An Altered Electronic Order Set Could Create Cost Savings, Better Care

Altering the design of an electronic order set in electronic medical record (EMR) could ultimately lead to better care and increased cost savings for patients, says a University of Missouri researcher.

Victoria Shaffer, an assistant professor of health sciences in the MU School of Health Professions, and a team of researchers looked at how physicians selected lab tests using three order set list designs on the same EMR. One was “opt-in,” where no lab tests were pre-selected; the second was opt-out, in which physicians had to de-select lab tests that were not clinically relevant; and third had only a few tests pre-selected based on recommendations by pediatric experts.

What they found was clinicians ordered three more tests when using the opt-out version than the opt-in or recommended versions. Additionally, they ordered more tests recommended by the pediatric experts when using the recommended design than when using the opt-in design.

“Essentially we found that including default selections, either with the opt-out method or the recommended method, increased the quality of lab tests the clinicians ordered. That is, clinicians ordered more tests recommended by pediatric experts with these methods,” Shaffer said in a statement. “However, there were costs associated with using these approaches. Use of the opt-out method costs about $71 more per patient. Using a set of recommended defaults keeps costs down but requires consensus about which tests to set as defaults.”

According to Shaffer, often, software systems encounter problems because they are designed by IT experts and with minimal input from the people who use it. She says the two sides must work together to design these systems to reach optimal performance.

The study was published in Health Psychology.