EHRs Can Help Reduce Unnecessary Diagnostic Testing

Researchers at Boston University School of Medicine (BUSM; MA, USA) and Boston Medical Center (BMC, MA, USA) conducted a study that focused on five areas of the “Choosing Wisely” campaign, an initiative of the American Board of Internal Medicine Foundation launched in 2012. The areas chosen for review were the overutilization of chest x-rays, routine daily lab tests, red blood cell (RBC) transfusions, the use of urinary catheters, and underutilization of pain and pneumonia prevention orders for patients after surgery.

To do so, the researchers incorporated “Choosing Wisely” recommendations into the EHR that would alert the provider to best practice information. The researchers then examined data between July 2014 and December 2016 to look at how the interventions played out clinically. The results revealed that six months after implementation of the recommendations at BMC, the proportion of patients receiving pre-admission chest x-rays showed a decrease of 3.1%, and the proportion of lab tests ordered decreased by four percent. Total lab utilization declined with a post-implementation decrease of 1,009 orders per month.

The researchers found no significant difference in the estimated RBC transfusion utilization rate or the number of non-intensive care unit (ICU) urinary catheter days. On the other hand, the proportion of postoperative patients who received appropriate pain and pneumonia prevention orders showed an absolute increase of 20%. The researchers suggest that future efforts aimed at increasing high-value care should consider elements such as clinician education, audits, feedback, and peer comparison. The study was published in the October 2018 issue of the Joint Commission Journal on Quality and Patient Safety.

“In order to move the needle on reducing unnecessary healthcare costs, we need to consider multi-pronged approaches in order to engage providers in ways that can truly make a difference in how we deliver exceptional, high-value care to every patient,” said corresponding author Nicholas Cordella, MD, of BUSM. “The results from our interventions suggest that they alone show promise in improving high-value care, but using only an electronic medical record intervention may not be adequate to achieve optimal outcomes.”

Related Links:
Boston University School of Medicine
Boston Medical Center