Embedding guidelines into direct physician order entry: simple methods, powerful results
Journal
Proc AMIA Symp
Publication Date
1999
Pages
221-5
Summary:
- HIT Description: Electronic health record, computerized physician order entry and guidelines. More info...
- Purpose of Study: Assess the effectiveness of guidelines in the ordering process through computerized physician order-entry.
- Years of study: 1993-1997
- Study Design: Time series
- Outcomes: Impact on health care effectivness/quality, Other outcome
- Settings: Kaiser Permanente in the Northwest Region, which has a membership of membership of 440,000 patients.
- Intervention: A computer-based patient record (CPR) with direct physician order-entry, including guidelines into the ordering process.
- Evaluation Method: Measures of ordering tests or medications, and tests conforming to guideline indications.
- Description: Through the use of the CPR, clinicians electronically order laboratory tests, radiology tests, and prescriptions. The system also documents encounters, codes diagnoses and procedures, maintains problem lists, and sends patient-specific messages and referrals to other medical providers. The guidelines in the physician order-entry were implemented in 1994.
- Healthcare Utilization: The number of upper-GI radiology tests ordered after the implementation of the guidelines compared to before decreased from 10.6 /1000 members to 5.6 /1000 members, and the ordering of chest-x rays showed a 20% reduction. The number of new ÒZoloftÓ prescriptions ordered after the implementation of the guidelines compared to before decreased from 4.7% to 2.4%.
- Quality of Care and Patient Safety Outcome: The percent of upper-GI radiology tests that conformed to guideline indications after the implementation of the guidelines increased from 55% to 86-90%.