Changing styles of medical practice can be really tough, even if major trade organization sticks its oar in to encourage new behavior from docs.
Such is the situation with cardiac telemetry, which is listed by the American Board of Internal Medicine Foundation as either unnecessary or overused in most cases. But a recent piece of research demonstrated that configuring an EMR to help doctors comply with the guideline can help hospitals lower needless cardiac monitoring substantially.
Often, it takes a very long time to get doctors to embrace new guidelines like these, despite pressure from payers, employers and even peers. (Physicians may turn on a dime and try out a new drug when the right pharmaceutical rep shows up, but that’s another story.) Doctors say they stick to their habits because of patient, institutional or personal preferences, as well as fear of lawsuits.
But according to a recent study appearing in JAMA Internal Medicine, reprogramming its Centricity EMR did the trick for Wilmington, Del.-based Christiana Care Health System.
To curb the use of cardiac telemetry that was unnecessary, Christiana Care removed the standard option for doctors to order cardiac monitoring outside of AHA guidelines, and required them to take an extra step to order this type of test.
Meanwhile, when the cardiac monitoring order did fall within AHA guidelines, Christiana Care added an AHA-recommended time frame for the monitoring. After that time passed, the EMR notified nurses to stop the monitoring or ask physicians if they believed it would be unsafe to stop.
The results were striking. After implementing the changes in the EMR, the health systems average daily not intensive care unit patients with cardiac monitoring fell by 70%. What’s more, Christiana Care’s average daily cost of administering non-ICU cardiac monitoring held by 70%, from $18,971 to $5,772.
Christiana Care’s health IT presence is already well ahead of many hospitals — it’s reached Stage 6 of the HIMSS EMRAM scale — so it’s not surprising to see it leading the way in shaping physician behavior.
The question now is how the system builds on what it’s learned. Having survived a politically-sensitive transition without creating a revolution in its ranks, I’d argue the time is now to jump in and work on compliance with other clinical guidelines. With pressure mounting to deliver efficient care, it’d be smart to keep the ball rolling.