Effect of a Novel Clinical Decision Support Tool on the Efficiency and Accuracy of Treatment Recommendations for Cholesterol Management.
BACKGROUND
The 2013 American College of Cardiology / American Heart Association Guidelines for the Treatment of Blood Cholesterol emphasize treatment based on cardiovascular risk. But finding time in a primary care visit to manually calculate cardiovascular risk and prescribe treatment based on risk is challenging. We developed an informatics-based clinical decision support tool, MayoExpertAdvisor, to deliver automated cardiovascular risk scores and guideline-based treatment recommendations based on patient-specific data in the electronic heath record.


OBJECTIVE
To assess the impact of our clinical decision support tool on the efficiency and accuracy of clinician calculation of cardiovascular risk and its effect on the delivery of guideline-consistent treatment recommendations.


METHODS
Clinicians were asked to review the EHR records of selected patients. We evaluated the amount of time and the number of clicks and keystrokes needed to calculate cardiovascular risk and provide a treatment recommendation with and without our clinical decision support tool. We also compared the treatment recommendation arrived at by clinicians with and without the use of our tool to those recommended by the guidelines.


RESULTS
Clinicians saved 3 minutes and 38 seconds in completing both tasks with MayoExpertAdvisor, used 94 fewer clicks and 23 fewer key strokes, and improved accuracy from the baseline of 60.61% to 100% for both the risk score calculation and guideline-consistent treatment recommendation.


CONCLUSIONS
Informatics solution can greatly improve the efficiency and accuracy of individualized treatment recommendations and have the potential to increase guideline compliance.
Marianne R
MR
Scheitel
Maya E
ME
Kessler
Jane L
JL
Shellum
Steve G
SG
Peters
Dawn S
DS
Milliner
Hongfang
H
Liu
Ravikumar
R
Komandur Elayavilli
Karl A
KA
Poterack
Timothy A
TA
Miksch
Jennifer
J
Boysen
Ron A
RA
Hankey
Rajeev Chaudhry, MBBS,MPH, Associate Professor of Medicine, Division of Primary Care Internal Medicine, Knowledge and Delivery Center, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, TEL: (507) 255-3956, E-mail:Chaudhry.Rajeev@mayo.edu.
Rajeev
R
Chaudhry
D000924:Anticholesteremic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000628:therapy; D002784:Cholesterol / Q000378:metabolism*; D020000:Decision Support Systems, Clinical; D057286:Electronic Health Records; D011320:Primary Health Care; D012307:Risk Factors; D011795:Surveys and Questionnaires
D000924:Anticholesteremic Agents; D002784:Cholesterol
Clinical decision support system; ambulatory care information systems; electronic health records; knowledge delivery; knowledge management; testing and evaluation of health information technology