Patients do better, save money when doctors follow EHR alerts

Technology has streamlined many aspects of healthcare, but outcomes are further improved when doctors actually follow alerts prompted by electronic health records (EHRs), according to a recent study.

Hospitalized patients experience fewer complications and lower costs when physicians follow computer alerts embedded in EHRs, according to the study, which was conducted by researchers from Cedars-Sinai and published in The American Journal of Managed Care.

Alerts that appeared on EHRs often deviated from evidence-based guidelines, but still led to better outcomes, and patients were also less likely to be readmitted when the alerts were followed, the study found. The researchers looked at data from inpatient visits at Cedars-Sinai Medical Center from October 2013 to July 2016 when one or more of the 18 most frequent alerts were triggered.

The alerts, based on an initiative called Choosing Wisely, identified tests and procedures that may not actually benefit a patient, but served as a reminder to the physician to only provide necessary care and avoid care that could expose a patient to unnecessary radiation and costs.

Unnecessary services contribute as much as $210 billion in wasteful healthcare spending in the U.S. annually, according to one estimate from the Institute of Medicine.

“Sometimes the best care for certain patient conditions means doing less,” Scott Weingarten, MD, MPH, chief clinical transformation officer at Cedars-Sinai and a senior author of the study, said in a statement. “We have seen that real-time aids for clinical decision-making can potentially help physicians reduce low-value care and improve patient outcomes while lowering costs.” 

Just 6 percent of physicians followed all triggered alerts, while 94 percent followed none. Physicians who followed the alerts reduced the risks of complications and improved health outcomes for their patients significantly, according to the study. The data of more than 26,000 patients was examined.

Patients whose physicians did not follow the alerts saw their risk of complications increase 29 percent compared to the group whose physicians followed the alerts. Furthermore, the odds of a readmission within 30 days were 14 percent higher in patients whose physicians did not follow the alerts. This group of patients had hospital stays an average of 6.2 percent longer and accrued an additional 7.3 percent in costs—or $944 per patient.

“Sometimes doctors order tests that they think are in the patient’s best interest, when research doesn’t show that to be the case. Unnecessary testing can lead to interventions that can cause harm,” Harry C. Sax, MD, executive vice chair of Surgery at Cedars-Sinai and a senior author of the study, said in a statement. “This work is about giving the right care that patients truly need.” 

Authors of the study did not measure if one type of alert was more significant than others. A typical alert was triggered, for example, when a doctor ordered a CT scan when it was unlikely to improve the patient’s condition.