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Finding a method to implement Appropriate Use Criteria (AUC) for echocardiography into Electronic Medical Records (EMR) has represented a major challenge. In addition, the effects of its implementation on volume and compliance have not been assessed.
To accomplish this implementation a unique adaptation of the 2011 AUC for Echocardiography Guidelines was created and then adapted into EMR. This EMR serves 7 hospitals within a large healthcare organization. The process included: generation of a user-friendly list of indications, use of key words, alphabetical arrangement, education of providers, and the option to select only a specific AUC from the menu. It went live on Jan 4, 2012. We then compared total volume of echocardiograms (echos), both inpatient (IP) and outpatient (OP), over the 6 months prior to and 6 months post implementation. We also obtained the percentage of inappropriate indications before and after the implementation.
Between Jul-Dec 2011 there were 20,196 echos (13,846 IP and 6,350 OP). Between Jan-Jun 2012 there were 20,879 echos (14,479 IP and 6,400 OP). There was no statistical difference when comparing inpatient, outpatient or total echos between the 2 periods. We also compared the 1st semester of 2011 with the 1st semester of 2012 with similar results. The percentage of inappropriate indications prior to implementation was 21.8%. This percentage dropped to 0% for IP and 8% for OP after the implementation.
This is the first large-scale implementation of AUC into EMR in the nation using a unique adaptation of the guidelines. The implementation of AUC did not affect the total, IP or OP volume of echos. There was a very significant drop in the percentage of inappropriate indications after the implementation. This study serves as a model for the implementation of AUC into EMR that will promote the use of AUC for echocardiography without affecting the overall inpatient or outpatient volumes.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Appropriateness and Gaps in Care
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1116-107
- 2013 American College of Cardiology Foundation