Using the Electronic Medical Record to Increase Laboratory Test Monitoring in Ocular Inflammation Patients: A Quality...

Managing chronic ocular inflammation requires monitoring for drug-related risks. Prior research established that corticosteroids and biologics need routine lab checks. However, no prior work had resolved how to consistently enforce these checks in clinical practice. This gap motivated a study to evaluate EMR-based interventions. Established knowledge shows that lab tests like CBC and metabolic panels are essential for tracking side effects. Yet, physician adherence to monitoring guidelines remains variable. This paper's contribution is a novel approach using EMR alerts to influence test ordering. The study addresses a specific uncertainty about how EMR alerts affect monitoring frequency. It also explores whether alert design impacts long-term compliance with lab monitoring recommendations.

The study aimed to assess how EMR alerts influence lab test ordering in patients with ocular inflammation. Researchers focused on high-risk medications like corticosteroids and biologics. These drugs require regular monitoring to prevent complications. The intervention involved adding an alert within the EMR system. The goal was to determine if this alert could increase lab test frequency. Researchers examined changes in test ordering at 3, 6, and 12 months post-intervention. They also compared these changes to pre-intervention levels. The study sought to identify which tests showed improved monitoring and which did not.

The study used a prospective, interventional design at the Wilmer Eye Institute. Researchers implemented an EMR alert for high-risk medication patients. They tracked lab orders for CBC, metabolic panels, DXA scans, lipid profiles, and interferon tests. Data collection occurred over 12 months with three time points. The sample included 153 patients prescribed high-risk medications. Researchers compared pre- and post-intervention test frequencies. Statistical analysis assessed changes in ordering patterns. The study focused on both baseline and longitudinal trends in test ordering.

DXA and interferon gamma release assays showed increased ordering after the alert activation. These tests are typically ordered annually, suggesting the alert improved adherence. However, lipid profiles and hemoglobin A1c saw decreased ordering at all time points. Complete blood count and metabolic panels also declined at the 6-month mark. The alert had a stronger effect on less frequent tests than on routine ones. The decline in some tests suggests alert fatigue may have occurred. The effect of the alert varied by test type and frequency. These findings indicate that alert design impacts long-term monitoring behavior.

The EMR alert increased ordering of infrequent tests like DXA and interferon assays. This effect was sustained over the study period, unlike more frequent tests. The alert’s impact diminished for tests ordered regularly, suggesting alert fatigue. The study shows EMR alerts can improve monitoring for high-risk medications. However, the effect depends on test frequency and alert design. Non-silencable alerts may yield different results, as proposed by the authors. The findings suggest EMR alerts can be adapted for other clinical scenarios. The study contributes a novel approach to improving lab monitoring compliance.