CDS alerts reduce unnecessary tests for heart failure

Alerts generated to advise physicians that a test on heart failure patients already had been performed helped Lehigh Valley Health Network in Pennsylvania reduce unnecessary testing by 21 percent and save approximately $92,000 a year.

The health system's Test Utilization Committee noticed that some patients were being tested daily--and sometimes twice daily--for B-Type Natriuretic Peptide (BNP), which is secreted by the heart in response to changes in pressure during congestive heart failure. It's used as a gauge of the severity of heart failure, but repeat testing is inappropriate and may be misleading, according to research published at BMC Medical Informatics and Decision Making.

The health system implemented a clinical decision support intervention--an alert for the doctor in the computerized physician order entry system. The system searched for a BNP value in the records of the patient's current hospital stay and alerted the physician that further tests were unnecessary. The alerts were considered a "soft stop," meaning physicians still could perform the tests if they chose.

The estimated savings were based on a supply cost of $28.04 per test, but fewer tests freed up the lab to perform other work. The authors say the long-term benefit will be greater than the short-term cost of implementing the alerts.

They also noted a downward trend in BNP testing during the research period--January 2008 to September 2011--which they said could be due to changes in physician behavior, differing patient demographics or other factors.

A recent study from the University of Edinburgh on e-prescribing found that alerts came too late in the prescribing process. Oftentimes, alerts appeared after a physician had explained the options, selected a treatment with the patient, and instructed the patient on how to take a medication. Others came with too much information.

Meanwhile, in February, 90 more tests and treatments were added to the "Choosing Wisely" campaign, which pinpoints major sources of unnecessary care. The total now numbers 135.

At FierceHealthFinance, Ron Shinkman said that it's time to put medical tests to a financial means test.

To learn more:
- find the research (.pdf)

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