From leadership research to district action: Implementation of Electronic Clinical Decision Support for Radiology Referrals: The Role of Governance, Clinician Engagement and Education

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

ABSTRACT Objectives Medical imaging utilisation continues to increase globally, raising concerns regarding sustainability, workforce capacity, patient safety and environmental impact. Electronic Clinical Decision Support (eCDS) systems have been proposed as a strategy to improve imaging appropriateness; however, international experience suggests that technology alone is insufficient for successful adoption. This study describes an organisational implementation strategy for an eCDS programme for imaging referrals and examines early changes in imaging utilisation associated with clinician engagement and education strategies preceding system go‐live. Methods An eCDS system was implemented within the electronic medical record at a quaternary referral centre in Melbourne, Australia. The initiative included governance structures, clinician engagement and targeted education to support integration into clinical workflows. Imaging utilisation data, including computed tomography (CT) examinations per emergency department (ED) presentation, were obtained from hospital activity records and analysed descriptively across engagement and deployment phases. Results Prior to eCDS go‐live, CT utilisation increased from 32 to 44 examinations per 100 ED presentations. During the engagement phase preceding system deployment, CT ordering declined by 9.1%, coinciding with clinician engagement and education activities. Following eCDS deployment, imaging utilisation trends stabilised. Conclusions Successful implementation of eCDS requires more than technological deployment. Governance, clinician engagement and sustained education appear important for supporting adoption of decision support systems and may facilitate early cultural change in imaging utilisation. Keywords: clinical decision support systems, diagnostic imaging utilisation, emergency department, imaging appropriateness, implementation

Study methods

This descriptive implementation study reports the introduction of an eCDS system for imaging referrals at Alfred Hospital, a quaternary referral centre in Melbourne, Australia, providing comprehensive emergency, inpatient and outpatient radiology services. The study describes the governance structures, stakeholder engagement strategies and organisational processes used to support integration of eCDS into clinical workflows.

Limitations

This study represents a single‐centre experience and reports observational trends rather than causal effects of the intervention. Changes in imaging utilisation may also have reflected concurrent education initiatives, organisational change processes and broader institutional influences in addition to eCDS deployment. Inferential statistical modelling was not performed, limiting attribution of observed effects specifically to the eCDS platform.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Select one recurring district decision. Publish the decision owner, evidence requirements, consultation process and appeal route; test the process on a bounded low-risk decision. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Track decision time, unresolved objections, documented reasons, appeals and access differences. Review whether the process changes who can participate and who carries the burden. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Bruno Di Muzio; Saman Salaran; Ben Morgan; Andrew Woo; Christopher Perry; Alex Jarema; Philippa Hawkings; Peter Cameron; Meng Law. Implementation of Electronic Clinical Decision Support for Radiology Referrals: The Role of Governance, Clinician Engagement and Education. Emergency Medicine Australasia (2026-08-01). https://doi.org/10.1111/1742-6723.70305

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.