CDS alerts in hospital EHR reduce costs, improve outcomes

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A new study finds that clinical decision support alerts embedded into a hospital records system have improved patient health and financial outcomes.

Researchers at Cedars-Sinai Medical Center say the results show the positive effects of leveraging Choosing Wisely recommendations. An article on the study was published this week in the American Journal of Managed Care.

For the study, Cedars-Sinai evaluated the 18 highest-volume Choosing Wisely alerts integrated into its Epic EHR. The observational study of 26,424 inpatient encounters examined the associations between adherence to Choosing Wisely recommendations embedded into CDS alerts and four measures of resource use and quality.

“Encounters in which providers adhered to all alerts had significantly lower total costs, shorter lengths of stay, a lower probability of 30-day readmissions, and a lower probability of complications compared with non-adherent encounters,” according to the study’s authors.

When it comes to financial outcomes, the authors noted that adherence to Choosing Wisely alerts was associated with savings of $944 from a median encounter cost of $12,940.

Also See: Cedars-Sinai reduces unnecessary care using EHR alerts

“Inpatient alerts selected for study were those deemed the most technically feasible to deploy accurately and with a sufficient number of relevant orders that would trigger an alert, thus providing a sufficient volume of alerted encounters to evaluate,” state the authors. “When initiating a potentially inappropriate order, a provider received real-time notification of deviation from a CW recommendation. That provider then had the option to cancel, change, or justify the order, if he or she agreed with the alert’s recommendation in the context of the individual patient.”

The American Board of Internal Medicine Foundation’s Choosing Wisely initiative is based on guidance from medical specialty societies and has identified nearly 500 common diagnostic tests and procedures that may not have clear benefit for patients and sometimes should be avoided.

“We recommend that provider organizations consider the introduction of real-time CDS to support adherence to evidence-based guidelines, but because we cannot determine the cause of the associations between CDS interventions and improved clinical and financial outcomes, further study is required,” conclude the authors.

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