Evaluation and cost estimation of laboratory tests overuse through a CCDSS in a university hospital

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Vallone ◽  
A Tamburrano ◽  
C Carrozza ◽  
A Urbani ◽  
A Cambieri ◽  
...  
Keyword(s):  
Cost Estimation ◽  
Laboratory Tests ◽  
Quality Care ◽  
Clinical Decision Support Systems ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
University Hospital ◽  
Specific Patient ◽  
Global Rate ◽  
Common Laboratory

Abstract Computerized Clinical Decision Support Systems (CCDSS) are information technology-based systems that use specific patient characteristics and combine them with rule-based algorithms. The aim of this study is to conduct a survey to measure and assess the over-utilization rates of laboratory requests and to estimate the monthly cost of inappropriate requests in inpatients of the “Fondazione Policlinico Universitario A. Gemelli IRCCS” Care Units. This observational study is based on the count of rules violations for 43 different types of laboratory tests requested by the Hospital physicians, for a total of 5,716,370 requests, over a continuous period of 20 months (from 1 July 2016 to 28 February 2018). Requests from all the hospital internal departments (except for Emergency, Intensive Care Units and Urgent requests) were monitored. The software intercepted and counted, in silent mode for the operator, all requests and violations for each laboratory test among those identified. During the observation period a mean of 285,819 requests per month were analyzed and 40,462 violations were counted. The global rate of overuse was 15.2% ± 3.0%. The overall difference among sub-groups was significant (p < 0.001). The most inappropriate exams were Alpha Fetoprotein (85.8% ± 30.5%), Chlamydia trachomatis PCR (48.7% ± 8.8%) and Alkaline Phosphatase (20.3% ± 6.5%). All the exams, globally considered, generated an estimated avoidable cost of 1,719,337€ (85,967€ per month) for the hospital. This study reports rates (15.2%) similar to other works. The real impact of inappropriateness is difficult to assess, but the generated costs for patients, hospitals and health systems are certainly high and not negligible. Key messages It would be desirable for international medical communities to produce a complete panel of prescriptive rules for all the most common laboratory exam. That is useful not only to reduce costs, but also to ensure standardization and high-quality care.

scholarly journals Interface, information, interaction: a narrative review of design and functional requirements for clinical decision support

2017 ◽  
Vol 25 (5) ◽  
pp. 585-592 ◽  
Author(s):  
Kristen Miller ◽  
Danielle Mosby ◽  
Muge Capan ◽  
Rebecca Kowalski ◽  
Raj Ratwani ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Quality Care ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
The Body ◽  
Narrative Review ◽  
Functional Requirements ◽  
Design Features ◽  
And Function

Abstract Objective Provider acceptance and associated patient outcomes are widely discussed in the evaluation of clinical decision support systems (CDSSs), but critical design criteria for tools have generally been overlooked. The objective of this work is to inform electronic health record alert optimization and clinical practice workflow by identifying, compiling, and reporting design recommendations for CDSS to support the efficient, effective, and timely delivery of high-quality care. Material and Methods A narrative review was conducted from 2000 to 2016 in PubMed and The Journal of Human Factors and Ergonomics Society to identify papers that discussed/recommended design features of CDSSs that are associated with the success of these systems. Results Fourteen papers were included as meeting the criteria and were found to have a total of 42 unique recommendations; 11 were classified as interface features, 10 as information features, and 21 as interaction features. Discussion Features are defined and described, providing actionable guidance that can be applied to CDSS development and policy. To our knowledge, no reviews have been completed that discuss/recommend design features of CDSS at this scale, and thus we found that this was important for the body of literature. The recommendations identified in this narrative review will help to optimize design, organization, management, presentation, and utilization of information through presentation, content, and function. The designation of 3 categories (interface, information, and interaction) should be further evaluated to determine the critical importance of the categories. Future work will determine how to prioritize them with limited resources for designers and developers in order to maximize the clinical utility of CDSS. Conclusion This review will expand the field of knowledge and provide a novel organization structure to identify key recommendations for CDSS.

scholarly journals Laboratory test ordering in inpatient hospitals: a systematic review on the effects and features of clinical decision support systems

2020 ◽  
Author(s):  
Sahar Zare ◽  
Zahra Meidani ◽  
Mohammad Shirdeli ◽  
Ehsan Nabovati
Keyword(s):  
Laboratory Test ◽  
Laboratory Tests ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Blood Institute ◽  
Time Period ◽  
National Heart Lung ◽  
Quasi Experimental ◽  
Test Ordering

