The increasing use of health information technology (HIT) is due to a rising interest in improving the quality of health care. HIT has the potential to reduce cost and transform services. Proper clinical support systems will contribute to the meaningful use of HIT systems by providing a wide array of data to clinicians for the diagnosis and treatments. Clinical guidelines, created by a consensus of experts, can be put in place to assist physicians in making clinical decisions. Delphi methods are commonly used to create consensus from surveys completed by a team of experts. Image-based studies could create guidelines that standardize severity, deformity or other clinical classifications. As these studies were traditionally conducted using paper-based media, the cost and time requirement often make the process impractical. Using state of the art Web 2.0 technologies, a web-based system can aid medical researchers in conducting image-based Delphi studies for improved clinical guidelines and decision support.