East Midlands Imaging Network (EMRAD) has launched the iRefer Clinical Decision Support (CDS) software solution for radiology referrals across the region, in partnership with software provider MedCurrent. iRefer is the radiological investigation guidelines tool from The Royal College of Radiologists (RCR). It synthesises evidence-based guidelines from UK and international sources and provides recommendations for the daily use of clinical imaging services.
MedCurrent’s iRefer CDS is an initiative to improve the decision-making process of radiology referrers in real-time. It uses more than 300 guidelines to improve healthcare delivery by ensuring the selection of the most appropriate imaging. The guidance works alongside GPs’ and other healthcare professionals’ existing processes to ensure minimal extra work in the referral process.
Benefits of using iRefer CDS include: supporting the referral process, including getting patients to the most appropriate type of imaging or other specialist referral as soon as possible; reducing unnecessary workload in radiology departments by removing inappropriate requests; and providing information to referrers at the point of access to support training and education.
The GIRFT (Getting It Right First Time) programme recommended iRefer in a report: “We recommend that the iRefer online tool is used more widely to support radiology referrals, and that trusts follow the best practice examples we identified to help reduce the volume of investigations of low clinical value they undertake. These approaches should help to reduce the demand for such imaging, freeing up resources for the higher value tasks. iRefer is also now available in a CDS-enabled version that integrates with referral systems in primary and secondary care. We would welcome the use of this version across England as this would allow consistent access to clear and standardised imaging referral guidelines.”
The EMRAD iRefer project board agreed a phased approach to deployment whereby modalities would be introduced one by one to allow proper understanding and control of the operational effects CDS would have. EMRAD and the East Midlands Cancer Alliance collaborated on the initial discovery phase for implementation. As part of the national Digital Diagnostic Capability Programme, NHS England funded the deployment of the project. Since then, the solution has gone live or is in planning across the EMRAD network.
iRefer CDS was deployed in Nottingham University Hospital NHS Trust, Kettering General Hospital NHS Foundation Trust and Sherwood Forest Hospitals NHS Foundation Trust in August to October last year. So far, 1,400 GPs have submitted over 26,000 requests using iRefer CDS guidance. Deployment at United Lincolnshire Hospitals NHS Trust, Northampton General Hospital NHS Trust, University of Derby and Burton NHS Foundation Trust and Chesterfield Royal Hospital NHS Foundation Trust is expected soon.
Results and feedback from the regions that have gone live are encouraging. Inappropriate or suboptimal requests are being adjusted at the point of request and the volumes of these requests reducing over time suggests improvements in user education.
EMRAD network director Penny Storr said: “So far, the solution has shown much promise in Nottinghamshire and Kettering. It provides clinicians with evidence-based guidance and makes it easy to get the right test first time, which minimises patient delays.”
Nottingham University Hospital NHS Trust radiology general manager Sara Bharmal said: “We are very pleased with the roll out of iRefer CDS for x-rays being requested by GPs and we are looking at extending this to referrals for ultrasound appointments in the near future. iRefer CDS complements the existing radiology advice and guidance system in place, which together improve communications and information between GPs and radiology, all for the benefit of getting patients access to the right imaging first time.”
Sherwood Forest Hospital radiology service manager Sarah Sentence added: “The potential impact of this clinical decision-making tool is to streamline patient pathways and remove unnecessary delays.”
The solution factors in patients’ clinical history, such as lab results and previous imaging, to ensure that recommendations are specific to each patient’s health profile.
Picture: Referral request data from iRefer.
Submitted by EMRAD project manager Phil Vale and MedCurrent vice president, account management, Martin Kepa.
Published on page 24 of the March 2023 issue of RAD Magazine.