PARIS - Plans for a new fully online edition of imaging guidelines for French-speaking referring physicians across Europe and Africa were unveiled on the opening day of the Journées Françaises de Radiologie (JFR) by Dr. Philippe Grenier of the French Society of Radiology (SFR).
The second edition of the "Guide du bon usage des examens d'imagerie" will go live on 1 January 2013. Its easily accessible and comprehensive nature will represent a major step forward in the more appropriate use of imaging by general practitioners and other referrers, according to Grenier, a past president of the European Congress of Radiology (ECR) and former secretary general of the SFR.
The new guidelines will go live on 1 January 2013, according to Dr. Philippe Grenier."The weakness of the 2005 edition was that it was only sent to radiologists and nuclear medicine specialists. There was not enough publicity, and many people had never heard of it," he said. "We have developed new software that will make it uploadable on personal computers and eventually smartphones."
Users can enter a keyword, and within two or three seconds a recommendation and set of relevant links will come up, he explained. A total of 900 individual recommendations involving 400 different clinical situations will be included in the new edition, which has been a work-in-progress since 2009. The powerful Haute Autorité de Santé (HAS) has promised to publicize the new edition, and Grenier hopes it will receive the full seal of approval from the HAS early next year. But some observers remain skeptical.
"Clinicians prescribe anything at any moment, according to their own ideas, and don't care about recommendations," a senior French radiologist commented. "The only way forward is to have a more compelling system: computerized demand with algorithms to ensure consistency between clinical queries and exams. If not accepted, the clinician may force the system, but there should be a benchmarking system to assess the clinician profile and establish financial penalties."
Implementing clinical decision support systems would be valuable, Grenier admits, but he does not think it would be practical to do so yet across the board because they are very difficult to establish. Only the Australians have attempted to adopt such systems to date, although the SFR would like to integrate the referral guidelines in clinical decision system support for MRI requests.
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Grenier has some useful allies to support him, however, including his younger brother and fellow radiologist, Dr. Nicolas Grenier from Bordeaux University Hospital, who is president of the college of academic radiologists (Collège des Enseignants en Radiologie de France [CERF]). CERF has agreed to incorporate the referral guidelines in the training programs of students at medical faculties.
"These guidelines might be used as a frame of reference in continuous professional development programs (DĂ©veloppement Professionnel Continu [DPC]), which is the new format for continuous medical education in France," he commented, adding that a committee has been established to provide regular updates of the guidelines.
Developing referral guidelines at a national level has been a long and costly process, involving a large number of physicians, he stressed.
"A Delphi process, performed at a national level, certainly helps appropriation of referral guidelines by radiologists and clinicians in the country. Advertisement, distribution, reminders, and education are necessary to ensure the use of guidelines by physicians, and a Web version of guidelines should be recommended to facilitate practical use, availability, distribution, and continuous update," he concluded.
