Hospital EHR, add-ons help reduce costly, unnecessary GI testing

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An alert and “hard stop” programmed into an electronic health records system at an academic medical center resulted in a significant reduction in inappropriate gastrointestinal panel testing and cost savings.

Researchers at the University of Nebraska Medical Center hard-wired criteria into the hospital’s EHR to provide clinicians with a best-practice alert and a hard stop that prevented them from ordering a gastrointestinal pathogen panel (GIPP)—a costly test that detects common disease-causing organisms—more than once per admission or in patients hospitalized for more than 72 hours.

As a result of the EHR’s best-practice alert and hard stop, the hospital was able to reduce inappropriate testing by 46 percent and saved as much $168,000 over 15 months, according to a study published on Tuesday in the journal Infection Control & Hospital Epidemiology.

“We can improve the care we deliver by hard-wiring criteria for appropriate test ordering and diagnostic stewardship into the electronic health record,” says Jasmine Marcelin, MD, the study’s lead author and associate medical director of antimicrobial stewardship at University of Nebraska Medical Center. “We found that when it comes to diarrheal illnesses in the hospital, asking physicians to reconsider if the testing is appropriate through hard-wired alerts saves money without compromising quality of care.”

Also See: PatientSafe, ILUM Health join to offer infectious disease alerts

On Tuesday, the journal Infection Control & Hospital Epidemiology also published a white paper on how incorporating EHRs and “add-on” clinical decision support systems into antimicrobial stewardship programs can help improve the efficiency of the interventions and facilitate tracking and reporting of key metrics.

“When used intentionally, information technology can help ease the growing demands placed on healthcare systems to meet antimicrobial stewardship standards and reporting requirements, even as financial and personnel resources are reduced,” says Kristi Kuper, lead author of the white paper and senior clinical manager for infectious diseases in the Center for Pharmacy Practice Excellence at healthcare performance improvement vendor Vizient.

At the same time, the white paper’s authors recommended several health IT improvements:

  • Creating more nimble systems for non-acute settings, such as primary care clinics, surgery centers and outpatient dialysis centers.
  • Improving documentation processes for clinical decision support and EHR tools to reduce the provider burden.
  • Enhancing the ability to track and report patient outcomes.
  • Establishing user networks to share best practices and reduce redundancies to help increase the efficiency of the development of rules and reports.

“While existing systems may present challenges, when used optimally, informatics can create readily available tools for local and national reporting, help guide appropriate antimicrobial prescribing that improves selection, dosing, and duration of therapy, and serve as an educational reference for trainees and providers,” adds Kuper.

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