Fall 2016 (Volume 26, Number 3)

Choosing Wisely at the Université de Sherbrooke

Download PDF

In 2014, one year after the launch of the national Choosing Wisely Canada campaign, physicians—including rheumatologists—in Sherbrooke organized some local conferences about the issues, and the urgency to act, regarding the subject of appropriate use of scarce medical resources. After initial enthusiasm, the desire to pursue the Choosing Wisely philosophy progressively wore off, and no concrete changes in practice were observed. Inspired by successful experiences at other Canadian medical institutions, the Université de Sherbrooke aimed to adopt a better strategy in 2016 to actually change medical practice.

We recently received an internal grant to develop IT resources to continually promote wise choices. In our hospital, diagnostic tests are prescribed by a computerized physician order entry (CPOE) system. Our approach will be to add a function to the software to automatically generate a pop-up window presenting the Choosing Wisely Canada recommendation as clinical decision support for some targeted radiologic tests. For instance, in a CPOE prescription for a magnetic resonance imaging (MRI) scan for lower back pain, a pop-up will briefly remind users of its recognized scientific indications. A second function will generate a dashboard allowing physicians and residents to consult their own statistics about tests prescribed within the last year, comparing themselves anonymously to their peers. This exercise will allow physicians to easily obtain Type 3 credits from the CRCSP.

Even if we are now more optimistic than in 2014, we remain conscious that changing practice is probably one of the biggest institutional challenges. We hypothesize that a few inexpensive electronic resources promoting continuous educational feedback could be a pragmatic strategy to promote changes in practice patterns.

Ariel Masetto, MD
On behalf of the Rheumatology Department,
Université de Sherbrooke