Economic and organizational impact of a clinical decision support system on laboratory test ordering

Abstract

BackgroundWe studied the impact of a clinical decision support system (CDSS) implemented in a few wards of two Italian health care organizations on the ordering of redundant laboratory tests under different perspectives: (1) analysis of the volume of tests, (2) cost analysis, (3) end-user satisfaction before and after the installation of the CDSS.Methods(1) and (2) were performed by comparing the ordering of laboratory tests between an intervention group of wards where a CDSS was in use and a second (control) group where a CDSS was not in use; data were compared during a 3-month period before (2014) and a 3-month period after (2015) CDSS installation. To measure end-user satisfaction (3), a questionnaire based on POESUS was administered to the medical staff.ResultsAfter the introduction of the CDSS, the number of laboratory tests requested decreased by 16.44% and costs decreased by 16.53% in the intervention group, versus an increase in the number of tests (+3.75%) and of costs (+1.78%) in the control group. Feedback from practice showed that the medical staff was generally satisfied with the CDSS and perceived its benefits, but they were less satisfied with its technical performance in terms of slow response time.ConclusionsThe implementation of CDSSs can have a positive impact on both the efficiency of care provision and health care costs. The experience of using a CDSS can also result in good practice to be implemented by other health care organizations, considering the positive result from the first attempt to gather the point of view of end-users in Italy.

Effects of combined decision-support and performance-based incentives on reported client satisfaction with maternal health services in primary facilities: A quasi-experimental study in the Upper East Region of Ghana

“…An assessment of the effect of electronic medical records-based clinical decision-support on HIV care in resource-constrained settings reported reductions in documentation errors, missed appointments, missed CD4 results, and waiting times [47]. An Italian study reported that introducing CDSS was associated with a 16% reduction in the number of inappropriate laboratory tests requested, which also reduced costs [48,49]. A cross-sectional study in northern Ghana showed that CDSS implementation was associated with reduced proportions of delivery complications and fewer maternal deaths [50].…”

Leitlinienbasierter Clinical Decision Support – Anforderungen an evidenzbasierte Entscheidungsunterstützungssysteme

“…Die Implementierung von CDS-Systemen hat das Potenzial, Effizienz und Präzision der Versorgung zu verbessern, insbesondere in Disziplinen, die komplexe Entscheidungen erfordern. Clinical Decision Support kann zu Kostenersparnissen im Gesundheitssystem führen [8], durch klinische Interventionen [9], durch die Verkürzung der stationären Verweildauer, durch den Vorschlag kostengünstigerer Medikamentenalternativen [10] oder durch die Reduzierung von Doppeluntersuchungen [11]. Die Vorteile umfassen neben einer Reduzierung unerwünschter Arzneimittelwirkungen [12] auch verringerte Mortalitätsrisiken [13].…”

The Potential of Clinical Decision Support Systems for Prevention, Diagnosis, and Monitoring of Allergic Diseases

“…At first sight, these digital platforms seem to clearly outperform traditional approaches. However, the impact of their use on diagnostic precision, treatment efficacy, safety, quality of life and treatment costs needs to be objectivized and studied in more detail with regard to allergic diseases as it has been already done in other specialties and areas of medical care ( 70 – 73 ).…”