiological procedures, in order to reduce unnecessary radiation exposure and financial costs. The European Society of Radiology (ESR) and its expert senior...

The ESR iGuide project in Region Jönköping county started with two parallel tracks. Meetings with technical and IT personnel together with the vendor of the computerised radiological order entry (ROE) were held, with the motive to create a seamless integration of ESR iGuide with the current referral workflow. Two technical integration alternatives were evaluated, and the region ultimately decided to use a loose integration with our currentERS system. This technical solution has many advantages, but one of the drawbacks (as opposed to a complete integration)...

To conclude, a pilot of the ESR iGuide CDS system is feasible, but in a country as administrative-heavy as Sweden, the preparation phase is longer than expected. However, ESR iGuide can be satisfactorily integrated into advanced pre-existing ROE systems. No results of the actual pilot phase are available for the time being, but communication has proved to be very important to the success of creating a satisfactory implementation environment. Pilot clinics are looking forward to getting the benefits of a clinical decision support system.

Henriettæ Ståhlbrandt MD, PhD Consultant in Radiology Senior Lecturer Assistant Head of Department Hospital of the Highlands Eksjö, Sweden Lars Lindeberg MD Radiological safety officer Consultant in Radiology Head of Department Emeritus Hospital of the Highlands Eksjö, Sweden

ICSI (Institute for Clinical Systems Improvement), white paper on Decision Support for Ordering Appropriate High-Tech Diagnostic Imaging Scans at the Point-of-Order. Accessed online 2017-01-18 at: https://www.icsi.org/_asset/0g594t/HTDI-Decision-Support-Overview.pdf Sistrom, C. L., Dang, P. A., Weilburg, J. B., Dreyer, K. J., Rosenthal, D. I., & Thrall, J. H. (2009). Effect of Computerized Order Entry with Integrated Decision Support on the Growth of Outpatient Procedure Volumes: Seven-year Time Series Analysis 1. Radiology, 251(1), 147-155.