Abstract
Purpose :
Treatment of chronic, non-infectious ocular inflammation includes corticosteroids, disease modifying anti-rheumatic medications (DMARDs), and biologics. To mitigate adverse effects associated with the use of these medications, routine laboratory test monitoring is recommended throughout treatment. We evaluated the effectiveness of an alert added to the electronic medical record (EMR) to aid in laboratory test monitoring for patients prescribed these high-risk medications.
Methods :
A prospective, interventional study assessed the effect of an alert within the EMR on laboratory test ordering at the Division of Ocular Immunology at the Wilmer Eye Institute. The primary outcome measure was the change in number of ordered lab tests at 3, 6, and 12-months after the alert activation compared to pre-interventional levels and overall throughout the study period. The laboratory tests that were monitored included complete blood count (CBC), comprehensive metabolic panel (CMP), dual-energy x-ray absorptiometry (DEXA) scans, fasting lipid panel, hemoglobin A1c, and interferon gamma release assays (IGRA).
Results :
The laboratory test orders for 162 patients on high-risk medications were analyzed. Only the frequency of ordering the DEXA and IGRA increased significantly, compared to baseline, throughout the study. Conversely, there was a significant decrease in the frequency of ordering of fasting lipid profiles and hemoglobin A1c at each time point and for CBC and CMP at the 6-month time point.
Conclusions :
An EMR alert results in increased laboratory test ordering initially for tests drawn on a yearly basis, but the effect on more frequently ordered tests wanes with time if the alert can be silenced by the provider. Nonetheless, it provides a novel mechanism to increase laboratory ordering in patients on high-risk medications that can be adapted for use in other EMR software. Future studies are needed to assess if physician laboratory test ordering behavior is altered throughout the study period with the use of a non-silenceable alert.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.