EHR visual aid cuts duplicate orders for lab, radiology tests

The implementation of a visual aid in an electronic health record ordering system resulted in a significant reduction in duplicate orders for both laboratory and radiology tests.

Results of a study, involving emergency department clinicians at Boston’s Beth Israel Deaconess Medical Center, were published Monday in the journal JAMA Network Open.

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Beth Israel Deaconess Medical Center

“The introduction of a visual aid was associated with a 49 percent reduction in unintentional duplicate orders for laboratory tests and a 40 percent reduction in unintentional duplicate orders for radiology tests,” concludes the study.

However, according to the study’s authors, there was no statistically significant change in unintentional duplicate orders for medications.

In the cohort study of 184,694 ED patients, BIDMC implemented a user interface within the ED’s computerized provider order entry system, enabling passive visual cues for just-in-time duplicate order decision support.

Specifically, if an order had previously been placed during an ED visit, the user was cued by a red highlight around the checkbox of that order.

“Our implementation was specific to the ED, but is applicable to any care setting where clinical care teams must collaborate,” contend the authors. “Other care settings that have clinicians who are geographically dispersed would amplify the changes associated with such an intervention.”

Going forward, BIDMC plans to iteratively develop new user interfaces—given the increased complexity—as it implements the intervention across different care settings.

The authors point out that different care settings require different thresholds for determining if an order is a duplicate. For example, in the ICU that threshold might be four to 12 hours, while in the hospitalist setting that threshold may be 24 hours—and in the outpatient setting, it may be one week or one month.

“In the ED, having a simple binary representation of whether an order was a duplicate during that ED visit was intuitive and clinically meaningful,” add the authors. “However, in the ICU, having multiple stages corresponding with last order time with additional information, such as ordered 5 minutes ago or ordered 6 hours ago, could be important.”

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