It's crucial for a physicial to carefully assess each patient and decide if it is appropriate to put them through medical imaging tests. The American Medical Association (AMA) Steps Forward collection provides physicians with a new module, listing steps to integrate clinical decision support for imaging into one's practice:

•    Familiarize yourself with clinical decision support and its role in optimizing care delivery. Clinical decision support enables clinicians to quickly and confidently determine the appropriateness of imaging tests at the point of care. It can also help you gather data to assist you in providing higher quality care at lower cost, two key metrics of value-based payment models.

•    Select an imaging area to improve. Identify specific projects that have the potential to drive practice changes and improve appropriate imaging in your organization. Target imaging studies that you suspect are overused and could benefit from clinical decision support, and establish baselines from which to gauge improvement.

•    Prepare your practice to adopt clinical decision support tools for image ordering and appropriate use. It is important to bring radiologists and referring clinicians together to improve imaging appropriateness and streamline image ordering. This effort can be guided by an action plan found on R-SCAN, created by the American College of Radiology, and resources and recommendations on the American Board of Internal Medicine Foundation’s Choosing Wisely website. ACR has contributed to Choosing Wisely a list of five imaging orders physicians and patients should question.

•    Actively discuss imaging appropriateness with patients and begin making decisions about imaging orders together. Patients are less likely to demand a test once they understand why it is not recommended. Once you gain familiarity with clinical decision support through your participation in R-SCAN, you should feel more comfortable discussing appropriate imaging with your patients.

•    Work with your EHR implementation team to integrate clinical decision support technology. Clinical decision support technology is most useful when it is integrated into your EHR platform. Include your EHR vendor in discussions about decision support.

The AMA suggests that you can take further steps by engaging the rest of your staff on these steps and considering establishing a relationship with a radiologist to get expert advice.