Clinical and Economic Impact of Implementing HealthPathways at a Musculoskeletal Radiology Department

Objective: To show the impact HealthPathways, a clinical information portal providing locally agreed management and referral advice to primary care clinicians, has on musculoskeletal radiological referrals at a single institution. Methods: We retrospectively examined the clinical benefits of general practitioners (GPs) requesting magnetic resonance imaging (MRI) scans of the lumbar spine and knee and/or ultrasound scans of the shoulder. HealthPathways were formulated on the basis of providing support and guidance to GPs on the management of musculoskeletal conditions. Request rates and the number of scans undertaken before and after implementation of HealthPathways, and referral rates to the relevant orthopedic departments and physiotherapy department, were also collected. Results: Following the introduction of HealthPathways, there was a marked reduction in request rates. The number of MRI knee scans decreased by 82%, lumbar spine MRI scans decreased by 70%, and ultrasound scans of the shoulder decreased by 92%. These changes have saved the health board a theoretical £374 424 ($470 000) on diagnostic imaging on an annual and reoccurring basis, and has freed up diagnostic capacity, which has been invaluable in the post-COVID recovery era. Despite the reduced ability for GPs to access radiological investigations, there has been no increase in referrals to physiotherapy or orthopedic knee and shoulder surgeons, with a minimal increase in referrals to spinal surgeons. Conclusions: The introduction of HealthPathways is an effective way of reducing referral rates for musculoskeletal radiological investigations. We found that there was no subsequent increase in referrals to other secondary care services, except to spinal services, and the financial savings are significant and recurrent.