The use of transthoracic echocardiograms (TTEs) has increased dramatically, particularly over the last ten years. There is a perceived lack of harm in performing a non‐invasive TTE, though high cost and overdiagnosis are important downsides. Appropriate use guidelines for echocardiograms have been developed but have not changed the pace at which echocardiogram use is increasing. We sought to study the changes in TTE ordering that occurred at our institution following implementation of an electronic medical record (EMR).
We analyzed echocardiogram ordering practices at our institution over a two‐year period, including inpatient and outpatient studies. The first year of the database was prior to implementation of our EMR (June 2, 2012) and the second year was after. Transesophageal echocardiograms and stress echocardiograms were excluded while complete and limited TTEs were both included. Repeat TTEs were defined as a second TTE performed on the same patient within six months of a prior TTE. Repeat TTEs were analyzed during the six months before and six months after implementation of our EMR.
19,902 total TTEs were performed during the two years of the study. There were 8,698 TTEs during the year prior to our EMR and 11,204 TTEs during the year after, an increase of 29%. The providers that ordered the largest number of TTEs were Medicine (including inpatient medicine services and primary care providers) and Cardiology. During the six months before and six months after EMR implementation, repeat TTEs accounted for 25% of total TTEs. There were 1,250 repeat TTEs during the six months prior to EMR and 1,246 repeat TTEs during the six months after EMR. 1,103 of those repeat TTEs, or 44%, were repeated within just 30 days of the prior TTE.
The total number of TTEs increased by 29% after implementation of our EMR while the number of repeat TTEs did not increase during this same period. The increased ease of ordering TTEs via EMR may have contributed to the increase in total TTE orders. The increased ease of viewing prior TTE results on EMR may have contributed to the lack of an increase in repeat TTEs. This may have important implications given the increasing use of and federal mandate for EMRs.
To cite this abstract:Stewart E, Soni K, Qasim A. Echo‐Ing Change: The Effect of an Electronic Medical Record on Transthoracic Echocardiogram Ordering. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 151. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/echoing-change-the-effect-of-an-electronic-medical-record-on-transthoracic-echocardiogram-ordering/. Accessed May 21, 2019.