Optimize Your Electronic Medical Record to Increase Value: Reducing Laboratory Overutilization

Abstract

A simple modification to the order entry system significantly and immediately altered provider practices throughout a large tertiary care academic center. This strategy is replicable by the many hospitals that use the same electronic health record system, and possibly, by users of other systems. Future areas of study include evaluating the additive effects of education and real-time decision support.

Adherence to Recommended Inpatient Hepatic Encephalopathy Workup

“…3 EMR-based strategies can curb unnecessary testing in inpatient settings. 12 The use of HE order sets, the inclusion of clinical decision support systems, and the restriction of access to specialized testing can be readily incorporated into the EMR to encourage adherence to guideline-based care while limiting unnecessary testing.…”

Decreasing daily blood work in hospitals: What works and what doesn't

“…Many interventions are multifaceted incorporating both a component of person‐oriented intervention as well as change in system design or process. Table lists the studies reviewed that have used education and reminders, audit and feedback, computer physician entry order systems, and forcing restraints …”

“…One such tool is the Hierarchy of Effectiveness, a widely Table 1 lists the studies reviewed that have used education and reminders, [15][16][17][18] audit and feedback, [19][20][21] computer physician entry order systems, [22][23][24] and forcing restraints. [25][26][27][28][29][30] So, while education is always a component of changing ordering behaviors, there is a limited role for education as a sole intervention given the lack of long-term effects. In total, these negative studies suggest that lack of awareness of guidelines contributes minimally to inappropriate laboratory test ordering.…”

Effectiveness of provider price display in computerized physician order entry (CPOE) on healthcare quality: a systematic review

“…While price display did not result in consistent reduction in laboratory test utilization, other equally simple design-based interventions, such as eliminating default daily laboratory draw frequencies in EHR, resulted in significant reduction. 24,41,42 Eliminating default daily laboratory orders is a particularly promising intervention as the prevalence of patients receiving admission day orders for daily recurring laboratory tests has been reported to be as high as 95% in a large urban teaching hospital. 42 An argument can be made about improving the design of existing passive price display tools to create interactive second-generation price display tools based on sophisticated clinical decision support architecture.…”

“…24,41,42 Eliminating default daily laboratory orders is a particularly promising intervention as the prevalence of patients receiving admission day orders for daily recurring laboratory tests has been reported to be as high as 95% in a large urban teaching hospital. 42 An argument can be made about improving the design of existing passive price display tools to create interactive second-generation price display tools based on sophisticated clinical decision support architecture. However, improving the design of a price display tool by adding more visible information and creating the need for additional provider-computer interaction has potential negative consequences such as physician dissatisfaction (increased time spent in CPOE) and increased investment required to design and maintain these tools.…”