Norfolk and Norwich University Hospitals NHS Foundation Trust Launches Clinical Decision Support For Radiology Referrals

Norfolk and Norwich University Hospitals (NNUH) NHS Foundation Trust has deployed the iRefer® CDS solution from MedCurrent, a global leader in radiology Clinical Decision Support (CDS) software solutions, in order to provide primary and secondary care clinicians with real-time radiology referral guidelines integrated directly into their existing clinical workflows.

The project was launched in January 2021 to three practices (Humbleyard, Drayton and St Stephens) in collaboration with NHS N&WCCG. The Trust is looking to engage with secondary care clinicians to pilot the system for a three month period. Data will be gathered during the pilot and an evaluation carried out in November 2021 to assess any further roll-out across the North and South Norfolk and Norwich Primary Care Networks (PCN).

MedCurrent’s iRefer® CDS solution incorporates the latest version of iRefer® guidelines from the Royal College of Radiologists (RCR), a collection of over 300 evidence-based radiology referral guidelines to provide recommendations for everyday use of clinical imaging services. iRefer® CDS presents actionable recommendations at the point-of-care to support clinicians in making the most appropriate imaging request and reduce patient exposure to unnecessary ionising radiation. The solution offers a user-friendly interface and bi-directional integration with the Clinisys ICE® Order Communications system that factor in the patients’ demographics and clinical history to enable patient-specific recommendations and more efficient radiology workflows downstream.

Dr Ed Prosser-Snelling, NNUH Chief Clinical Information Officer, said: “We are delighted to have launched this innovative system to improve clinical care with faster access for GP referrers to ensure patients receive the best test first, usually within a few clicks. This helps provide efficiency and uniformity of imaging decisions between referrer and radiologist. It provides clinicians with evidenced-based guidance and makes it easy to get the right test first time and minimise delays for patients”.

The iRefer® CDS solution includes Authoring and Analytics tools to support localisation and quality improvement. More specifically, the Authoring Studio facilitates the review and modification of referral pathways to ensure alignment with local practice and policy. The Analytics module uses real-time data visualisations to enable the Trust and CCG to derive insights on referral behaviour while highlighting opportunities for improvement.

Dr Steve Herman, Founder & CEO of MedCurrent, said: “MedCurrent is very proud to be working with the Norfolk and Norwich University Hospitals NHS Foundation Trust team to help demonstrate how clinical decision support can help clinicians deliver more appropriate, evidence-based care for their patients. As one of the first projects in the UK that extends CDS to primary care, this initiative represents a great opportunity to optimise the continuum of care at a regional level”.

Initial Findings from three month preliminary evaluation

• Over the 3-month period (1 March – 31 May 2021), iRefer CDS processed 1,771 radiology referrals for NNUH and presented evidence-based recommendations for 98.3% of referrals (i.e. CDS coverage).

• Using MedCurrent’s Analytics module, further analysis indicates that 6.7% of all radiology referrals were changed to a different imaging test, and 6.7% of all referrals were cancelled by the referring GP.

• Overall, the appropriateness of all referrals was 89.5%. GPs cancelled 54.7% of inappropriate tests when prompted to do so by CDS, while 38.6% of inappropriate tests were changed when it was suggested by CDS.

Conclusion

• iRefer CDS effectively provides GPs with access to evidence-based guidance for radiology referrals at the point of care. This is highlighted by 98% CDS coverage

• iRefer CDS improves the appropriateness and quality of radiology referrals, highlighted by a change and cancellation rates of 6.7% and 6.7% respectively.

• For the pilot group, iRefer CDS provided cost avoidances of £7,696 within the first 3-month period of implementation. Extrapolation of this data yields an estimated annual savings of £30,869 in tariffs.

• For the pilot group, iRefer CDS has the potential to save 50 hours of radiology workforce time annually with the implementation of a semi-automated vetting workflow using CDS appropriateness ratings.

Notes to editors

About Norfolk and Norwich University Hospitals NHS Foundation Trust

The Norfolk and Norwich University Hospital is a 1,200 bed teaching hospital with state-of-the-art facilities for modern patient care. Our staff of more than 9,000 care for and support patients who are referred to us by around 100 local GP practices and from other acute hospitals and from GPs around the country.

We have a range of more specialist services such as cancer care and radiotherapy, orthopaedics, plastic surgery, ophthalmology, rheumatology, children’s medicine and surgery, and specialist care for sick and premature babies. We have world class facilities, highly skilled staff and we are proud to be involved in pioneering research. Our patients rate us highly on quality of care and having friendly, approachable staff.

About MedCurrent

MedCurrent is a physician-founded Clinical Decision Support (CDS) company focused on improving the quality of care and managing health system costs through our innovative and scalable solutions, OrderWise® and iRefer® CDS. Our solutions enhance the clinical decision-making process with real-time, evidence-based guidelines integrated at the point of care to improve health and healthcare delivery. Deep healthcare experience, superior technology and business agility make MedCurrent a global leader in CDS solutions. For more information, visit www.medcurrent.com.