Clinical decision support provides best return among EHR functions

Although the ultimate goal of the electronic health record Meaningful Use incentive program is to reduce care costs and improve care for patients, according to National Coordinator for Health IT Farzad Mostashari, debates continue to rage about whether the program can, in fact, achieve both goals.

In seeking to deduce which specific technologies are up to that task, researchers found that clinical decision support in EHRs produced the best return on investment for providers, according to a study published this month in the American Journal of Managed Care.

What's more, the researchers said that the most lucrative functionality of health information exchanges was their ability to coordinate care among providers.

In total, the researchers identified 54 functionality-setting combinations--27 for EHRs and 27 for HIE--that ranked as having an above-average positive financial impact for providers. Alerts for redundant lab orders, for example, ranked high on a value scale created by the researchers, as did functions such as sending and receiving imaging reports and enabling structured medication reconciliation.

"Although EHRs and HIE products are adopted as whole applications, different functionalities may be turned on or off by individual technicians and users of these systems," the researchers said. "Thus, our finding that some functionalities have more potential for positive financial effects than others matters. If whole applications are adopted, but the most promising functionalities are turned off, then the likelihood of a positive financial effect for the whole application is low."

The authors pointed out that providers have been found, according to previous studies, to adopt EHRs without taking advantage of clinical decision support, which they call a "prime mediator of ... positive financial effect." However, a recent survey conducted by Black Book Rankings found clinical decision support to be the highest priority for hospital IT leaders, particularly among those in developing accountable care organizations.

To learn more:
- read the full study in the American Journal of Managed Care

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