Diagnostic imaging ordering practices: physician perspectives and implications for decision support

This study explored how referring physicians order diagnostic imaging (DI) services, and possible methods to reduce inappropriate ordering. Telephone interviews were conducted with non-radiologist physicians (general practitioners and specialists). Interview data were analyzed using grounded theory. Both appropriate and inappropriate DI ordering practices emerged as the overarching themes. Specifically, the majority of participants described their top methods of obtaining information support as (1) contacting another physician or (2) consulting the literature. Additionally, participants discussed contributing factors and solutions to inappropriate DI ordering, including clinical decision support systems. These results were used to inform the design of a DI decision support system prototype. This study explored ways to reduce inappropriate DI ordering and identified socio-technical factors that need to be considered when developing ways to mitigate this phenomenon. Promoting more appropriate ordering can improve patient safety and the responsible use of limited diagnostic imaging resources.