Can ICT Help to Solve the Clinical Appropriateness Problem?—An Experience in the Italian Public Health

Clinical exams are essential in modern medicine for disease screening, diagnosis and monitoring, but their misuse can lead to resources dissipation. In recent years there has been a significant increase in clinical exams demand. This can be seen both as a positive result of an improved health awareness, mostly in terms of prevention, and as the direct and logical consequence of the medical defensive behaviour, which arises from the potential occurrence of legal controversies and of the clinician's unawareness and indifference about the cost of clinical exams. Often the reasons are related to practical problems, such as the lack of knowledge about an already performed exam, the unavailability or inaccessibility of previous test results, doubts about the reliability of the obtained result for a specific exam or, even, the loss of the previous medical report. In order to reduce the occurrence of inappropriate exams requests we propose an approach, mainly based on Open Data and Open Software, to enforce a suitable set of "appropriateness rules" which can be used to check the appropriateness of the request exam as soon as the request is submitted to the medical unit in charge to perform it. The appropriateness rules come from an open and update repository that can allow the total comprehension about the clinical appropriateness topic and facilitate discussions and debates on the theme. The paper discusses also an implementation of the proposed approach and its application to a public hospital, in Italy.