Electronic Medical Record Prompts for Lab Orders in Patients Initiating Statins

Abstract

SummaryBackground: The Institute of Medicine (IOM) reports that at least a fourth of all medication related injuries are preventable. Therefore, the IOM recommends healthcare organizations and providers implement electronic prescribing and clinical decision support systems in practices to aid in medication error prevention. Objective: To assess the impact of noninstrusive-intrusive prompts from an electronic medical record on recommended baseline and follow up laboratory monitoring, CK and liver transaminase levels (AST and ALT), in patients initiated on statin therapy. Methods: Hybrid nonintrusive-intrusive prompts for laboratory monitoring specific for statin initiation were implemented in the electronic medical record system in a community based, university affiliated family medicine residency program. A retrospective chart review was conducted to compare and assess laboratory monitoring in patients initiated on statin therapy from two specific time periods: a six month period prior to initiation of the prompts and a six month period after initiation of the prompts. Results: One hundred seventy three patients met inclusion criteria. There were no significant differences in assessment of baseline liver transaminases and CK levels from the initial study period to the follow up study period. There were significant differences in follow up liver transaminase levels (18% vs 33%, p = 0.035) and CK levels (none vs 7%, p = 0.03) from the initial study period to the activated prompt interval. Conclusion: A hybrid nonintrusive-intrusive specific prompts for laboratory monitoring triggered by statin initiation within an electronic medical record improved follow up lab assessments for liver transaminases and CK but did not improve baseline assessments of CK or liver transaminases.

Using the Electronic Medical Record to Increase Laboratory Test Monitoring in Ocular Inflammation Patients: A Quality Improvement Study

“…Although this study provides a widely adaptable EMR alert to promote laboratory test ordering by ocular immunology specialists, future studies should aim to design an alert that requires an action prior to dismissal (Table 2). Although this version was not effective due to the limitations previously mentioned, alerts have been shown to increase laboratory test monitoring 12. Although the concern that “alert fatigue” may occur when these pop-up menus are too frequently encountered, these reminders are simple to program and tailor to the ordering ophthalmologist to avert an increased charting burden 14.…”

“…Although this version was not effective due to the limitations previously mentioned, alerts have been shown to increase laboratory test monitoring. 12 Although the concern that "alert fatigue" may occur when these pop-up menus are too frequently encountered, these reminders are simple to program and tailor to the ordering ophthalmologist to avert an increased charting burden. 14 Future studies are needed to assess whether an alert can improve patient safety with the prescription of high-risk medications.…”

“…An alternative method to alter physician behavior and evaluate compliance with clinical guidelines has been the construction of clinical alerts built into the electronic medical record (EMR). In previous studies, initiation of these alerts resulted in increased ordering of required referrals, a reduction in inappropriate prescription orders, and increased ordering of tests for drug monitoring 10–12. Thus, electronic alerts can change physician practice patterns and improve laboratory test monitoring in patients with chronic health conditions using long-term medications.…”

“…In previous studies, initiation of these alerts resulted in increased ordering of required referrals, a reduction in inappropriate prescription orders, and increased ordering of tests for drug monitoring. [10][11][12] Thus, electronic alerts can change physician practice patterns and improve laboratory test monitoring in patients with chronic health conditions using long-term medications. We describe the effectiveness of a newly implemented alert in the EMR to increase physician compliance in monitoring for side effects of oral corticosteroids, DMARDs, and biologic medications in an ocular immunology subspecialty clinic.…”