After it implemented electronic health record-based interventions, Boston Medical Center reduced unnecessary diagnostic testing and increased the use of postoperative order sets, two markers of providing high-value medical care, a new study shows.
The data from the hospital's efforts demonstrates the impact of deploying multiple interventions simultaneously within the EHR as a way to deliver high-value care -- which is defined as delivering the best possible care while simultaneously reducing unnecessary healthcare costs.
At six months following Boston Medical Center's intervention, which was activated hospital-wide for specific patients using the Epic EHR, the proportion of patients receiving pre-admission chest X-rays showed a decrease of 3.1 percent, and the proportion of labs ordered at routine times decreased by 4 percent. Total lab utilization decreased by 1,009 orders per month.
The researchers found no significant difference in the estimated red blood cell transfusion utilization rate, or the number of non-ICU urinary catheter days. But the proportion of postoperative patients who received appropriate pain and pneumonia prevention orders showed an increase of 20 percent.
The focus on providing high-value medical care was renewed in 2012 with the release of the Choosing Wisely campaign, an initiative of the American Board of Internal Medicine Foundation. Many institutions have responded by developing EHR-based interventions that target individual recommendations.
BMC focused on five areas in the Choosing Wisely recommendations: The overutilization of chest X-rays, routine daily labs, red blood cell transfusions, urinary catheters and underutilization of pain and pneumonia prevention orders for patients after surgery.
To do this, the researchers worked with the information technology team to incorporate new recommendations into the EHRs that would alert the provider to best practice information. The researchers examined data between July 2014 and December 2016 to look at how the interventions played out clinically.
The study suggests that future efforts aimed at increasing high-value care should consider other elements, such as clinician education, audits and feedback, and peer comparison.
EHRs can giveth, but according to some, they can also taketh away. An increasing number of experts are warning that EHRs can contribute to physician burnout, largely because each system is different. With disparate electronic health record systems comes an added hardship for physicians, affecting their work -- and their reimbursement.