Pings and alerts generated by electronic health records directly to a physician’s desktop computer or mobile device might be an annoyance and nuisance to some doctors.  But when physicians follow computer alerts embedded in electronic health records, their hospitalized patients experience fewer complications and lower costs, leave the hospital sooner and are less likely to be readmitted, according to a study of inpatient care, says new research from Cedars-Sinai Medical Center.

The research examined alerts that popped up on physician computer screens when their care instructions deviated from evidence-based guidelines.

The alerts were based on an initiative called Choosing Wisely, which identifies common tests and procedures that may not have clear benefit for patients and should sometimes be avoided. For example, an alert might pop up on the screen if a physician orders a CT scan when it’s unnecessary and likely won’t improve the patient’s outcome. The alert would serve as a reminder that the order could expose the patient to unnecessary radiation and costs, say researchers/

“

,” says Cedars-Sinai chief clinical transformation officer Scott Weingarten. “We have seen that real-time aids for clinical decision-making can potentially help physicians reduce low-value care and improve patient outcomes while lowering costs.”

Many leaders in the healthcare industry have targeted unnecessary care as a means of improving patient safety while cutting wasteful spending. One 2010 estimate from the Institute of Medicine found that “unnecessary services” contribute to about $210 billion in wasteful healthcare spending in the U.S. each year.

The Cedars-Sinai research examined data from inpatient visits at Cedars-Sinai Medical Center from October 2013 to July 2016 in which one or more of the 18 most frequent alerts was triggered.

For 26,424 of the inpatient visits studied, the treating physician followed either all or none of the Choosing Wisely guidance. In 6% of visits, physicians in the “treatment group” followed all triggered alerts while in the remaining 94% of visits, physicians in the “control group” followed none of the triggered alerts. An alert was triggered, for example, if a physician tried ordering a sedative for a sleepless older patient or an appetite stimulant for an older patient who was ill and losing weight. Sedatives can put seniors at risk for falls, bone fractures and car accidents, and appetite stimulants can put seniors at risk of fluid retention, stroke and death.

Researchers found a significant difference in health outcomes and costs between the two groups. For patients whose physicians did not follow the alerts, the odds of complications increased by 29% compared to the group whose physicians followed the alerts. Likewise, the odds of hospital readmissions within 30 days of the patients’ original visits was 14% higher in the group whose physicians did not follow the alerts.

Patients of these physicians also saw a 6.2% increase in their length of stay and an additional 7.3% (or $944 per patient) in costs, after adjusting for differences in patient illness severity and case complexity, says Cedar-Sinai.

“Sometimes doctors order tests that they think are in the patient’s best interest, when research doesn’t show that to be the case. Unnecessary testing can lead to interventions that can cause harm,” says Harry C. Sax, executive vice chair of surgery at Cedars-Sinai. “This work is about giving the right care that patients truly need.”

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