Abstract Background: Studies have revealed inappropriate laboratory testing as a source of waste. This review aimed at evaluating the effects and features of CDSSs on physicians' appropriate laboratory test ordering in inpatient hospitals.Method: Medline through PubMed, SCOPUS, Web of Science, and Cochrane were queried without any time period restriction. Studies using CDSSs as an intervention to improve laboratory test ordering as the primary aim were included. The study populations in the included studies were laboratory tests, physicians ordering laboratory tests, or the patients for whom laboratory tests were ordered. The included papers were evaluated for their outcomes related to the effect of CDSSs which were categorized based on the outcomes related to tests, physician, and patients. The primary outcome measures were the number and cost of the ordered laboratory tests. The instrument from The National Heart Lung and Blood Institute (NIH) was used to assess the quality of the included studies. Moreover, we applied a checklist for assessing the quality and features of the CDSSs presented in the included studies. A narrative synthesis was used to describe and compare the designs and the results of included studies.Result: Sixteen studies met the inclusion criteria. Most studies were conducted based on a quasi-experimental design. The results showed improvement in laboratory test-related outcomes (e.g. proportion and cost of tests) and also physician-related outcomes (e.g. guideline adherence and orders cancellation). Patient-related outcomes (e.g. length of stay and mortality rate) were not well investigated in the included studies. In addition, the evidence about applying CDSS as a decision aid for interpreting laboratory results was rare.Conclusion: CDSSs increase appropriate test ordering in hospitals through eliminating redundant test orders and enhancing evidence-based practice. Appropriate testing and cost saving were both affected by the CDSSs. However, the evidence is limited about the effects of laboratory test CDSSs on patient-related outcomes.

scholarly journals Laboratory test ordering in inpatient hospitals: a systematic review on the effects and features of clinical decision support systems

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sahar Zare ◽  
Zahra Meidani ◽  
Mohammad Shirdeli ◽  
Ehsan Nabovati
Keyword(s):  
Laboratory Test ◽  
Laboratory Tests ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Blood Institute ◽  
Time Period ◽  
National Heart Lung ◽  
Quasi Experimental ◽  
Test Ordering

Abstract Background Studies have revealed inappropriate laboratory testing as a source of waste. This review aimed at evaluating the effects and features of CDSSs on physicians' appropriate laboratory test ordering in inpatient hospitals. Method Medline through PubMed, SCOPUS, Web of Science, and Cochrane were queried without any time period restriction. Studies using CDSSs as an intervention to improve laboratory test ordering as the primary aim were included. The study populations in the included studies were laboratory tests, physicians ordering laboratory tests, or the patients for whom laboratory tests were ordered. The included papers were evaluated for their outcomes related to the effect of CDSSs which were categorized based on the outcomes related to tests, physician, and patients. The primary outcome measures were the number and cost of the ordered laboratory tests. The instrument from The National Heart Lung and Blood Institute (NIH) was used to assess the quality of the included studies. Moreover, we applied a checklist for assessing the quality and features of the CDSSs presented in the included studies. A narrative synthesis was used to describe and compare the designs and the results of included studies. Result Sixteen studies met the inclusion criteria. Most studies were conducted based on a quasi-experimental design. The results showed improvement in laboratory test-related outcomes (e.g. proportion and cost of tests) and also physician-related outcomes (e.g. guideline adherence and orders cancellation). Patient-related outcomes (e.g. length of stay and mortality rate) were not well investigated in the included studies. In addition, the evidence about applying CDSS as a decision aid for interpreting laboratory results was rare. Conclusion CDSSs increase appropriate test ordering in hospitals through eliminating redundant test orders and enhancing evidence-based practice. Appropriate testing and cost saving were both affected by the CDSSs. However, the evidence is limited about the effects of laboratory test CDSSs on patient-related outcomes.

scholarly journals Laboratory test ordering in inpatient hospitals: a systematic review on the effects and features of clinical decision support systems

2020 ◽  
Author(s):  
Sahar Zare ◽  
Zahra Meidani ◽  
Mohammad Shirdeli ◽  
Ehsan Nabovati
Keyword(s):  
Laboratory Test ◽  
Laboratory Tests ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Blood Institute ◽  
Time Period ◽  
National Heart Lung ◽  
Quasi Experimental ◽  
Test Ordering

