The Problem
Healthcare costs are increasing at an unsustainable rate; up to 30% (over $750 billion annually) has been reported as wasted care that is potentially avoidable or unnecessary and would not negatively affect patient care if eliminated. In the era of value-based care and constrained resources, there is a need to reduce practice variability, optimize limited health care resources, and deliver the highest quality care to patients. The implementation of electronic health records (EHR) has created a vast repository of granular patient and population data. However, accessing the right information at the right time is complex and challenging, particularly in a time-compressed care delivery environment. This project focuses on the design and implementation of EHR-based clinical decision support tools to facilitate a system-wide intervention for presenting real-time clinical information in the routine care workflow to optimize laboratory ordering decisions. A key underpinning of this work includes standardizing laboratory analyte orderable and historical naming, in order to present relevant previous results at the point of order entry. The presentation of the relevant lab results saves provider and system time, and decreases both the number and frequency of unwarranted, unnecessary, or repeat laboratory tests.
Our Solution
Locating historical relevant lab analyte results at point of care can be time consuming and incomplete due to the fragmentation of the health system; frequently leading to redundant and unnecessary testing. By employing a lab clustering algorithm to present relevant historical lab results at the point of care, clinicians have actionable information available for rapid and relevant clinical decision making. Using existing EHR-based tools we selected 5 lab analytes to pilot in order to save provider and system time, reduce inappropriate or redundant lab testing, and improve the care of our patient population. The initial phase of the pilot involved a retrospective analysis to identify “hot-spots” (clinics, departments, inpatient units) where specific lab analytes were frequently ordered inappropriately and to develop clinical partners to test pilot ordering interventions. Analytes selected for the pilot phase: Hemaglobin A1C (HgB A1C), Thyroid Stimulating Hormone (TSH), Vitamin D, Vitamin B12, and Folate. Hepatitis C Antibody was added in February 2019.
Impact
Leverage a technology solution to collect data from
disparate sources, analyze the data against defined
rules for clinical criteria for repeating laboratory testing
and deliver actionable information to support clinical
decision making. We evaluated several options existing
outside and within Epic. We aimed to reduce workflow
friction, find the best fit to minimize disruption, and
tailor the information. We decided to use existing Epic
functionality, Best Practice Advisory (BPA).
When evaluating the options for the pilot and clinical
decision support (CDS) we used the framework of the
five rights of clinical decision support: right information,
right person, right channel, right CDS intervention
format, and right point in the workflow.
Silent BPAs were implemented September 2017 and
continue to run in Epic for systemwide data collection.
An abstract was submitted to High Value Care Practice
Academic Alliance annual meeting.
