Electronic alerts remind doctors to use different tests

Electronic medical alerts for a test that helps detect blood clots in the elderly may help doctors  think twice about ordering unnecessary diagnostic tests for patients as well as reduce costs and the burden of invasive testing.

That’s according to a study by Kaiser Permanente. In the paper published in the November edition of American Journal of Managed Care the company said the D-dimer test combined with a clinical risking algorithm, can help in the diagnosis of deep vein thrombosis (blood clots in veins, otherwise known as DVTs) and pulmonary embolism (blood clots in the lungs).  

It said the risk of developing a blood clot in the venous circulation increases with age. However the paper found that the overall accuracy of the D-dimer test worsens as patients get older, and is only 35 percent for patients 65 years of age and over.  This can result in numerous false-positives and additional, unnecessary testing.

The study found that when physicians ordered the D-dimer test, but were subsequently alerted about the high rates of false-positives, they remembered to use radiological tests instead, a type of test that is more accurate. This study is among the first to look at the effectiveness of an electronic alert for a specific condition in a specific patient population.

“Physicians sometimes find it hard to remember to follow evidence-based clinical practice guidelines. Many people have suggested that computer generated alerts within electronic medical records may serve as reminders to improve adherence to best practices,” said study lead author Dr. Ted E. Palen.

Healthcare institutions have generally had a rough time integrating electronic medical records (EMR) and other software into existing paper-based methods, but Kaiser has been the leader of the pack with its integration of tele-medicine and robots.

“As the health care industry moves to widely adopt EMR technology, it is critical that physicians and other caregivers are given specific and relevant data at the point of care to avoid alert fatigue,” continued Palen.

“This study shows that delivering a very targeted electronic message for a particular patient profile can result not only in better use of the test in question, it can alter a physician’s ordering behaviour and promote improved adherence to a clinical practice guideline. This finding is important when designing systems that will support better coordination of patient care.”