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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