Effect of Electronic Clinical Decision Support on Imaging for the Evaluation of Acute Low Back Pain in the Ambulatory Care Setting

2020

Preprint

Background Unnecessary healthcare utilization, non-adherence to current clinical guidelines, or insufficient personalized care are perpetual challenges and remain potential major cost-drivers for healthcare systems around the world. Implementing decision support systems into clinical care is promised to improve quality of care and thereby yield substantial effects on reducing healthcare expenditure. In this article, we evaluate the economic impact of clinical decision support (CDS) interventions based on electronic health records (EHR).Methods We searched for studies published after 2014 using MEDLINE, CENTRAL, WEB OF SCIENCE, EBSCO, and TUFTS CEA registry databases that encompass an economic evaluation or consider cost outcome measures of EHR based CDS interventions. Thereupon, we identified best practice application areas and categorized the investigated interventions according to an existing taxonomy of front-end CDS tools. Results and discussion Twenty-seven studies are investigated in this review. Of those, twenty-two studies indicate a reduction of healthcare expenditure after implementing an EHR based CDS system, especially towards prevalent application areas, such as unnecessary laboratory testing, duplicate order entry, efficient transfusion practice, or reduction of antibiotic prescriptions. On the contrary, order facilitators and undiscovered malfunctions revealed to be threats and could lead to new cost drivers in healthcare. While high upfront and maintenance costs of CDS systems are a worldwide implementation barrier, most studies do not consider implementation cost. Finally, four included economic evaluation studies report mixed monetary outcome results and thus highlight the importance of further high-quality economic evaluations for these CDS systems. Conclusion Current research studies lack consideration of comparative cost-outcome metrics as well as detailed cost components in their analyses. Nonetheless, the positive economic impact of EHR based CDS interventions is highly promising, especially with regard to reducing waste in healthcare.

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Economic impact of clinical decision support interventions based on electronic health records

2020

Preprint

“…Furthermore, an overview of the characteristics of included studies is listed in Table 2. Table 2: Characteristics of included studies (n=27) Generally, twenty-two studies (81%) [5,[13][14][15][16]18,[20][21][22][23][24][25][28][29][30][31]32,[34][35][36][37][38] out of the included twenty-seven studies report cost savings after implementing an EHR based CDS intervention. Four studies (15%) [17,26,27,33] report a rise in cost expenditure.…”

Section: Resultsmentioning

confidence: 99%

Economic impact of clinical decision support interventions based on electronic health records

2020

Preprint

Background Unnecessary healthcare utilization, non-adherence to current clinical guidelines or insufficient personalized care are perpetual challenges and remain potential major cost-drivers for healthcare systems around the world. Implementing decision support systems into clinical care is promised to increase quality of care and thereby yield substantial effects on reducing healthcare expenditure. In this article we evaluate the economic impact of clinical decision support (CDS) interventions which are based on electronic health records (EHR). Methods We searched for studies published after 2014 using MEDLINE, CENTRAL, WEB OF SCIENCE, EBSCO, and TUFTS CEA registry databases that encompass an economic evaluation or consider cost outcome measures of EHR based CDS interventions. Thereupon, we identified best practice application areas and categorized the investigated interventions according to an existing taxonomy of front-end CDS tools. Results and discussion Twenty-seven studies are investigated in this review. Of those, twenty-two studies indicate a reduction of healthcare expenditure after implementing an EHR based CDS system, especially towards prevalent application areas, such as unnecessary laboratory testing, duplicate order entry, efficient transfusion practice or reduction of antibiotic prescriptions. On the contrary, order facilitators and undiscovered malfunctions revealed to be threats and could lead to new cost drivers in healthcare. While high upfront and maintenance cost of CDS systems are a worldwide implementation barrier, most studies do not consider implementation cost. Finally, four included economic evaluation studies report mixed monetary outcome results and thus highlight the importance for further high quality economic evaluations for these CDS systems. Conclusion Current research studies lack to consider comparative cost-outcome metrics as well as detailed cost-components in their analyses. Nonetheless, the positive economic impact of EHR based CDS interventions especially with regard to reducing waste in healthcare is highly promising.

“…According to the taxonomy by Wright et al [12] we identi ed twelve (44%) studies [5,13,15,20,22,23,26,31,32,[36][37][38] which explored EHR based CDS interventions based on point-of-care alerts or reminders (category 3). In addition, three interventions (11%) [17,27,34] were order facilitators (category 2), two studies (7%) [19,30] investigated medication dosing support (category 1), while relevant information display as well as expert systems (category 4 and 5) were each reported only once from an economic perspective (4%).…”

Section: Exploitation Of Different Front-end Cds Intervention Categoriesmentioning

confidence: 99%

Economic Impact of Clinical Decision Support Interventions Based on Electronic Health Records

2020

Preprint

BackgroundUnnecessary healthcare utilization, non-adherence to current clinical guidelines or insufficient personalized care are perpetual challenges and remain potential major cost-drivers for healthcare systems around the world. Implementing decision support systems into clinical care is promised to increase quality of care and thereby yield substantial effects onreducing healthcare expenditure. Inthis articleweevaluate the economic impact of clinical decision support (CDS) interventions which are based on electronic health records (EHR).MethodsWe searched for studies published after 2014 using MEDLINE, CENTRAL, WEB OF SCIENCE, EBSCO, and TUFTS CEA registrydatabases that encompass an economic evaluation or consider cost outcome measures of EHR based CDS interventions. Thereupon, we identified best practiceapplication areas and categorized the investigated interventions according to an existing taxonomy of front-endCDS tools. Results and discussionTwenty-sevenstudies are investigated in this review. Of those, twenty-twostudies indicate a reduction of healthcare expenditure after implementingan EHRbased CDS system, especiallytowardsprevalent application areas, such as unnecessarylaboratory testing, duplicate order entry, efficient transfusion practice or reduction of antibiotic prescriptions.On the contrary, order facilitators and undiscovered malfunctions revealed to be threats and could lead to new cost drivers in healthcare. While high upfront and maintenance cost of CDS systems are a worldwide implementation barrier, most studies do not consider implementation cost. Finally, four included economic evaluation studies report mixed monetary outcome results and thus highlight the importance for further high quality economic evaluations for these CDS systems. ConclusionCurrent research studies lack to consider comparative cost-outcome metrics as well as detailed cost-components in their analyses. Nonetheless, thepositive economic impact of EHR based CDS interventions especially with regard to reducing waste in healthcare is highly promising.