Unnecessary tests reduced by EMR alerts

Clinical-decision support reminders placed into electronic medical records (EMR) systems can stop physicians from ordering unnecessary treatments for hospitalized patients, according to researchers from the Stanford University School of Medicine and Lucile Packard Children's Hospital, both in Palo Alto, Calif.

In one of the first studies examining the potential of electronic reminders in clinical care, researchers--writing in this month's issue of Pediatrics--found that the pop-ups alerts saved Packard Children's 460 unnecessary red blood cell transfusions and $165,000 in one year. At the same time, the reminders did not detract from patients undergoing transfusions who needed them, they said.

In the study, a computer checked whether a patient had blood pressure and hemoglobin levels low enough to meet evidence-based transfusion criteria when a physician entered an order for a red blood cell transfusion. If the patient did not meet transfusion criteria, a window appeared that presented data listing current transfusion guidelines and then asked whether to proceed with the order.

The reminder system allowed physicians to go ahead with a transfusion if--after reviewing current clinical guidelines--they thought the procedure was still needed, said Eloa Adams, MD, a pediatric critical care physician at Packard Children's and a first author of the study.

"We recognize that clinical situations are variable," Adams said in a statement. He added that his main concern was preventing transfusions ordered on the basis of outdated guidelines. The reduction in transfusions during the study suggests physicians benefit from "a push in the right direction at a critical time."

For more information:
- see the Pediatrics abstract
- view the hospital's release
- check out Fierce's on-demand webinar: "The Connection between CPOE, CDS, EMR and Medication Safety"