Following an agreement with the ACR in 2014 that enabled the ESR to use their well-established Appropriateness Criteria,
developed over the past 25 years by 12 expert panels,
an ESR-appointed team of specialists from various areas of clinical radiology conducted a scientific review of the ACR’s criteria in order to adapt them for use in the European setting.
Led by a dedicated methodologist,
the ESR’s European Imaging Referral Guidelines constitute a common set of standard guidelines for use in Europe in a format that enables users to localise the guidelines according to national requirements or institutional circumstances.
This ‘Europeanisation’ process carried out in 2015 is the first step towards the ESR and ACR’s shared vision of developing a joint set of global,
evidence-based guidelines in the future.
The ESR and NDSC Europe are now in the process of bringing the benefits of CDS to Europe.
With ACR Select (the CDS system distributed in the United States by the ACR and NDSC since 2012) installed at more than 100 US sites,
the impact of making referral guidelines available to referrers within their workflow at the point of care has been demonstrated.
After an initial ACR Select pilot test at the Hospital Clinic in Barcelona,
the Clinic is currently in the process of switching to ESR iGuide,
which is being integrated into a new order entry system used by General Practitioners.
The process of introducing ESR iGuide for inpatient referrals within the hospital is also under way.
(Please refer to the ESR iGuide poster of the ECR 2016 EuroSafe Imaging exhibition for more information on the Barcelona pilot project.)
Another pilot project in Europe was recently concluded in Croatia.
Following the integration of ESR iGuide into the eReferral platform of the IN2 Group in the summer of 2016,
NDSC Europe and IN2 implemented pilot installations of ESR iGuide in five sites in Croatia,
overseen by Croatia's ministry of health,
that ran from September 2016 to January 2017.
The pilot period was split into two distinct phases: data collection to analyse the appropriateness of current referrals; and a second phase with appropriateness feedback shown to referrers within the order entry workflow,
according to the ESR's imaging referral guidelines.
Preliminary results indicate that up to 25 percent of referrals for diagnostic imaging were either inappropriate,
or could have been done using a more appropriate alternative modality.
Aside from statistically significant improvements in appropriateness of referrals,
the data captured through the use of ESR iGuide has led to findings for other qualitative improvements in the referral process.
NDSC and IN2 are currently compiling a report with a detailed statistical analysis of the pilot phase,
including recommendations to further improve the referral process.
Among the other pilot implementations in progress in Europe is a pilot project in five clinics in Jönköping County,
Sweden,
which is detailed in a dedicated EuroSafe Imaging Poster at ECR 2017 (Poster Number ESI-0009).