Reducing Healthcare Costs

Clinical Order Authorization System for Healthcare Facilities

In today’s healthcare climate and clinical settings, there are many trainees and non-experts that are responsible for decisions made for and on behalf of the patients. Residencies can last from three to seven years, and much of this time is spent in the hospital. Because resident physicians (residents) and other trainees are under the direct or indirect supervision of an attending physician (attending), special situations may arise in which quick decisions are needed but the attending isn’t present. These decisions can cost the hospital and patients in significant ways, such as monetarily or quality of life.

For example, if an order were written for a blood transfusion, the two criteria to consider would be whether the patient’s hemoglobin level meets a particular threshold or the patient is otherwise extremely ill. If these two criteria are not met, and a transfusion of blood products is administered, the procedure could potentially be unnecessary, or there could be a cheaper alternative therapy.

A new software, Clinical Order Authorization System software, uses real-time analytics to bridge the gap between the experts and nonexperts in an efficient and cost-effective manner. If the rules for administering a blood transfusion, for example, are bypassed, the person originally responsible for the patient, such as the attending physician, is notified of the procedure via an app. If the attending signs off on the procedure, it is recorded in the patient’s digital chart. However, if the attending disagrees with the procedure, the trainee and the attending physician are connected via app to discuss the case. This is all done without a delay in the process so that the amount of time that it takes to request and administer the transfusion is not altered. The system operates outside of the medical system; that is, there are no additional logins required with the exception of electronic medical records (EMRs).

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While the system does not necessarily reduce errors, the system is an incredible cost-saving modality. “Judgements that inexperienced people make are not necessarily errors. There is not a lot of evidence that they cause harm, but they do increase cost,” says James M. Blum, MD, an assistant professor of anesthesiology at Emory School of Medicine. If you look at the number of transfusions that Emory’s hospital does, about half of them do not meet the standard criteria for receiving blood products – why this happens is still unknown, but if the total number of transfusions could potentially be cut in half by the software, the projected savings is upward of $1 million.

The impact of this dual authorization process on patients, both short term and long term, is significant. There are innumerable ways to quantify the impact that the software can and will have on patients—total cost of care, length of hospital stays, and even mortality statistics. Residents won’t be forced to decide whether or not they want to call their attending, as there are fixed criteria as to when a trainee should call their superior. The effects range from a shortened diagnostic time, to preventing expensive and/or incorrect medications from being administered, potentially improving costs, quality of life, and the overall medical experience for medical facilities and patients.

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