EMR-based solutions help decrease unnecessary lab testing

Boston Medical Center reduced the number of patients who received unnecessary diagnostic testing after implementing new recommendations into its electronic medical record (EMR) system.

The study, published in the Joint Commission Journal on Quality and Patient Safety, looked at the effectiveness of implementing electronic health record (EHR)-based interventions to promote high-value care.

The hospital saw significant decreases in pre-admission chest x-rays and labs ordered at routine times six months after the implementation. The proportion of patients that received pre-admission chest x-rays significantly decreased 3.1 percent; the proportion of labs ordered at routine times decreased 4 percent; and total lab utilization declined 1,009 orders per month.

The proportion of postoperative patients who received appropriate pain and pneumonia prevention orders increased 20 percent, the results revealed. However, there was no significant difference in the estimated red blood cell transfusion utilization rate or number of non-ICU urinary catheter days following the implementation.

While the interventions reduced diagnostic testing, they did not have a significant effect on clinical interventions. 

The research and focus on providing better care was inspired by the 2012 release of the Choosing Wisely campaign, a health educational campaign that focuses on improving communication between patients and physicians and reducing unnecessary medical tests, treatments and procedures.

Boston Medical Center researchers worked with its IT team to incorporate new recommendations into its EMR, which alerted providers about best practices. Researchers then analyzed data between July 2014 and Dec. 2016 to measure effectiveness of the recommendations in a clinical setting.