Reduction in Unnecessary Red Blood Cell Folate Testing by Restricting Computerized Physician Order Entry in the Electronic Health Record

MacMillan, Thomas E.; Gudgeon, Patrick; Yip, Paul; Cavalcanti, Rodrigo B.

doi:10.1016/j.amjmed.2018.03.044

Cited by 17 publications

(20 citation statements)

References 22 publications

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“…In eight studies (30%) [14,16,25,28,30,31,33,35], interventions from two different categories were explored in combination. Moreover, we found three studies (11%) [21,29,32] in which the option to place a certain order or test, e.g., a laboratory test, was removed from the EHR CPOE system or the clinician's laboratory ordering preference list. These restrictive frond-end CDS intervention types were not yet mentioned in the predefined categories by Wright et al [12].…”

Section: Exploration Of Different Front-end Cds Intervention Categoriesmentioning

confidence: 99%

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

Lewkowicz

Wohlbrandt

Boettinger

2020

BMC Health Serv Res

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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.

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Section: Exploration Of Different Front-end Cds Intervention Categoriesmentioning

confidence: 99%

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

Lewkowicz

Wohlbrandt

Boettinger

2020

BMC Health Serv Res

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“…An overview of the characteristics of the included studies is listed in Table 2. 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%

“…In the majority of included studies the main cost outcome measures were related to laboratory test cost. [15][16][17]20,21,25,28,29,31,32,38] Exploration of different front-end CDS intervention categories According to the taxonomy by Wright et al [12], we identi ed ten (37%) studies [5,13,15,20,22,23,26,[36][37][38] which explored EHR based CDS interventions based on point-of-care alerts or reminders (category 3). Three interventions (11%) [17,27,34] were order facilitators (category 2).…”

Section: Resultsmentioning

confidence: 99%

“…[18,19,24] In eight studies (30%), [14,16,25,28,30,31,33,35] interventions from two different categories were explored in combination. Moreover, we found three studies (11%) [21,29,32] in which the option to place a certain order or test, e.g., a laboratory test, was removed from the EHR CPOE system or the clinician's laboratory ordering preference list. These restrictive frond-end CDS intervention types were not yet mentioned in the prede ned categories by Wright et al [12].…”

Section: Resultsmentioning

confidence: 99%

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

Lewkowicz

Wohlbrandt

Boettinger

2020

Preprint

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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.

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“…We read the findings of MacMillan and colleagues with great interest. 1 Their work to substantially reduce ordering of a useless laboratory test with a simple force function is aspirational. We had a similar experience with eliminating the fecal occult blood test at our institute.…”

mentioning

confidence: 99%

Balancing Measures When Restricting Laboratory Testing

Gupta

2018

The American Journal of Medicine

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Reduction in Unnecessary Red Blood Cell Folate Testing by Restricting Computerized Physician Order Entry in the Electronic Health Record

Cited by 17 publications

References 22 publications

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

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

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

Balancing Measures When Restricting Laboratory Testing

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