Effects of an Electronic Medical Record Intervention on Appropriateness of Transthoracic Echocardiograms: A Prospective Study

Overview

Journal J Am Soc Echocardiogr

Specialty Radiology

Date 2020 Nov 3

PMID 33139140

Citations 1

Authors

Weihan Chen

David T Saxon

Michael P Henry

John R Herald

Rob Holleman

Debbie Zawol

Stacy Sivils

Mohamad A Kenaan

Theodore J Kolias

Hitinder S Gurm

Nicole M Bhave

Affiliations

Soon will be listed here.

Abstract

Background: Transthoracic echocardiograms (TTEs) account for approximately half of U.S. spending on cardiac imaging. We developed an electronic medical record (EMR)-based decision-support algorithm for TTE ordering and hypothesized that it would increase the appropriateness of TTE orders.

Methods: This prospective observational study was performed at the Veterans Affairs Ann Arbor Healthcare System. From October to December 2016 (preintervention), consecutive TTEs ordered in the inpatient, outpatient, and emergency department settings were included. In May 2017, a decision-support algorithm was incorporated into the EMR, giving immediate feedback to providers. Chart review was performed for TTEs ordered from June to August 2017 (early intervention) and from June to August 2018 (late intervention). Appropriateness was determined based on the 2011 appropriate use criteria for echocardiography.

Results: Appropriate TTE orders increased from 87.6% preintervention to 94.5% at early intervention (z = 0.00018) but decreased to 90.0% at late intervention (z = 0.51, compared with preintervention). Among patients with no previous TTEs in our system, 95.3% of TTEs were appropriate, compared with 87.7% of TTEs for patients with prior TTEs within 30 days prior (odds ratio = 2.85; 95% CI, 1.18-6.31; P = .005).

Conclusions: The EMR algorithm initially increased the percentage of appropriate TTEs, but this effect decayed over time. Further study is needed to develop EMR-based interventions that will have lasting impacts on provider ordering patterns.

Citing Articles

Implementation effort: Reducing the ordering of inappropriate echocardiograms through a point-of-care decision support tool.

Ashraf H, Rambarat C, Setteducato M, Winchester D Am Heart J Plus. 2024; 18:100185.

PMID: 38559418 PMC: 10978316. DOI: 10.1016/j.ahjo.2022.100185.

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