Implementation of Electronic Clinical Decision Support for Radiology Referrals: The Role of Governance, Clinician Engagement and Education

OBJECTIVES: Medical imaging utilisation continues to increase globally, raising concerns regarding sustainability, workforce capacity, patient safety and environmental impact. Electronic Clinical Decision Support (eCDS) systems have been proposed as a strategy to improve imaging appropriateness; however, international experience suggests that technology alone is insufficient for successful adoption. This study describes an organisational implementation strategy for an eCDS programme for imaging referrals and examines early changes in imaging utilisation associated with clinician engagement and education strategies preceding system go-live. METHODS: An eCDS system was implemented within the electronic medical record at a quaternary referral centre in Melbourne, Australia. The initiative included governance structures, clinician engagement and targeted education to support integration into clinical workflows. Imaging utilisation data, including computed tomography (CT) examinations per emergency department (ED) presentation, were obtained from hospital activity records and analysed descriptively across engagement and deployment phases. RESULTS: Prior to eCDS go-live, CT utilisation increased from 32 to 44 examinations per 100 ED presentations. During the engagement phase preceding system deployment, CT ordering declined by 9.1%, coinciding with clinician engagement and education activities. Following eCDS deployment, imaging utilisation trends stabilised. CONCLUSIONS: Successful implementation of eCDS requires more than technological deployment. Governance, clinician engagement and sustained education appear important for supporting adoption of decision support systems and may facilitate early cultural change in imaging utilisation.