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Christopher Jason


Health systems are saving money after implementing CDS alerts into their respective EHR systems.


EHR-based clinical decision support (CDS) interventions have an overall positive economic impact on health systems, according to a study published in the US National Library of Medicine.

While researchers noted a lack of extensive cost components in their analysis, researchers acknowledged CDS interventions had a positive economic impact on health systems, such as reducing healthcare waste.

CDS tools enable prescribers to access real-time patient data, ideally resulting in enhanced patient safety and medication accuracy. CDS alerts can also prevent errors and additional adverse drug events from happening. Implementing CDS alerts into EHRs aims to reduce costs based on these typical health system challenges.

In a literature review of 27 studies, researchers aimed to evaluate the economic impact of CDS interventions based on EHRs. Researchers also identified and categorized CDS best practices.

Of the 27 studies, 22 studies noted a positive economic impact following CDS implementation. The implementation of CDS tools lowered costs on laboratory testing, antibiotic prescriptions, transfusion practice, and decreased duplicate order entries.

However, researchers also found previously undiscovered CDS malfunctions, order facilitators, and maintenance costs that could lead to added costs for a health system.

“While high upfront and maintenance costs of CDS systems are a worldwide implementation barrier, most studies do not consider implementation cost,” explained the study authors. “Finally, four included economic evaluation studies report mixed monetary outcome results and thus highlight the importance of further high-quality economic evaluations for these CDS systems.”

While researchers found several studies to show the economic impact, the study authors said evaluating this impact and its future value remains a significant challenge for researchers. The 22 studies reporting cost savings did not highlight how CDS solutions maintained or developed costs.

“Therefore, we could not draw a sound correlation between vendor-purchased or home-grown systems’ costs to their economic benefit,” explained the study authors. “Nonetheless, this study reveals several use cases with coherent CDS tools that have proven to be cost-saving and could be eligible for other healthcare providers, clinic managers, and researchers for implementation or further exploration.”

Researchers questioned the increasing number of CDS interventions based on point-of-care alerts, how much algorithm-based systems and numerous interventions would impact health system costs.

Health systems will have to consider the number of alerts, time expenses, and process-cost analysis to better understand the entire CDS economic impact, said researchers. Even implementing comparative metrics to assess the cost per useful alert could be a better way to look at these numbers.

“In a simple model, the authors introduce this measure to analyze how different parameters affect the cost of implementing EHR based CDS alerts for genomic precision medicine,” wrote researchers. “However, for future economic evaluations of EHR based CDS interventions, a more specific approach for individual application areas or focus on medical risk factors is needed to draw meaningful conclusions from cost and outcome comparisons.”

On the other hand, researchers said computerized physician order entry (CPOE) systems with automated lists and order sets could increase costs, thus, decreasing the value of CDS alerts.

“For example, the rate of unnecessary laboratory tests can increase when healthcare professionals tend to accept the whole order set rather than de-selecting single order items,” the study authors said. “This can be explained by alert fatigue, which must not directly be related to the order set, in combination with the ‘button clicking syndrome’, which explains the inducement of moving along inattentively.”

Extensive research is needed to come to a concrete conclusion, but researchers found CDS interventions have a positive economic impact.

“Predominantly point-of-care alerts concerning unnecessary laboratory testing, efficient transfusion practice, or reduction of antibiotic prescription emerged as application areas with already promising potential for high-cost savings,” concluded study authors.

“Nonetheless, most studies lack consideration of coherent cost components as well as comparative metrics. Therefore, the economic dimension of EHR based CDS interventions needs to be further explored.”