Challenges and insights from implementing clinical decision support systems for radiologic imaging: experience from the MIDAS trial

Abstract Clinical decision support systems (CDSSs) have been developed to give guidance for referring physicians to make appropriate decisions at the point of care. The MIDAS study, a multicenter cluster randomized trial at four German university hospitals, was designed to evaluate the effectiveness...

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Main Authors: Thomas Kroencke, Stijntje W. Dijk, Moritz C. Halfmann, Claudia Wollny, Joerg Barkhausen, Olav Janssen, Dimitris Rizopoulos, M. G. Myriam Hunink
Format: Article
Language:English
Published: SpringerOpen 2025-07-01
Series:Insights into Imaging
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Online Access:https://doi.org/10.1186/s13244-025-02027-0
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author Thomas Kroencke
Stijntje W. Dijk
Moritz C. Halfmann
Claudia Wollny
Joerg Barkhausen
Olav Janssen
Dimitris Rizopoulos
M. G. Myriam Hunink
author_facet Thomas Kroencke
Stijntje W. Dijk
Moritz C. Halfmann
Claudia Wollny
Joerg Barkhausen
Olav Janssen
Dimitris Rizopoulos
M. G. Myriam Hunink
author_sort Thomas Kroencke
collection DOAJ
description Abstract Clinical decision support systems (CDSSs) have been developed to give guidance for referring physicians to make appropriate decisions at the point of care. The MIDAS study, a multicenter cluster randomized trial at four German university hospitals, was designed to evaluate the effectiveness of a CDSS for imaging referral (ESR iGuide) in routine clinical care. Based on our experience within the MIDAS study, we aim to describe the hurdles and difficulties, as well as the various insights gained, in the process of implementing a CDSS in a clinical and research setting. To successfully implement a CDSS for imaging requests, it is essential to monitor and address technical issues, adapt local workflows, define the scope and content, and prioritize user experience and acceptance. Critical relevance statement By identifying and addressing the various technical, content-related, and workflow challenges, this article gives valuable insights to facilitate future implementations of the ESR iGuide and similar clinical decision support systems CDSSs for imaging orders. Trial registration number Approval from the Medical Ethics Review Committee was obtained under protocol numbers 20-069 (Augsburg), B 238/21 (Kiel), 20-318 (Lübeck) and 2020-15125 (Mainz). The trial is registered in the ClinicalTrials.gov register under registration number NCT05490290. Key Points This manuscript reviews the challenges of implementing a clinical decision support system (CDSS) (ESR iGuide). Clinical implementation of a CDSS for imaging requests requires monitoring and adjustments in technical issues, local workflow, scope and content, and attention to user experience and acceptance. Our experience may equip stakeholders with the knowledge to proactively address these challenges. Graphical Abstract
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spelling doaj-art-e3cdae97cdc440fe9b8a3d935185dcb72025-08-20T03:38:18ZengSpringerOpenInsights into Imaging1869-41012025-07-0116111310.1186/s13244-025-02027-0Challenges and insights from implementing clinical decision support systems for radiologic imaging: experience from the MIDAS trialThomas Kroencke0Stijntje W. Dijk1Moritz C. Halfmann2Claudia Wollny3Joerg Barkhausen4Olav Janssen5Dimitris Rizopoulos6M. G. Myriam Hunink7Department of Diagnostic and Interventional Radiology, University Hospital AugsburgDepartment of Radiology and Nuclear Medicine, Erasmus MC University Medical CenterDepartment of Radiology, University Medical Center MainzDepartment of Diagnostic and Interventional Radiology, University Hospital AugsburgDepartment of Radiology and Nuclear Medicine, University Medical Center Schleswig-Holstein (UKSH)Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH)Department of Epidemiology and Biostatistics, Erasmus MC University Medical CenterDepartment of Radiology and Nuclear Medicine, Erasmus MC University Medical CenterAbstract Clinical decision support systems (CDSSs) have been developed to give guidance for referring physicians to make appropriate decisions at the point of care. The MIDAS study, a multicenter cluster randomized trial at four German university hospitals, was designed to evaluate the effectiveness of a CDSS for imaging referral (ESR iGuide) in routine clinical care. Based on our experience within the MIDAS study, we aim to describe the hurdles and difficulties, as well as the various insights gained, in the process of implementing a CDSS in a clinical and research setting. To successfully implement a CDSS for imaging requests, it is essential to monitor and address technical issues, adapt local workflows, define the scope and content, and prioritize user experience and acceptance. Critical relevance statement By identifying and addressing the various technical, content-related, and workflow challenges, this article gives valuable insights to facilitate future implementations of the ESR iGuide and similar clinical decision support systems CDSSs for imaging orders. Trial registration number Approval from the Medical Ethics Review Committee was obtained under protocol numbers 20-069 (Augsburg), B 238/21 (Kiel), 20-318 (Lübeck) and 2020-15125 (Mainz). The trial is registered in the ClinicalTrials.gov register under registration number NCT05490290. Key Points This manuscript reviews the challenges of implementing a clinical decision support system (CDSS) (ESR iGuide). Clinical implementation of a CDSS for imaging requests requires monitoring and adjustments in technical issues, local workflow, scope and content, and attention to user experience and acceptance. Our experience may equip stakeholders with the knowledge to proactively address these challenges. Graphical Abstracthttps://doi.org/10.1186/s13244-025-02027-0Clinical decision support systemsOverdiagnosisReferralHealthcare costsRadiology
spellingShingle Thomas Kroencke
Stijntje W. Dijk
Moritz C. Halfmann
Claudia Wollny
Joerg Barkhausen
Olav Janssen
Dimitris Rizopoulos
M. G. Myriam Hunink
Challenges and insights from implementing clinical decision support systems for radiologic imaging: experience from the MIDAS trial
Insights into Imaging
Clinical decision support systems
Overdiagnosis
Referral
Healthcare costs
Radiology
title Challenges and insights from implementing clinical decision support systems for radiologic imaging: experience from the MIDAS trial
title_full Challenges and insights from implementing clinical decision support systems for radiologic imaging: experience from the MIDAS trial
title_fullStr Challenges and insights from implementing clinical decision support systems for radiologic imaging: experience from the MIDAS trial
title_full_unstemmed Challenges and insights from implementing clinical decision support systems for radiologic imaging: experience from the MIDAS trial
title_short Challenges and insights from implementing clinical decision support systems for radiologic imaging: experience from the MIDAS trial
title_sort challenges and insights from implementing clinical decision support systems for radiologic imaging experience from the midas trial
topic Clinical decision support systems
Overdiagnosis
Referral
Healthcare costs
Radiology
url https://doi.org/10.1186/s13244-025-02027-0
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