Study: EHRs Can Boost Clinical Guideline Adherence, Cuts Costs

September 24, 2014 in News

A hospital group that adapted its electronic health record system to encourage its physicians to adhere to American Heart Association guidelines reduced its use of cardiac telemetry and cut related costs by 70%, while maintaining care quality, according to a study published in JAMA Internal Medicine, the Wall Street Journal reports.

Background

Cardiac telemetry is one of the procedures in the American Board of Internal Medicine Foundation’s Choosing Wisely campaign, which lists health care tests and procedures that professional societies consider to be unnecessary or overused. While professional associations such as the AHA publish treatment guidelines, physicians sometimes deviate from them, which can result in unnecessary procedures and tests, according to the Journal. Physicians’ reasons for deviating from the guidelines include patient, personal or institutional preferences, and fears of malpractice lawsuits.

Study Details, Findings

For the study, Wilmington, Del.-based Christiana Care Health System changed its EHR system. For situations outside of AHA guidelines, Christiana removed the initial option for physicians to order cardiac monitoring and required doctors to take an additional step to order such monitoring situations. For situations within the AHA guidelines, Christiana added an AHA-recommended timeframe for cardiac monitoring, after which it notified nurses to stop the monitoring or ask a physician if they believed it would be unsafe.

After implementing the changes:

  • The health system’s average daily non-intensive care unit patients with cardiac monitoring declined by 70%, from 357.5 to 109.1; and
  • The health system’s average daily cost of administering non-ICU cardiac monitoring declined by 70%, from $18,971 to $5,772.

In the meantime, mortality rates, patient care and the amount of “code blue” emergency alerts to resuscitate patients remained constant (Whalen, Wall Street Journal, 9/22).

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