Abstract Background: Studies have revealed inappropriate laboratory testing as a source of waste. This review aimed at evaluating the effects and features of CDSSs on physicians' appropriate laboratory test ordering in inpatient hospitals.Method: Medline through PubMed, SCOPUS, Web of Science, and Cochrane were queried without any time period restriction. Studies using CDSSs as an intervention to improve laboratory test ordering as the primary aim were included. The study populations in the included studies were laboratory tests, physicians ordering laboratory tests, or the patients for whom laboratory tests were ordered. The included papers were evaluated for their outcomes related to the effect of CDSSs which were categorized based on the outcomes related to tests, physician, and patients. The primary outcome measures were the number and cost of the ordered laboratory tests. The instrument from The National Heart Lung and Blood Institute (NIH) was used to assess the quality of the included studies. Moreover, we applied a checklist for assessing the quality and features of the CDSSs presented in the included studies. A narrative synthesis was used to describe and compare the designs and the results of included studies.Result: Sixteen studies met the inclusion criteria. Most studies were conducted based on a quasi-experimental design. The results showed improvement in laboratory test-related outcomes (e.g. proportion and cost of tests) and also physician-related outcomes (e.g. guideline adherence and orders cancellation). Patient-related outcomes (e.g. length of stay and mortality rate) were not well investigated in the included studies. In addition, the evidence about applying CDSS as a decision aid for interpreting laboratory results was rare.Conclusion: CDSSs increase appropriate test ordering in hospitals through eliminating redundant test orders and enhancing evidence-based practice. Appropriate testing and cost saving were both affected by the CDSSs. However, the evidence is limited about the effects of laboratory test CDSSs on patient-related outcomes.

The Acceptance of Interruptive Medication Alerts in an Electronic Decision Support System Differs between Different Alert Types

2021 ◽  
Author(s):  
Janina A. Bittmann ◽  
Elisabeth K. Rein ◽  
Michael Metzner ◽  
Walter E. Haefeli ◽  
Hanna M. Seidling
Keyword(s):  
Decision Support ◽  
Adverse Drug Events ◽  
Inappropriate Medication ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Acceptance Rate ◽  
University Hospital ◽  
Free Text ◽  
Active User ◽  
Electronic Decision Support System

Abstract Background Through targeted medication alerts, clinical decision support systems (CDSS) help users to identify medication errors such as disregarded drug–drug interactions (DDIs). Override rates of such alerts are high; however, they can be mitigated by alert tailoring or workflow-interrupting display of severe alerts that need active user acceptance or overriding. Yet, the extent to which the displayed alert interferes with the prescribers' workflow showed inconclusive impact on alert acceptance. Objectives We aimed to assess whether and how often prescriptions were changed as a potential result of interruptive alerts on different (contraindicated) prescription constellations with particularly high risks for adverse drug events (ADEs). Methods We retrospectively collected data of all interruptive alerts issued between March 2016 and August 2020 in the local CDSS (AiDKlinik) at Heidelberg University Hospital. The alert battery consisted of 31 distinct alerts for contraindicated DDI with simvastatin, potentially inappropriate medication for patients > 65 years (PIM, N = 14 drugs and 36 drug combinations), and contraindicated drugs in hyperkalemia (N = 5) that could be accepted or overridden giving a reason in free-text form. Results In 935 prescribing sessions of 500 274 total sessions, at least one interruptive alert was fired. Of all interruptive alerts, about half of the sessions were evaluable whereof in total 57.5% (269 of 468 sessions) were accepted while 42.5% were overridden. The acceptance rate of interruptive alerts differed significantly depending on the alert type (p <0.0001), reaching 85.7% for DDI alerts (N = 185), 65.3% for contraindicated drugs in hyperkalemia (N = 98), and 25.1% for PIM alerts (N = 185). Conclusion A total of 57.5% of the interruptive medication alerts with particularly high risks for ADE in our setting were accepted while the acceptance rate differed according to the alert type with contraindicated simvastatin DDI alerts being accepted most frequently.

scholarly journals Analysis of drug-food interactions in inpatient treatment: A university hospital case

2021 ◽  
Vol 9 (2) ◽  
Author(s):  
Ilker Kose ◽  
Gizem Gencyurek ◽  
Zeynep Atan ◽  
Beytiye Elmas
Keyword(s):  
Inpatient Treatment ◽  
Drug Allergy ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
University Hospital ◽  
Prescription Data ◽  
Nutrient Interactions ◽  
Prescribing Information ◽  
Observation Period ◽  
Data Banks

