Effect of Electronic Clinical Decision Support on 25(OH) Vitamin D Testing

Abstract

Background Unnecessary healthcare utilization, non-adherence to current clinical guidelines, or insu cient 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 identi ed 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, e cient 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.

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

“…An overview of the characteristics of the included studies is listed in Table 2. Generally, twenty-two studies (81%) [5,[13][14][15][16]18,[20][21][22][23][24][25][28][29][30][31]32,[34][35][36][37][38] out of the included twenty-seven studies report cost savings after implementing an EHR based CDS intervention. Four studies (15%) [17,26,27,33] report a rise in cost expenditure.…”

“…In the majority of included studies the main cost outcome measures were related to laboratory test cost. [15][16][17]20,21,25,28,29,31,32,38] Exploration of different front-end CDS intervention categories According to the taxonomy by Wright et al [12], we identi ed ten (37%) studies [5,13,15,20,22,23,26,[36][37][38] which explored EHR based CDS interventions based on point-of-care alerts or reminders (category 3). Three interventions (11%) [17,27,34] were order facilitators (category 2).…”

“…Application areas for cost-savings: We identi ed four primary application areas based on their investigated prevalence that resulted in cost-savings after EHR based CDS implementation. Firstly, two studies report on reducing unnecessary Vitamin D routine testing, which led to a decrease in laboratory test cost of $300,000 [15] and $1.4 mill. [28] per year.…”

Economic Impact of Clinical Decision Support Interventions Based on Electronic Health Records

“…According to the taxonomy by Wright et al [12] we identi ed twelve (44%) studies [5,13,15,20,22,23,26,31,32,[36][37][38] which explored EHR based CDS interventions based on point-of-care alerts or reminders (category 3). In addition, three interventions (11%) [17,27,34] were order facilitators (category 2), two studies (7%) [19,30] investigated medication dosing support (category 1), while relevant information display as well as expert systems (category 4 and 5) were each reported only once from an economic perspective (4%).…”

“…Cost estimation based on model Application areas for cost-savings Thereupon, we identi ed four main application areas based on their investigated prevalence that resulted in cost-savings after EHR based CDS implementation. Firstly, two studies report on essentially reducing unnecessary Vitamin D routine testing that led to a decrease of laboratory test cost of $300,000 [15] and $1,4mill. [28] per year.…”