Journal:The effect of a test ordering software intervention on the prescription of unnecessary laboratory tests - A randomized controlled trial

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Full article title The effect of a test ordering software intervention on the prescription of unnecessary laboratory tests - A randomized controlled trial
Journal BMC Medical Informatics and Decision Making
Author(s) Martins, C.M.; da Costa Teixeira, A.S.; de Azevedo. L.F.; Sá, L.M.; Santos, P.A.; do Couto, M.L.; da Costa Pereira, A.M.;
Hespanhol, A.A.; da Costa Santos, C.M.
Author affiliation(s) University of Porto
Primary contact E-mail: carlosmartins20 at gmail dot com
Year published 2017
Volume and issue 17 (1)
Page(s) 20
DOI 10.1186/s12911-017-0416-6
ISSN 1472-6947
Distribution license Creative Commons Attribution 4.0 International
Website https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-017-0416-6
Download https://bmcmedinformdecismak.biomedcentral.com/track/pdf/10.1186/s12911-017-0416-6 (PDF)
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Abstract

Background: The way electronic health record and laboratory test ordering system software is designed may influence physicians’ prescription. A randomized controlled trial was performed to measure the impact of a diagnostic and laboratory tests ordering system software modification.

Methods: Participants were family physicians working and prescribing diagnostic and laboratory tests.

The intervention group had modified software with basic shortcut menu changes, where some tests were withdrawn or added, and with the implementation of an evidence-based decision support system based on United States Preventive Services Task Force (USPSTF) recommendations. This intervention group was compared with typically used software (control group).

The outcomes were the number of tests prescribed from those: withdrawn from the basic menu; added to the basic menu; marked with green dots (USPSTF’s grade A and B); and marked with red dots (USPSTF’s grade D).

Results: Comparing the monthly average number of tests prescribed before and after the software modification, from those tests that were withdrawn from the basic menu, the control group prescribed 33.8 tests per 100 consultations before and 30.8 after (p = 0075); the intervention group prescribed 31.3 before and 13.9 after (p < 0001). Comparing the tests prescribed between both groups during the intervention, from those tests that were withdrawn from the basic menu, the intervention group prescribed a monthly average of 14.0 vs. 29.3 tests per 100 consultations in the control group (p < 0.001). From those tests that are USPSTF’s grade A and B, the intervention group prescribed 66.8 vs. 74.1 tests per 100 consultations in the control group (p = 0.070). From those tests categorized as USPSTF grade D, the intervention group prescribed an average of 9.8 vs. 11.8 tests per 100 consultations in the control group (p = 0.003).

Conclusions: Removing unnecessary tests from a quick shortcut menu of the diagnosis and laboratory tests ordering system had a significant impact and reduced unnecessary prescription of tests.

The fact that it was not possible to perform the randomization at the family physicians’ level, but only on the computer servers is a limitation of our study. Future research should assess the impact of different test ordering systems during longer periods.

Trial registration: ISRCTN45427977, May 1st 2014 (retrospectively registered).

Keywords: Preventive health services, primary health care, evidence-based practice, decision support systems, clinical decision making, computer-assisted

Background

Informatics has undoubtedly changed the way societies live, socialize, learn, work, and deal with healthcare. We now live in a period of increasing concern about the excessive presence of medicine in our lives.[1][2][3] When inefficient software is combined with a non-evidence-based medical practice, there is the risk of patient harm, significant impact to quality of life, and damage to the healthcare system due to unnecessary costs.

The implementation of electronic health records (EHRs) has both potential benefits and drawbacks.[4] Among the benefits, the prevention of medical errors and the promotion of patient safety has often been mentioned and confirmed in clinical practice.[4][5][6] Despite the positive effects of EHR implementation in clinical practice, a range of barriers faced by physicians has been identified. These barriers may include technical and financial aspects, time, psychological, social, legal, and organizational changes to the process.[7] After having removed the first barriers to EHR implementation, it is now time to implement continuing improvement and development of the available tools and to incorporate the scientific evidence obtained to this point.[4][8]


References

  1. ↑ Glasziou, P.; Moynihan, R.; Richards, T. et al. (2013). "Too much medicine; too little care". BMJ 347: f4247. doi:10.1136/bmj.f4247. PMID 23820022. 
  2. ↑ Moynihan, R.; Doust, J.; Henry, D. (2012). "Preventing overdiagnosis: How to stop harming the healthy". BMJ 344: e3502. doi:10.1136/bmj.e3502. PMID 22645185. 
  3. ↑ Getz, L.; Sigurdsson, J.A.; Hetlevik, I. (2003). "Is opportunistic disease prevention in the consultation ethically justifiable?". BMJ 327 (7413): 498–500. doi:10.1136/bmj.327.7413.498. PMC PMC188390. PMID 12946974. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC188390. 
  4. ↑ 4.0 4.1 4.2 Raposo, V.L. (2015). "Electronic health records: Is it a risk worth taking in healthcare delivery?". GMS Health Technology Assessment 11: Doc02. doi:10.3205/hta000123. PMC PMC4677576. PMID 26693253. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4677576. 
  5. ↑ Ben-Assuli, O. (2015). "Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments". Health Policy 119 (3): 287–97. doi:10.1016/j.healthpol.2014.11.014. PMID 25483873. 
  6. ↑ Ben-Assuli, O.; Leshno, M. (2016). "Assessing electronic health record systems in emergency departments: Using a decision analytic Bayesian model". Health Informatics Journal 22 (3): 712–29. doi:10.1177/1460458215584203. PMID 26033468. 
  7. ↑ Boonstra, A.; Broekhuis, M. (2010). "Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions". BMC Health Services Research 10: 231. doi:10.1186/1472-6963-10-231. PMC PMC2924334. PMID 20691097. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924334. 
  8. ↑ Roukema, J.; Los, R.K.; Bleeker, S.E. (2006). "Paper versus computer: Feasibility of an electronic medical record in general pediatrics". Pediatrics 117 (1): 15–21. doi:10.1542/peds.2004-2741. PMID 16396855. 

Notes

This presentation is faithful to the original, with only a few minor changes to presentation. In some cases important information was missing from the references, and that information was added. A significant amount of grammar edits were made to make the document more readable.

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