Patients' nutrition during inpatient treatment can reduce the pharmacodynamics of drugs. Therefore, monitoring of drug-nutrient interactions is essential for patient safety. Pharmaceutical Data Banks (PDB) databases provide information regarding potential drug-drug, drug-food, and drug-allergy interactions. When Clinical Decision Support Systems (CDSS) are integrated with PDBs, drug-drug and drug-allergy interactions can be prevented when physicians prescribe drugs and when pharmacists evaluate those prescriptions. However, nutrition planning is done by dieticians, and it is not common practice for dieticians to use CDSSs integrated with PDB to access patient prescription information. This study aims to measure drug-food interactions in hospitals where physicians and pharmacists use CDSSs integrated with PDBs. For the most part, dieticians plan patient diets according to the patient's primary disease (diabetes, etc.) and do not access prescription data. We cooperated with a university hospital in Turkey, accredited by HIMSS in 2017 at EMRAM Stage 6, to monitor hospitalized patients for at least one week in 2018. According to the findings, it was determined that 1,451 different drugs were administered 1,620,573 times to a total of 27,455 patients. It was determined that eight (0.55%) different drugs administered to 581 (2.1%) of the patients could interact with food and that these eight drugs were prescribed 8,089 times (0.49%) during the observation period. Although some drug-nutrient interactions were documented due to the study, the number of detected and documented interactions and their severity were relatively low. Precautions taken by dieticians, such as completely removing certain nutrients, like grapefruit, from the diet list, seem to be effective in preventing common interactions. To eliminate drug-nutrient interactions, it will be beneficial for dieticians to access patients' prescribing information and use the CDSS integrated with PDB.

scholarly journals Informing physicians using a situated decision support system: Disease management for the smart city

2014 ◽  
pp. 472-492
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Smart Cities ◽  
Systems Design ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
University Hospital ◽  
Future Research ◽  
Great Promise ◽  
Clinical Environment

We are in the midst of a healthcare paradigm shift driven by the wide adoption of ubiquitous computing and various modes of information communications technologies. As a result, cities worldwide are undergoing a major process of urbanization with ever increasing wealth of sensing capabilities – hence the Internet of Things (IoT). These trends impose great pressure on how healthcare is done. This paper describes the design and implementation of a situated clinical decision support (SCDSS) system, most appropriate for smart cities. The SCDSS was prototyped and enhanced in a clinic. The SCDSS was then used in a clinic as well as in a university hospital centre. In this article, the system’s architecture, subcomponents and integrated workflow are described. The systems’ design was the result of a knowledge acquisition process involving interviews with five specialists and testing with 50 patients. The reports (specialist consultation report) generated by the SCDSS were shown to general practitioners who were not able to distinguish them from human specialist reports. We propose a context-aware CDSS and assess its effectiveness in managing a wide medical range of patients. Five different patient cases were identified for analysis. The SCDSS was used to produce draft electronic specialist consultations, which were then compared to the original specialists’ consultations. It was found that the SCDSS-generated consults were of better quality for a number of reasons discussed herein. SCDSSs have great promise for their use in the clinical environment of smart cities. Valuable insights into the integration and use of situated clinical decision support systems are highlighted and suggestions for future research are given.

Architectures for Architects

1993 ◽  
Vol 32 (01) ◽  
pp. 12-13 ◽  
Author(s):  
M. A. Musen
Keyword(s):  
Decision Support ◽  
Decision Support Systems ◽  
Clinical Decision Support ◽  
Support Systems ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Design And Development

Abstract:Response to Heathfield HA, Wyatt J. Philosophies for the design and development of clinical decision-support systems. Meth Inform Med 1993; 32: 1-8.

Characterizing Decision Support Telemedicine Systems

2006 ◽  
Vol 45 (05) ◽  
pp. 523-527 ◽  
Author(s):  
A. Abu-Hanna ◽  
B. Nannings
Keyword(s):  
Decision Support ◽  
Decision Support Systems ◽  
Clinical Decision Support ◽  
Literature Search ◽  
Support Systems ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Problem Dimension ◽  
Process Dimension

Summary Objectives: Decision Support Telemedicine Systems (DSTS) are at the intersection of two disciplines: telemedicine and clinical decision support systems (CDSS). The objective of this paper is to provide a set of characterizing properties for DSTSs. This characterizing property set (CPS) can be used for typing, classifying and clustering DSTSs. Methods: We performed a systematic keyword-based literature search to identify candidate-characterizing properties. We selected a subset of candidates and refined them by assessing their potential in order to obtain the CPS. Results: The CPS consists of 14 properties, which can be used for the uniform description and typing of applications of DSTSs. The properties are grouped in three categories that we refer to as the problem dimension, process dimension, and system dimension. We provide CPS instantiations for three prototypical applications. Conclusions: The CPS includes important properties for typing DSTSs, focusing on aspects of communication for the telemedicine part and on aspects of decisionmaking for the CDSS part. The CPS provides users with tools for uniformly describing DSTSs.

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