Programming a hospital's electronic health record system to provide information on appropriate use of a costly gastrointestinal panel and to block unnecessary orders, reduced inappropriate testing by 46 percent and saved up to $168,000 over 15 months, according to a study published today in Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.
Dr. Jasmine R. Marcelin, associate medical director of Antimicrobial Stewardship at University of Nebraska Medical Center and lead author of the study, implemented the approach at her health system and said that when it comes to diarrheal illnesses, asking physicians to reconsider the appropriateness of testing via hardwired alerts saves money without compromising care quality.
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Researchers hardwired criteria into the health system's EHR to provide informational best practice alerts, as well as a "hard stop" that prevented inappropriate orders for the Gastrointestinal Pathogen Panel (GIPP), a quick and sensitive but costly test that detects 22 common disease-causing organisms.
The test panel is useful for new patients who may have been exposed to a wider variety of pathogens, but it is considered unnecessary for most patients later in their hospital stay or when used more than once on the same patient.
In the 15 months before the hard stop was activated, 21.5 percent of the GIPP tests ordered were found to be inappropriate. Following the changes to the EHR, only 4.9 percent were inappropriate.
Researchers concluded that the diagnostic stewardship intervention, including both the best practice alert and hard stop, reduced testing by 46 percent for a potential savings of $168,000, even after accounting for the cost of alternative testing.
The authors said future research on diagnostic stewardship could include the evaluation of outcomes like length of hospital stay or reduction of inappropriate antibiotic use associated with a hard stop, and these tactics could be applied to similar laboratory tests.
As long as EHRs remain relatively simple to use and implement, the findings could be good news for physicians, with prior research showing that simple EHRs can actually help hospital and health systems retain physicians longer.
The EHR systems that caused the most headaches, and drove physicians away in certain instances, typically featured computerized order entry or physician documentation, which can often suck up physicians' time and wrest their attention away from patient care.