Just-in-time radiologist decision support: the importance of PACS-integrated workflow

Decision support systems for radiologists can provide information during image interpretation that may efficiently improve diagnostic accuracy and increase radiologists' confidence. However, most decision support systems require radiologists to exit PACS, which may deter busy radiologists from pursuing decision support. The purpose of this study was to determine whether radiologists would use a PACS-integrated decision support tool more frequently than an equivalent nonintegrated system.

Forty-eight radiology residents were randomly assigned to one of two groups: the control group was provided access to a radiology clinical decision support tool via Web access, which required the resident to launch a Web browser from a desktop icon and then log in to the decision support application. The experimental group was provided access to the same tool but was allowed to launch from a PACS-integrated portal with automated login and authentication. Halfway through the 10-month study period, the groups were switched. The main outcome measure was the average number of decision support sessions initiated each month over the study period.

The experimental (integrated) group had higher use than the control (nonintegrated) group by a factor of 3.0 (P < .05). When integrated access was removed from the experimental group, their use fell by 52%. When integrated access was granted to the control group, their use rose by only 20%.

Integration with PACS improves radiologists' use of clinical decision support tools. Integrated access is critical at the time of initial deployment, or acceptance of the decision support tools may be undermined.