The HSE is planning to introduce new clinical decision support tools to help reduce unnecessary GP referrals, the Medical Independent (MI) has learned.
In a recently released document, the HSE outlined it is seeking information from companies on how best to introduce “innovative clinical decision support solutions” to enhance the “quality, safety, and appropriateness of GP referrals”.
Emerging evidence indicates that a proportion of imaging referrals, particularly for ultrasound, CT, and MRI, may not always be clinically necessary, according to the HSE.
“This highlights the need for improved tools that support clinicians at the point of referral, ensuring imaging is appropriate, reducing unnecessary investigations, minimising radiation exposure, and helping health systems manage constrained resources more effectively.”
While guidelines such as iRefer and iGuide exist, they are “not embedded in day-to-day workflows and therefore are not routinely accessed”.
Radiology plays a critical role in healthcare delivery, with approximately 80 per cent of clinical pathways depending on imaging.
“Demand for radiology services is expected to rise significantly in the coming years. Radiology services across the HSE are delivered through a variety of care settings and provider types, including acute hospital radiology departments, and private radiology providers, each with different workflows, referral pathways, and levels of service availability.”
According to the document, similar challenges exist across many other GP referral pathways, such as outpatient specialty referrals, community intervention teams, and mental health.
“In many of these areas, there is evidence of variability in referral appropriateness, incomplete information, and differing local criteria, all of which contribute to delays, unnecessary appointments, inefficiencies, and avoidable bottlenecks.”
The document added: “Emerging international evidence shows that a significant proportion of referrals across multiple pathways may be avoidable or could be better directed, particularly where clear guidance exists, but is not embedded into GP workflows.”
“This reinforces the need for decision support tools that guide clinicians before the referral is submitted, ensuring the referral is clinically appropriate, complete, and directed to the right service at the right time.”
The HSE stated that any new solution must align with Healthlink, but added it was also open to assessing other solutions.
Chair of the IMO GP committee Dr Tadhg Crowley told MI any proposed changes must not lengthen GP consultations, which would negatively impact overall patient care by reducing GP access.
Dr Crowley also expressed concern that any new system “should not block care” by creating too much bureaucracy around referrals and suggested that changes should first be trialled in cooperation with GPs.
“There are always outliers in clinical care, those small number of cases that don’t necessarily fit into an algorithmic model or that are outside guidelines that may need investigations based on GP judgement. Any new system should not stop or block clinical care,” he cautioned.
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