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

BackgroundEndoscopists 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.ObjectiveStudy the feasibility of an automated pre-procedure alert system for outpatient endoscopy.DesignWe retrospectively reviewed 5 physicians' use of the application and their responses to the alerts.SettingA hospital-based endoscopy unit and its two satellite outpatient clinics, Boston area, Massachusetts.PatientsAdult outpatients referred for endoscopy with moderate sedation.InterventionPre-procedure alerts automatically sent 7 days before the procedure, highlighting any conditions/clinical history that may affect management of the patient.Main Outcome MeasurementsPhysician use of the pre-procedure alert system and its effect on patient management.ResultsWe 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).LimitationsThe 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.ConclusionUse of advanced electronic health record technologies, such as QPID, may improve provider efficiency and patient outcomes in endoscopy units.