- Adhering to a real-time clinical decision support system embedded in the EHR helped providers at Cedars-Sinai cut wasteful healthcare spending by almost $1000 per patient and improve patient outcomes, according to a study published in The American Journal of Managed Care.
The alerts appeared in the EHR workflow when physicians’ care instructions deviated from evidence-based guidelines. The notifications, based on the Choosing Wisely initiative, identify common procedures or medications that may not benefit patients and that providers should sometimes avoid.
Researchers from Cedars-Sinai and Optum Advisory Services found that patients of physicians who did not follow EHR alerts experienced an additional 7.3 percent increase in care costs, or $944 per patient.
Moreover, physicians who didn’t adhere to the EHR alerts raised the odds of patient complications by 29 percent compared to physicians who followed all EHR alerts.
Eliminating unnecessary healthcare services is a key way to cut costs and improve care delivery.
To discover whether CDS systems are truly associated with lower costs and enhanced patient outcomes, researchers observed inpatient visits at Cedars-Sinai from October 2013 to July 2016, when one or more of the 18 most frequent EHR alerts was triggered.
For example, if a physician ordered a CT scan that likely won’t improve a patient’s outcome, an alert would pop up reminding the physician that the order could expose the patient to unnecessary testing and costs.
In the 26,424 visits examined in the study, physicians either followed all or none of the alerts. Six percent of visits showed physicians following all alerts, while the remaining 94 percent of visits showed physicians adhering to none of the triggered alerts.
In addition to higher costs and a greater risk of complications, patients whose physicians did not follow the alerts experienced a 14 percent increase in their risk of hospital readmissions within 30 days of their original visit.
Patients of these physicians also experienced a 6.2 percent increase in their length of stay in comparison to patients of physicians who adhered to all the alerts.
The results of the study show the potential for real-time CDS tools to improve treatment decisions and reduce needless spending.
“Sometimes doctors order tests that they think are in the patient’s best interest, when research doesn’t show that to be the case,” said Harry C. Sax, MD, Executive Vice Chair of Surgery at Cedars-Sinai.
“Unnecessary testing can lead to interventions that can cause harm. This work is about giving the right care that patients truly need.”
The researchers acknowledged that there were some limitations to the study, including that they could not measure the impact of particular alerts on outcomes to determine if one alert was more significant than others.
Additionally, the team excluded visits in which providers followed some but not all the alerts, which limits their understanding of the clinical and financial impact of those visits.
Still, the study demonstrates that real-time alerts may be key in reducing unnecessary procedures.
“Sometimes the best care for certain patient conditions means doing less,” said Scott Weingarten, MD, MPH, chief clinical transformation officer at Cedars-Sinai.
“We have seen that real-time aids for clinical decision-making can potentially help physicians reduce low-value care and improve patient outcomes while lowering costs.”