Cost and economic benefit of clinical decision support systems for cardiovascular disease prevention: a community guide systematic review

Jacob, Verughese; Thota, Anilkrishna B.; Chattopadhyay, Sajal K.; Njie, Gibril J.; Proia, Krista; Hopkins, David P.; Ross, Murray N.; Pronk, Nicolaas P.; Clymer, John M.

doi:10.1093/jamia/ocw160

Cited by 52 publications

(56 citation statements)

References 29 publications

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“…110 Cost analysis is notoriously missing in the literature, but examples can be found. 107,111,112 Payers may be more willing to support CDSS if cost-savings can be shown elsewhere in the system / process. This means looking at more than just direct costs a using metrics such as patient outcomes or qualityadjusted life years (QALY).…”

Section: Financial Challengesmentioning

confidence: 99%

An overview of clinical decision support systems: benefits, risks, and strategies for success

et al. 2020

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Computerized clinical decision support systems, or CDSS, represent a paradigm shift in healthcare today. CDSS are used to augment clinicians in their complex decision-making processes. Since their first use in the 1980s, CDSS have seen a rapid evolution. They are now commonly administered through electronic medical records and other computerized clinical workflows, which has been facilitated by increasing global adoption of electronic medical records with advanced capabilities. Despite these advances, there remain unknowns regarding the effect CDSS have on the providers who use them, patient outcomes, and costs. There have been numerous published examples in the past decade(s) of CDSS success stories, but notable setbacks have also shown us that CDSS are not without risks. In this paper, we provide a state-of-the-art overview on the use of clinical decision support systems in medicine, including the different types, current use cases with proven efficacy, common pitfalls, and potential harms. We conclude with evidence-based recommendations for minimizing risk in CDSS design, implementation, evaluation, and maintenance.

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Section: Financial Challengesmentioning

confidence: 99%

An overview of clinical decision support systems: benefits, risks, and strategies for success

et al. 2020

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“…[52] However, for future economic evaluations of EHR based CDS interventions, a more speci c approach for individual application areas or focus on medical risk factors is needed to draw meaningful conclusions from cost and outcome comparisons. [9] Moreover, decisionanalytic modelling techniques, e.g., Markov models, enable the evaluation of multiple income and outcome parameters. They address downstream costs or savings that may result from the introduction of health information technology.…”

Section: Discussionmentioning

confidence: 99%

“…During our search process, we found that the number of studies meeting the inclusion criteria increased tremendously in the past years, partially overlapping the present research question. [9][10][11] The most recent review by Jacob et al [9] examined the cost and economic bene ts of CDS systems restricted to cardiovascular disease prevention. However, the authors were unable to conclude whether these interventions were costbene cial or cost-effective.…”

Section: Table 1: Inclusion and Exclusion Criteriamentioning

confidence: 99%

“…[61] For instance, a systematic review of EHR embedded CDS systems for cardiovascular disease prevention derived the mean annual cost of development, implementation, and ongoing costs of operations to be $102 per patient and $6,056 per practice for small practices, and $49 per patient and $35,201 per practice for medium-sized practices. [9] Finally, achieving a decrease in healthcare expenditure should never in uence a patient's quality of life or disease treatment in a negative way. Even though eliminating a laboratory order option from a CPOE system led to cost-savings, each patient's value and health outcome is of the highest importance and should be individually assessed.…”

Section: Support From Policymakers Could Accelerate Economic Bene Tsmentioning

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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“…1,2,4–7 According to Community Guide processes, since the Task Force recommended all five interventions based on evidence of their effectiveness, systematic economic reviews were subsequently completed. 3,5,8,9 …”

Section: Methodsmentioning

confidence: 99%

Community Guide Cardiovascular Disease Economic Reviews: Tailoring Methods to Ensure Utility of Findings

Chattopadhyay

Jacob

Mercer

et al. 2017

American Journal of Preventive Medicine

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Context: The Community Preventive Services Task Force recommended five interventions for cardiovascular disease (CVD) prevention between 2012 and 2015. Systematic economic reviews of these interventions faced challenges that made it difficult to generate meaningful policy and programmatic conclusions. Objectives: This paper describes the methods used to assess, synthesize, and evaluate the economic evidence to generate valid, reliable, and useful economic conclusions and address the comparability of economic findings across interventions. Methods: Steps were taken to assess completeness of data and identify the components and drivers of cost and benefit. Except for intervention cost of self-measured blood pressure monitoring (SMBP) intervention, either alone or with patient support, all cost and benefit estimates were standardized as per patient per year. When possible, intermediate outcomes were converted to quality-adjusted life year (QALY). Differences within and between interventions were considered to generate economic conclusions and inform their comparability. Results. Intervention cost per patient per year was highest for team-based care (TBC), either alone or in combination with other interventions. TBC, SMBP with patient support, and SMBP within TBC were found to be cost-effective; however their cost-effectiveness estimates were not comparable because of differences in the intervention characteristics. Lack of enough data and/or incomplete information made it difficult to reach an overall economic finding for the other interventions. Conclusions: Appropriate methods to handle the complexity of systematic economic reviews can help to draw transparent and valid economic conclusions for public health interventions to prevent or control CVD and inform judgment about their comparability.

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Cost and economic benefit of clinical decision support systems for cardiovascular disease prevention: a community guide systematic review

Cited by 52 publications

References 29 publications

An overview of clinical decision support systems: benefits, risks, and strategies for success

An overview of clinical decision support systems: benefits, risks, and strategies for success

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

Community Guide Cardiovascular Disease Economic Reviews: Tailoring Methods to Ensure Utility of Findings

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