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 |