When physicians get the right kind of alert in an electronic health record—and actually follow its recommendation—it could result in fewer complications and lower costs among hospitalized patients, according to a new study.
Published in the American Journal of Managed Care, researchers from Cedars-Sinai Medical Center and Optum Advisory Services teamed up to examine alerts that popped up on physician computer screens inside their EHR system when their care instructions deviated from evidence-based guidelines.
Those alerts were based on the 'Choosing Wisely' initiative in which different specialties have identified common tests and procedures in their respective areas of expertise that may not benefit patients and should be avoided.
Looking at nearly 26,500 inpatient admissions at Cedars-Sinai Medical Center between October 2013 and July 2016, the researchers studied whether the treating physician followed either all or none of the Choosing Wisely guidance. In 6% of visits, physicians followed all of the triggered alerts and in 94% of visits, physicians followed none of the alerts. In particular, they examined data in which one more of the 18 most frequent alerts were triggered.
For patients whose physicians did not follow the alerts, the odds of complications increased by 29% and the risk of readmissions within 30 days of the patients' original visit was 14% higher. There was also a 6.2% increased length of stay and an additional 7.3% or more than $900 per patient increase in costs after adjusting in differences in patient complexity.
To be clear, the study was examining a product created by Stanson Health, a spinout company founded by Cedars-Sinai executives and in which the health system is a major shareholder.
Optum is a licensed reseller of Stanson's Health's Choosing Wisely alert content and, for the study, married Stanson's data with its own analytics on cost and complications and length of stay for those same admissions.
“We said, ‘Hey, let’s look and see if we can demonstrate that we’re not only able to get docs to look at alerts but we can actually change the ultimate outcomes we’re trying to change like complications and readmissions," John Kontor, M.D., an executive vice president at Clinovations within Optum told FierceHealthcare in an interview. "For us, it was risk-free but it was very risky for Stanson."
It worked out by showing the association they were looking for, he said.
But there are limitations to the study, they acknowledge.
There was no way to measure the impact of specific alerts on outcomes to see if one was more significant than others. There is also no way to know if providers who were more likely to follow alerts may also be more engaged around quality and efficiency in how they practice day to day, Kontor said.
More study is needed to more closely examine the direct impact of the alerts, officials said. But, they said, the study shows using tools could have a real impact on costs and quality.
"The next step is to look at the characteristics of overall alerts and say 'We see a positive impact. Now let's look at what’s most effective about clinical decision support in order to maximize the positive impact on both for patients and providers," said Anne Wellington, a co-author of the study and managing director of the Cedars-Sinai accelerator.