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Table 3 Application areas and cost outcome measures in relation to CDS intervention categories 1.-7

From: Economic impact of clinical decision support interventions based on electronic health records

Study Sizea Application area CDS intervention period (in month) Change in cost outcome per year (in US$, if not other stated) b
     per patient per activated alert
1. Medication (dosing) support
   Tamblyn [19] Medium Reduce out-of-pocket cost for patients with uncomplicated hypertension 60 no differenced
2. Order facilitator
    Bolles [17] Small Inappropriate test ordering for specialized HIV laboratory testing 6 +$102 to +$670
    Schnaus [27] Large The order “complete blood count without differential” unintentionally changed to “complete blood count with differential” 23 days +$8
    Shaha [34] Small CDS order sets for managing new-onset stroke patients 6 -$1742 to -$4280
3. Point of care alerts or reminders
    Gong [5] Medium Inappropriate antibiotic prescribing for acute respiratory infection 18 -$0.16c
    Chen D [13] Large Reduce unnecessary imaging studies in patients with low back pain 12 -$30
    Chin [15] Large Decrease routine testing for 25(OH) vitamin D levels 12 -$65
    Bejjanki [20] Large Reduce 17 frequently used duplicate laboratory tests 17 n/a f
    Chen JR [22] Small Directing the physician to order penicillin allergy testing for patients receiving aztreonam 9 -$678
    Heekin [23] Large Adherence to 18 different Choosing Wisely (CW) alerts 36 -$944
    Sharifi [26] Small Clinical childhood obesity intervention 12 +$11c
Goodnough [36] Large Reduce overutilization in blood transfusion procedure 36 -$308
    Razavi [37] Small Reduce unnecessary waste in transfusion practice and blood use of cardiothoracic surgeons 12 -$82
    Bridges [38] Small Reduce unnecessary acute hepatitis profile laboratory tests 3 -$20
4. Relevant information display
    Fertel [18] Small Reduce the amount of frequent or high emergency department utilizers 24 -$24,672
5. Expert systems
    Nault [24] Large Antimicrobial stewardship that facilitates the post-prescription review process 36 - CAD $10
6. Workflow support
    none
7. Restriction of choice
    MacMillan [21] Large Reduce unnecessary frequent red blood cell folate tests 43 - CAD $5
    Konger [29] Large Define order frequency rules and reduce duplicate tests 24 n/a g
    Procop (b) [32] Large Reduce unnecessary, same day duplicate orders 24 -$8
Studies with combined multiple CDS intervention categories
1. Medication (dosing) support & 3. Point of care alerts or reminders
    Stenner [30] Large ePrescribing tool for therapeutic interchange prescribing 18 -$17
    Forrester [35] Medium CPOE CDS vs. paper-based prescribing in reducing medication errors and adverse drug events (ADE) 10 -$6c
2. Order facilitator & 3. Point of care alerts or reminders
    Goetz [16] Large Decrease serum folate laboratory testing 12 -$29
2. Order facilitator & 6. Workflow support
    Michaelidis [33] Medium Reduce inappropriate antibiotic prescribing for acute bronchitis 6 +$8c
2. Order facilitator & 7. Restriction of choice
    Sadowski [25] Medium Reduce admission order sets, which allowed multiple routine tests to be ordered repetitively 2 -$55e
3. Point of care alerts or reminders & 7. Restriction of choice
    Marcelin [14] Large Reduce inappropriate gastrointestinal pathogen panel testing 15 n/a h
    Felcher [28] Medium Reduce unnecessary Vitamin D testing 6 -$157
    Procop (a) [31] Medium Unnecessary duplicate laboratory testing 12 Hard-Stop -$16.08Smart-Alert -$3.52
  1. a Size is defined as the following:
  2. Number of patients or encounters involved
  3. 0–999 small size
  4. 1000–10,000 medium-size
  5. > 10,000 large size
  6. If the patient count was not reported, we applied this range of criteria to the number of triggered alerts in total
  7. b All cost outcomes were scaled and calculated to the overall change in cost outcome per year and per patient or activated alert. Values (for > $1) are rounded to full integer numbers. Because of the predominantly short CDS intervention period time range, a discount factor is not used for calculation. The originally reported cost data is mentioned in an additional file (see Additional file 2) [64,65,66,67,68]
  8. c Cost estimation based on a model
  9. d No statistically significant differences between control and intervention group regarding out-of-pocket cost per patient
  10. e Estimated reduced cost per inpatient day per year after intervention 1
  11. f No information regarding the number of patients or alerts. Overall cost outcome per year: - $51,206
  12. g No information regarding the number of patients or alerts. Overall cost outcome per year: - $157,782
  13. h No information regarding the number of patients or alerts. Overall cost outcome per year: -$53,600