Electronic decision support for diagnostic imaging in a primary care setting.

Clinical decision support systems have been explored in primary care settings to improve diagnostic imaging practices. Prior research has shown mixed results in adoption rates and workflow integration. No prior work had resolved how physicians respond to non-mandatory decision support tools. This gap motivated a study to evaluate guideline adherence and acceptance of electronic decision support in a rural clinic. It was already known that diagnostic imaging orders often deviate from clinical guidelines. That uncertainty drove an investigation into how physicians interact with decision support systems. No prior work had resolved how workflow disruption affects long-term acceptance of such tools. This study aimed to address these uncertainties in a real-world clinical environment.

The study aimed to assess clinical guideline adherence for diagnostic imaging orders and evaluate acceptance of electronic decision support in a rural primary care clinic. It focused on how physicians use non-mandatory decision support tools in their workflow. The specific problem addressed was the gap in understanding physician behavior with optional decision support systems. The motivation stemmed from the need to improve guideline compliance in diagnostic imaging. It was already known that guideline adherence is often low in primary care settings. That uncertainty drove the investigation into workflow disruption and acceptance patterns. No prior work had resolved how experience affects physician perception of decision support. This study sought to clarify these dynamics in a real-world context.

The study spanned 36 weeks in a rural community family practice clinic. Physicians wrote 904 diagnostic imaging orders during the period. The Canadian Association of Radiologists guidelines were used as a reference for appropriateness. Orders were categorized as appropriate, inappropriate, or unnecessary based on these guidelines. A clinical decision support system provided prompts for inappropriate orders. Physician responses to these prompts were tracked over time. Workflow disruption was measured through self-reported surveys. Acceptance rates and use patterns were analyzed to assess system adoption.

Of the 904 diagnostic imaging orders, 58% were covered by available guidelines. Among these, 76% were ordered correctly. Inappropriate or unnecessary orders triggered prompts from the decision support system. On 25% of these cases, physicians followed the suggestions to correct their orders. Use of the system was not mandatory, leading to variable adoption rates. Initially, 40% of physicians found the system disruptive to their workflow. By the end of the study, this perception dropped to 16%. Despite support for the concept, physicians were reluctant to change clinical habits to integrate the tool.

The study found that clinical decision support systems can improve guideline adherence for diagnostic imaging orders. Physicians followed suggestions in 25% of inappropriate cases, though the system was not mandatory. Acceptance improved as physicians gained experience with the tool. Workflow disruption decreased from 40% to 16% over the study period. Physicians supported the concept of decision support but were hesitant to alter clinical habits. The findings suggest that experience reduces resistance to new tools. However, voluntary adoption limits the system's impact. These results align with the authors' claim that non-mandatory systems face adoption challenges.