Optimization of the Order Menu in the Electronic Health Record Facilitates Test Patterns Consistent With Recommendations in the Choosing Wisely Initiative

Barry, Courtney; Kaufman, Steven; Feinstein, David; Kim, Nami; Gandhi, Shivani; Nikolić, Dejan; Edmonston, Tina Bocker; Bierl, Charlene

doi:10.1093/ajcp/aqz134

Cited by 11 publications

(5 citation statements)

References 18 publications

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“…In order to avoid ‘over-alerting’ and its product, ‘alert fatigue’, pop-up boxes were avoided altogether in the design of eOEFs 2 5 8 30–33. Mandatory pull-down menus and pick lists were avoided to improve completion rates of free-text fields.…”

Section: Methodsmentioning

confidence: 99%

Impact of computerised provider order entry on the quality and quantity of clinical information included with investigation requests: an interrupted time series analysis

et al. 2023

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IntroductionRelevant clinical information is vital to inform the analytical and interpretative phases of most investigations. The aim of this study is to evaluate the impact of implementation of computerised provider order entry (CPOE), featuring order-specific electronic order entry forms (eOEFs), on the quality and quantity of clinical information included with investigation requests.MethodsThe CPOE module of a commercially available electronic health record (Cerner Millennium) was implemented at a large, tertiary care centre. The laboratory information management system was interrogated to collect data on specimens sent for microbiological culture 1 year before implementation of CPOE (2018), immediately post implementation (2019) and 6 months post implementation (2020). An interrupted time series analysis was performed, using text mining, to evaluate the quality and quantity of free-text clinical information.ResultsIn total, 39 919 specimens were collected from 16 458 patients. eOEFs were used to place 10 071 out of 13 735 orders in 2019 (73.3%), and 9155 out of 12 229 orders in 2020 (74.9%). No clinical details were included with 653 out of 39 919 specimens (1.6%), of which 22 (3.4%) were ordered using eOEFs. The median character count increased from 14 in 2018, to 41 in 2019, and 38 in 2020. An anti-infective agent was specified in 581 out of 13 955 requests (4.2%) in 2018; 5545 out of 13 735 requests (40.4%) in 2019; and 5215 out of 12 229 requests (42.6%) in 2020. Ciprofloxacin or piperacillin-tazobactam (Tazocin) were mentioned in the clinical details included with 421 out of 15 335 urine culture requests (2.7%), of which 406 (96.3%) were ordered using eOEFs. Subsequent detection of in vitro non-susceptibility led to a change in anti-infective therapy for five patients.ConclusionsImplementation of CPOE, featuring order-specific eOEFs, significantly and sustainably improves the quality and quantity of clinical information included with investigation requests, resulting in changes to patient management that would not otherwise have occurred.

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Section: Methodsmentioning

confidence: 99%

Impact of computerised provider order entry on the quality and quantity of clinical information included with investigation requests: an interrupted time series analysis

et al. 2023

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“…This may involve careful design of alert systems and ensuring that prompts are relevant and actionable [6]. Furthermore, interventions that change the ease of structural access to tests of interest in these systems, known as "ease of ordering" interventions, may be particularly relevant in this context [25]. A key strategy in this phase is optimizing test utilization.…”

Section: Pre-analytical Domainmentioning

confidence: 99%

Understanding and Implementing Diagnostic Stewardship: A Guide for Resident Physicians in the Era of Antimicrobial Resistance

Schinas,

Dimopoulos,

Akinosoglou

2023

Microorganisms

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Antimicrobial resistance (AMR) poses a significant global health challenge, exacerbated by the COVID-19 pandemic. Antimicrobial stewardship programs (ASPs) are crucial in managing this crisis, with diagnostic stewardship (DS) emerging as a key component. DS refers to the appropriate use of diagnostic tests to optimize patient outcomes, improve antimicrobial use, and combat multi-drug-resistant (MDR) organisms. Despite its potential, understanding and application of DS remain ambiguous in multiple respects, which, however, do not directly implicate the implementation of such initiatives. DS is particularly important for resident physicians who are often at the forefront of patient care and can significantly influence future AMR strategies. This review provides a comprehensive overview of DS, discussing its importance, potential challenges, and future directions. It emphasizes the need for resident physicians to understand DS principles and integrate them into their clinical practice from the beginning of their careers. The review also highlights the role of various stakeholders in implementing DS and the importance of continuous education and training. Ultimately, DS is not just a clinical tool but a philosophy of care, essential for a more responsive, humane, and effective healthcare system.

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“…For example, mobile apps that provide current recommendations for diagnostic evaluations that include recommended testing modalities have gained broad acceptance among the clinician community [ 46 ]. In addition, there is significant work toward evolving the integration and use of clinical decision support tools within the EHR to expedite the diagnostic evaluation and clinical management of the patient [ 47 , 48 ]. The extent to which these innovations improve diagnoses across medical disciplines is not established and requires further study [ 49 ].…”

Section: Promoting Effective Use Of Credible Information Resources and Communication Among Laboratory Professionals Other Health Care Promentioning

confidence: 99%

Bringing the clinical laboratory into the strategy to advance diagnostic excellence

et al. 2021

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ObjectivesClinical laboratory testing provides essential data for making medical diagnoses. Generating accurate and timely test results clearly communicated to the treating clinician, and ultimately the patient, is a critical component that supports diagnostic excellence. On the other hand, failure to achieve this can lead to diagnostic errors that manifest in missed, delayed and wrong diagnoses.ContentInnovations that support diagnostic excellence address: 1) test utilization, 2) leveraging clinical and laboratory data, 3) promoting the use of credible information resources, 4) enhancing communication among laboratory professionals, health care providers and the patient, and 5) advancing the use of diagnostic management teams. Integrating evidence-based laboratory and patient-care quality management approaches may provide a strategy to support diagnostic excellence. Professional societies, government agencies, and healthcare systems are actively engaged in efforts to advance diagnostic excellence. Leveraging clinical laboratory capabilities within a healthcare system can measurably improve the diagnostic process and reduce diagnostic errors.SummaryAn expanded quality management approach that builds on existing processes and measures can promote diagnostic excellence and provide a pathway to transition innovative concepts to practice.OutlookThere are increasing opportunities for clinical laboratory professionals and organizations to be part of a strategy to improve diagnoses.

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Optimization of the Order Menu in the Electronic Health Record Facilitates Test Patterns Consistent With Recommendations in the Choosing Wisely Initiative

Cited by 11 publications

References 18 publications

Impact of computerised provider order entry on the quality and quantity of clinical information included with investigation requests: an interrupted time series analysis

Impact of computerised provider order entry on the quality and quantity of clinical information included with investigation requests: an interrupted time series analysis

Understanding and Implementing Diagnostic Stewardship: A Guide for Resident Physicians in the Era of Antimicrobial Resistance

Bringing the clinical laboratory into the strategy to advance diagnostic excellence

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