Effects of Electronic Medical Record Display on Provider Ordering Behavior: Leveraging the EMR to Improve Quality and Costs

Schnaus, Michael; Michalik, Michael; Skarda, Paula K.

doi:10.1016/j.amjmed.2017.08.019

Cited by 7 publications

(17 citation statements)

References 20 publications

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“…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. The remaining study (4%) [19] did not detect signi cant differences in cost outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…[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). Medication dosing support, relevant information display, and expert systems (categories 1, 4, and 5) were each reported only once from an economic perspective (11%).…”

Section: Resultsmentioning

confidence: 99%

“…Finally, one study also reported an increase in costs after an unplanned change in the CDS system. [27] Such malfunctions or unintended errors, when caused by newly integrated health information technology, are referred to as 'e-Iatrogenesis'. [55] These may also lead to yet another cost-driver and possibly cause unpredictable economic damage.…”

Section: Discussionmentioning

confidence: 99%

“…[17] Another study reports that an unplanned change of a pre-selected default order for 'complete blood count' to 'complete blood count with differential' led to an average cost increase of $293.11 per day. [27] Finally, the implementation of order sets as decision facilitators possibly entails adverse economic effects. One study found that only after uncoupling joint orders of Vitamin B12 and serum folate tests from prede ned order sets, laboratory test cost decreased by about $26,719 per year.…”

Section: Economic Impact For Prevalent Application Areasmentioning

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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Economic Impact For Prevalent Application Areasmentioning

confidence: 99%

See 2 more Smart Citations

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

Lewkowicz

Wohlbrandt

Boettinger

2020

Preprint

View full text Add to dashboard Cite

show abstract

“…The 12 selected articles reported on 10 distinct studies. Among these studies, three addressed monitoring and individual feedback [32][33][34], two compared framed presentations [35,36], two addressed heuristics [37,38] and [39], one was about social norms [40], one addressed the ordering effect [41], and one used a combination of overconfidence, risk aversion, and herding [42,43]. Figure 1 presents the flowchart of this systematic review.…”

Section: Resultsmentioning

confidence: 99%

Behavioral Economics Interventions in Clinical Decision Support Systems

Cho

Bates

2018

Yearb Med Inform

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Our review revealed that the use of behavioral economics techniques is increasing in areas such as antibiotics prescribing and preventive care, and that additional tests of the concepts and heuristics described would be useful in other areas of CDS. An improved understanding of the benefits and limitations of behavioral economics techniques is also still needed. Future studies should focus on successful design strategies and how to combine them with CDS functions for motivating clinicians.

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Assessing Usability and Ambulatory Clinical Staff Satisfaction with Two Electronic Health Records

et al. 2023

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BACKGROUND: A growing body of literature has linked usability limitations within electronic health records (EHRs) to adverse outcomes which may in turn affect EHR system transitions. NewYork-Presbyterian Hospital (NYP), Columbia University College of Physicians and Surgeons (CU) and Weill Cornell Medical College (WC) are a tripartite organization with large academic medical centers that initiated a phased transition of their EHRs to one system, EpicCare©. OBJECTIVES: To characterize usability perceptions stratified by provider roles by surveying WC ambulatory clinical staff already utilizing EpicCare© and CU ambulatory clinical staff utilizing iterations of Allscripts© before the implementation of EpicCare© campus-wide. METHODS: A customized 19-question electronic survey utilizing usability constructs based on the Health Information Technology Usability Evaluation Scale was anonymously administered prior to EHR transition. Responses were recorded with self-reported demographics. RESULTS: 1,666 CU and 1,065 WC staff with ambulatory self-identified work setting were chosen. Select demographic statistics between campus staff were generally similar with small differences in patterns of clinical and EHR experience. Results demonstrated significant differences in EHR usability perceptions among ambulatory staff based on role and EHR system. WC staff utilizing EpicCare© accounted for more favorable usability metrics than CU across all constructs. Ordering providers (OPs) denoted less usability than non-OPs. The Perceived Usefulness and User Control constructs accounted for the largest differences in usability perceptions. The Cognitive Support and Situational Awareness construct was similarly low for both campuses. Prior EHR experience demonstrated limited associations. CONCLUSIONS: Usability perceptions can be affected by role and EHR system. OPs consistently denoted less usability overall and were more affected by EHR system than non-OPs. While there was greater perceived usability for EpicCare© to perform tasks related to care coordination, documentation and error prevention, there were persistent shortcomings regarding tab navigation and cognitive burden reduction, which have implications on provider efficiency and wellness.

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Effects of Electronic Medical Record Display on Provider Ordering Behavior: Leveraging the EMR to Improve Quality and Costs

Cited by 7 publications

References 20 publications

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

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

Behavioral Economics Interventions in Clinical Decision Support Systems

Assessing Usability and Ambulatory Clinical Staff Satisfaction with Two Electronic Health Records

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