Imaging pathways: will they be well trodden or less traveled?

Evidence of inappropriate investigations is not hard to find, and these result in a range of adverse clinical and economic outcomes. An online, evidence-based education and decision support application called Diagnostic Imaging Pathways (DIP) has been developed to assist clinicians to request the most appropriate examinations in the best sequence to achieve diagnoses. The development of the clinical and academic content of DIP and its continuous review and revision involve a network of specialists and general practitioners coordinated by an editorial panel. A research fellow is employed to search the literature, evaluate the evidence, and draft pathways for review. An information technologist develops the Web site, including new functionality, as the scope of the application is expanded. Dissemination is straightforward, with DIP being freely available on the Web (http://www.imagingpathways.health.wa.gov.au). Raising awareness of DIP beyond the immediate clinical environment is challenging. This is assisted through the development of partnerships with national and international entities, which have the core purpose of encouraging evidence-based clinical practice. The greatest challenge, however, is implementation; that is, achieving compliance between requesting practice and recommendations. There is a need to embed DIP into the clinical workflow such that clinicians are guided to choose the "correct" examination. One strategy is to replace paper-based referral processes with an electronic process and to progressively link "electronic requesting" to decision support. Evaluated trials are planned to bring the strategy to the stage of "proof of concept" in Australia.