Omitting EHR’s auto-ordering option cuts costs without compromising care

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 - BloodTest

By stripping an EHR of its ability to facilitate automatic orders of daily lab tests without review, a team of utilization interveners has saved a large academic medical center upwards of $300,000.

What’s more, the authors of the study revealing the gain say their interface modification is both simple and replicable at other hospitals—including those using different EHRs.

Eduardo Iturrate, MD, of NYU Langone Medical Center, and colleagues report their work in the February American Journal of Medicine.

Examining 1.3 million lab tests performed on 92,799 unique patients over 434,059 patient days from 2013 to 2015, the team found that, before the intervention, targeted common tests were automatically ordered an average 33 percent of the time (range, 26.2 percent for complete blood count to 48.9 percent for phosphorus).

After the intervention, the team recorded a reduction of 8.52 percent in tests ordered per patient per day.

The authors estimated this utilization-rate reduction would cut costs by $323,489 per year.

In their discussion, Iturrate et al. note that, right after the intervention, order rates for the tests other than the top two (basic metabolic panel and complete blood count) were trending toward returning to their pre-intervention levels. Still, even these seemed to plateau at a lower rate than before the intervention.

“This suggests that after the initial decrease in ordering after the intervention, providers made a considered decision that the rate of utilization for the basic metabolic panel and complete blood count was likely at an appropriate level before the intervention,” the authors write. “Their behavior seems to suggest, however, that the other laboratory tests were in fact overutilized before the intervention.”

Saving money by slashing auto-ordered lab tests is all well and good, but what about possible impact on clinical outcomes?

Surveying providers on their experience with the intervention, the team was unable to ascertain whether any specific harm resulted due to the removal of auto-ordering.

However, they reviewed outcomes metrics and found that, during the study period, the metrics revealed “no large negative impact.”

Meanwhile, the exercise “elucidated concern on the part of the providers that patients have suffered a blood test being performed later than the usual morning phlebotomy time because laboratory tests were accidentally not ordered the night before,” the authors write.

They note that their technique is replicable by the many hospitals that use the same EHR system and possibly by users of other systems.

“This study demonstrates that a simple modification to the electronic order entry system has the capacity to alter provider practices that ultimately decreased costs of hospitalizations and likely did not cause serious patient harm,” Iturrate and colleagues conclude, allowing that their intervention “did create dissatisfaction with a substantial proportion of providers who view it as causing them to have more trivial time-consuming tasks added to their workload.”