- Hardwiring a hospital's EHR system to identify appropriate uses of a costly gastrointestinal diagnostic panel and block inappropriate orders cut unnecessary testing by 46% and saved the facility $168,000 over 15 months, a study published Tuesday in Infection Control & Hospital Epidemiology shows.
- The researchers programmed criteria into the EHR of an 830-bed Midwestern tertiary hospital to provide informational best practice alerts and a "hard stop" against inappropriate orders for the gastrointestinal pathogen panel, which was performed daily to detect 22 disease-causing organisms in patients' stools.
- After implementing the EHR changes, just 4.9% of GIPP tests were deemed inappropriate, compared with 21.5% in the 15 months before the alert and hard stop were deployed.
The study shows how EHRs can be used to cut down on costly and unneeded care, a major drain on the healthcare system. A survey of 2,106 U.S. physicians found that, on average, they believe 20.6% of medical care is unnecessary, including 24.9% of tests, 22% of prescriptions and 11.1% of procedures. The vast majority attributed overtreatment to fear of malpractice, according to the study in Plos One.
Before launching the EHR alerts, patients at the hospital were given GIPP tests on a daily basis, regardless of the quality of their stool. The researchers note the panel is useful for detecting pathogens in new patients, but not in patients who have been in the hospital or have already undergone the battery of tests.
By combining clinician education, feedback and real-time EHR ordering restrictions, hospitals can cut down on unneeded testing, according to the study. Such diagnostic stewardship efforts boost patient satisfaction, reduce false-positive results and unnecessary treatments and save hospitals valuable dollars, the authors add.
"GIPP testing in patients hospitalized for >72 hours or who have already had GIPP testing is almost always inappropriate. Implementing a hard stop in the EHR can significantly reduce inappropriate GIPP testing," the researchers write. "Responsible test ordering of low-yield tests such as the GIPP leads to significant cost savings without affecting high-quality patient care."
While the researchers did not look at the time the alert was fired, use of the restriction did not have a significant effect on laboratory workflow, the study says. Future research on EHRs' role in diagnostic stewardship could assess the impact on length of stay or antibiotic use, lead author Jasmine Marcelin said in a press release announcing the results.
In a white paper released alongside the study, the Society for Healthcare Epidemiology of America argues that EHRs and add-on clinical decision support systems should be integral to any antimicrobial stewardship program. Having access to an IT system will improve communication and workflow efficiency, lead to more appropriate patient interventions and help hospitals meet regulatory metrics and requirements, the authors say.
But to be truly beneficial, more system integration is required, the paper says. For example, systems should be able to track patients across various care delivery settings, monitor and report inappropriate antimicrobial prescribing and collect and aggregate health data systemwide on antimicrobial-related complications and antimicrobial resistance trends. Organizations should also be able to track compliance with accepted treatment guidelines.