Using Electronic Health Record Alerts to Reduce Unnecessary Medical Screenings in Older Adults: A Northwestern Medicine Study
Unnecessary medical screenings and treatments in older adults can potentially lead to more harm than good. This has been underscored by a recent study conducted by Northwestern Medicine, which effectively used electronic health record (EHR) alerts to reduce unnecessary screenings and treatments. In the study, the alerts were found to be compelling and influential, leading to a 9% decrease in unnecessary prostate-specific antigen (PSA) tests and a nearly 6% decrease in urine tests for urinary tract infections in women.
The Study and Its Findings
The study involved 370 clinicians across 60 Northwestern Medicine clinics over an 18-month period. The main goal was to curb unnecessary screenings for older adults, such as prostate cancer screening for men over 75 and urinary tract infection testing for women aged 65 and older. These practices are often adopted without solid evidence and can potentially lead to harms from unnecessary treatments.
The alerts were designed to underscore potential harms, foster a sense of social accountability, and propagate shared social norms. The findings from the study suggest that delivering compelling messages through electronic health records can be a straightforward way to improve care across large health systems. The effectiveness of the alert system was attributed to the timely delivery of these messages at the point clinicians place their orders.
Implications of Unnecessary Screening
Unnecessary screenings not only increase healthcare expenses but can also lead to serious health problems for older adults. For instance, the overtreatment of prostate cancer or urinary tract infections can cause unnecessary anxiety and physical harm to patients. Moreover, the overtesting for urinary tract infections in asymptomatic older women and the overdiagnosis and overtreatment of prostate cancer were highlighted as significant issues.
The study also stressed the risks associated with overtreating certain conditions, such as excessively controlling blood sugar levels in older adults. However, the alerts did not significantly affect the unnecessary tests for blood sugar levels, indicating a resistance to change in this area.
Building on the success of this initiative, the researchers plan to further explore and apply similar strategies to other areas where treatments may be overused. These include opioids, sleeping pills, and potentially harmful drug combinations. The ultimate goal is to continue improving the quality of care across large health systems, while reducing unnecessary procedures that may harm patients.
In conclusion, the Northwestern Medicine study demonstrates the potential of electronic health record alerts in driving a more effective and safer healthcare system. It highlights the need for continued research and innovative strategies to ensure medical decisions are tailored to an individual’s age and health condition, ultimately reducing unnecessary harm and fostering better patient outcomes.