Using the Electronic Health Record to Understand and Minimize Overuse

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    Flexibility of EHRs make them a valuable tool in addressing health care overuse

Background

The “overuse” of health care—the delivery of services that are either unnecessary or of low clinical value—accounts for substantial spending in our health system. It also may cause harm to patients. Many factors contribute to overuse, including the increasing role of technology in medicine, reliance on physician payment models that encourage utilization, and patients’ expectations for their treatment. In a JAMA “Viewpoint,” Commonwealth Fund Harkness Fellow Juliet Rumball-Smith, M.B.Ch.B., Ph.D., along with coauthors Paul Shekelle, M.D., and David Bates, M.D., argue that electronic health records (EHRs) can help target and eliminate unnecessary health care.

What the Study Found

The authors posit that the flexibility of EHR systems make them valuable tools for addressing overuse. They point to examples at three U.S. health care organizations:

  • Organization A uses EHRs to influence physicians’ behavior at the point of care. The system has incorporated recommendations from the American Board of Internal Medicine’s “Choosing Wisely” initiative to reduce overuse. If a physician orders a test that is included as a “do not do”—for example, an imaging test for an uncomplicated headache—the system will prompt them with information and alternative strategies.
  • Organization B uses EHRs to gather clinician data. At monthly meetings, physicians discuss specific recommendations and may consider why various clinicians (working with similar sets of patients) have different rates of ordering certain tests.
  • At Organization C, EHRs are mined to identify patients who fit a certain profile because of medical history and prescription patterns. Before a visit with such a patient, the physician is contacted through the EHR and provided with information and education about the best way to manage the patient’s condition.

Conclusions

The authors encourage further discussion about whether the most effective intervention for reducing overuse is one of the approaches outlined above or some combination of the three. With EHRs reaching 80 percent penetration in U.S. physician offices and hospitals, they have the potential to be a powerful tool for measuring and reducing overuse of care.

Publication Details

Publication Date:
January 27, 2017
Authors:
Juliet Rumball-Smith, David Bates, M.D., Paul G. Shekelle
Contact:
Mary Mahon, Vice President, Public Information, The Commonwealth Fund
E-mail: mm@cmwf.org
Summary Writer:
Deborah Lorber
Citation:
J. Rumball-Smith, P. G. Shekelle, and D. W. Bates, “Using the Electronic Health Record to Understand and Minimize Overuse,” Journal of the American Medical Association, published online Jan. 17, 2017.
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