Reducing unnecessary testing in a CPOE system through implementation of a targeted CDS intervention
Donald L Levick, Glenn Stern, Chad D Meyerhoefer, Aaron Levick and David Pucklavage. Reducing unnecessary testing in a CPOE system through implementation of a targeted CDS intervention. BMC Medical Informatics and Decision Making 2013 .
Observational studies are needed to assess the effect of CDS and CPOE systems on resource optimization and the appropriate use of laboratory tests and imaging techniques. This study describes the development and use of a CDS intervention to reduce unnecessary testing (and associated costs) in a CPOE system, and evaluates its effectiveness. B-Type Natriuretic Peptide (BNP) testing ( a diagnostic laboratory test among critical care patients) was identified as an overused laboratory test that has no beneficial effect to being repeated more than once in a hospital stay.
The CPOE system was modified to employ an expert rule to alert the ordering clinician that a BNP had been performed during the current admission and that repeat testing would add no value to the clinical decision making process. The authors carried out multivariate regression analysis to assess the effectiveness of the intervention.
The CDS intervention for repeat BNP testing was implemented in June, 2009 and BNP ordering decreased by approximately 65% within six months of introduction of the intervention. The regression results suggested the CDS intervention reduced BNP orders by 21% relative to the mean. The financial impact of the rule was also significant. Multiplying by the direct supply cost of $28.04 per test, the intervention saved approximately $92,000 per year.
The findings of this study suggest that appropriately designed and carefully implemented CDS interventions can have a substantial impact on resource optimization and healthcare costs. The intervention implemented to reduce unnecessary testing was effective due to:
- Alerted physicians that further BNP testing is potentially misleading
- Addressed an information failure associated with the EMR
- The invervention was implemented and evaluated in the content of an advanced CPOE system facilitating this cycle of implementation and evaluation
It is important that these interventions should be used appropriately and judiciously as too many alerts can give rise to alert fatigue , thus reducing the impact and efficacy of the CPOE/ CDS systems.
- Levick, D. L., Stern, G., Meyerhoefer, C. D., Levick, A., & Pucklavage, D. (2013). Reducing unnecessary testing in a CPOE system through implementation of a targeted CDS intervention. BMC medical informatics and decision making, 13(1), 43. http://www.biomedcentral.com/1472-6947/13/43
- Reducing unnecessary testing in a CPOE system through implementation of a targeted CDS intervention.http://www.biomedcentral.com/1472-6947/13/43