Impact of nonintrusive clinical decision support systems on laboratory test utilization in a large academic centre

Kevin P. Eaton, Natasha Chida, Ariella Apfel, Leonard Feldman, Adena Greenbaum, Susan Tuddenham, Emily A. Kendall, Amit Pahwa

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background: The near-universal prevalence of electronic health records (EHRs) has made the utilization of clinical decision support systems (CDSS) an integral strategy for improving the value of laboratory ordering. Few studies have examined the effectiveness of nonintrusive CDSS on inpatient laboratory utilization in large academic centres. Methods: Red blood cell folate, hepatitis C virus viral loads and genotypes, and type and screens were selected for study. We incorporated the appropriate indications for these labs into text that accompanied the laboratory orders in our hospital's EHR. Providers could proceed with the order without additional clicks. An interrupted time-series analysis was performed, and the primary outcome was the rate of tests ordered on all inpatient medicine floors. Results: The rate of folate tests ordered per monthly admissions showed no significant level change at the time of the intervention with only a slight decrease in rate of 0.0109 (P =.07). There was a 43% decrease in the rate of hepatitis C virus tests per monthly admissions immediately after the intervention with a decrease of 0.0135 tests per monthly admissions (P =.02). The rate of type and screens orders per patient days each month had a significant downward trend by 0.114 before the intervention (P =.04) but no significant level change at the time of the intervention or significant change in rate after the intervention. Discussion: Our study suggests that nonintrusive CDSS should be evaluated for individual laboratory tests to ensure only effective alerts continue to be used so as to avoid increasing EHR fatigue.

Original languageEnglish (US)
Pages (from-to)474-479
Number of pages6
JournalJournal of Evaluation in Clinical Practice
Volume24
Issue number3
DOIs
StatePublished - Jun 2018

Keywords

  • computer-decision support tools
  • high-value care
  • laboratory testing

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Fingerprint

Dive into the research topics of 'Impact of nonintrusive clinical decision support systems on laboratory test utilization in a large academic centre'. Together they form a unique fingerprint.

Cite this