Automated before-procedure electronic health record screening to assess appropriateness for GI endoscopy and sedation.

BACKGROUND: Endoscopists are performing greater numbers of procedures, often on patients with complex conditions, in ambulatory settings because of changing patient demographics and referral patterns. To assist with the pre-procedure assessment of such patients, we deployed an advanced electronic health record tool, the Queriable Patient Inference Dossier (QPID), to review clinical histories and generate e-mail alerts to providers, based on clinical guidelines.
OBJECTIVE: Study the feasibility of an automated pre-procedure alert system for outpatient endoscopy.
DESIGN: We retrospectively reviewed 5 physicians' use of the application and their responses to the alerts.
SETTING: A hospital-based endoscopy unit and its two satellite outpatient clinics, Boston area, Massachusetts. PATIENTS: Adult outpatients referred for endoscopy with moderate sedation. INTERVENTION: Pre-procedure alerts automatically sent 7 days before the procedure, highlighting any conditions/clinical history that may affect management of the patient. MAIN OUTCOME MEASUREMENTS: Physician use of the pre-procedure alert system and its effect on patient management.
RESULTS: We studied 1682 procedures that met inclusion criteria for review by QPID and 364 alerts (1.6% of the eligible procedures). Nearly 80% of the alerts were reviewed and responded to by the physicians, and 70 total alerts resulted in a change in patient management (4.2% of eligible procedures). LIMITATIONS: The small size of the study group and the low rate of adverse events during the study period limit our findings. We thus plan to conduct a larger follow-up study to demonstrate changes in safety and efficiency.
CONCLUSION: Use of advanced electronic health record technologies, such as QPID, may improve provider efficiency and patient outcomes in endoscopy units.