Cost-effectiveness of CDS unclear, researchers say

Clinical decision support tools in electronic medical records may well reduce inpatient costs, but there's little evidence yet to support that, according to research recently published in BMC Medical Informatics and Decision Making.

After screening thousands of published articles, the study's authors found that only 12.8 percent of the 78 published studies they closely examined directly measured the financial impact of CDS intervention. Only one study included data on cost-effectiveness, they found. The primary area of research involved pharmacotherapy and the impact of computerized physician order entry.

"Significantly more research is required on the impact of clinical decision support on inpatient costs," the researchers concluded. "In particular, there is a remarkable gap in the availability of cost effectiveness studies required by policy makers and decision makers in healthcare systems."

One 2006 study that evaluated cost as an outcome focused generally on health IT rather than specifically on CDS, the authors found, and relied on data gathered before 2004. Another study considered cost outcomes, but was limited to a study of randomized trials. Both potentially excluded relevant CDS intervention trials, the researchers said.

The study noted that inpatient care comprises the largest single chunk of U.S. health expenditures, accounting for 31.5 percent of the $2.7 trillion spent nationally on healthcare in 2011.

Health informatics "does not appear to be meeting the needs of these healthcare decision makers with regard to CDS, as we have not been providing sufficient, rigorous data related to the cost benefits of CDS interventions in the inpatient setting," the researchers concluded. "Further research with specific attention to cost implications of CDS systems in the inpatient setting is clearly needed."

At least some policymakers think CDS software is the way to go, at least when it comes to imaging.

U.S. Reps. Erik Paulsen (R-Minn.) and Jim Matheson (D-Utah) recently introduced a bill requiring use of clinical decision support software by physicians receiving Medicare and Medicaid reimbursement.

H.R. 3705--the "Excellence in Diagnostic Imaging Utilization Act," H.R. 3705, establishes criteria for the appropriateness of advanced imaging scans and requires physicians to use CDS tools in following that criteria.

Meanwhile, researchers reporting last fall in the Journal of the American Medical Informatics Association concluded a team-based approach could help hospitals be more successful in their use of CDS technology.

For more information:
- read the study