Clinical decision support within EHRs decreases high-cost imaging tests

Ordering computed tomography (CT) for pulmonary embolism (PE) and brain and C-spine injury can lead to a high price tag. Researchers found clinical decision support (CDS) integrated into patient’s electronic health records (EHRs) was able to decrease utilization. Finding were published in the Academic Emergency Medicine (AEM).

Led by Kelly Bookman, MD, associate professor of emergency medicine at the University of Colorado School of Medicine, the research team aimed to cut costs of CT brain, C-spine and PE tests by including CDS tools within patients EHRs. By providing physicians with access to these tools within the EHR, researchers hoped to provide physicians with easy access to information to improve decision-making.

The study evaluated 235,858 patient visits in five emergency department to measure tests ordered at baseline and after the integration of CDS tool in EHRs. Results showed an overall 6 percent decrease in need for brain and C-spine CT, while the use of PE CT remained unchanged. For high utilizers of these tests, the usage of brain and PE CT tests decreased by 14 percent.

"Getting CDS delivered at the right time to the right person seamlessly within their workflow is the key to driving compliance with standardized, evidence based, best practices,” said Bookman. “Embedded clinical decision support is associated with decreased overall utilization of high-cost imaging, especially among higher utilizers. It also affected low utilizers, increasing their usage consistent with improved adherence to guidelines, but this effect did not offset the overall decreased utilization for CT brain or CT C-spine. Thus, integrating clinical decision support into the provider workflow promotes usage of validated tools across providers, which can standardize the delivery of care and improve compliance with evidence-based guidelines.”