Boston Medical Center implemented electronic medical interventions to reduce unnecessary diagnostic testing

Upon implementing electronic medical record-based interventions, Boston Medical Center reduced unnecessary diagnostic testing and increased the use of postoperative order sets, two markers of providing high-value medical care.

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22 Oct. 2018

The data from the hospital’s efforts demonstrates the impact of deploying multiple interventions simultaneously within the electronic medical record as a way to deliver high-value care, which is defined as delivering the best possible care while simultaneously reducing unnecessary healthcare costs. This study was published in the Joint Commission Journal on Quality and Patient Safety.

The focus on providing high-value medical care was renewed in 2012 with the release of the Choosing Wisely campaign, an initiative of the American Board of Internal Medicine Foundation, to which many institutions have responded by developing electronic medical record-based interventions that target individual recommendations.

Boston Medical Center (BMC) focused on five areas in the Choosing Wisely recommendations: the overutilization of chest x-rays, routine daily labs, red blood cell transfusions, and urinary catheters, and underutilization of pain and pneumonia prevention orders for patients after surgery. To do this, the researchers worked with the information technology team to incorporate new recommendations into the electronic medical records that would alert the provider to best practice information. The researchers examined data between July 2014 and December 2016 to look at how the interventions played out clinically.

At six months following BMC’s intervention, which was activated hospital-wide for specific patients using the Epic electronic health record (Epic Systems, Inc.), the proportion of patients receiving pre-admission chest x-rays showed a significant decrease of 3.1 percent, and the proportion of labs ordered at routine times also decreased 4 percent. Total lab utilization declined with a post-implementation decrease of 1,009 orders per month.

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