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All Things HIT

Jan 15 2012   11:46PM GMT

Order sets, a prescription for defensive medicine

Posted by: AllinHIT
CDS, Chronic care management, clinical decision support, Defensive medicine, EHR usability, Order sets

According to CMS, health care costs in the state of Florida are at $132 billion annually. Although this is an astounding amount, and worthy of a huge gasp, learning that $40 billion of that cost was a result of defensive medicine was the most alarming! Defensive medicine, the act of providing clinical care combined with unnecessary testing for covering ones onus in case of malpractice, is a necessary evil in the eyes of some of the best doctors.

At the end of 2011, a Florida physician poll conducted by Oppenheim Research and Patients for Fair Compensation found that 88% of them practiced some form of defensive medicine in 2011.  Considering the amount of retirees in Florida, and that the “baby boomer” generation is aging, I expect this cost to increase substantially.  Hence, physicians will spend even more on this act of fighting lawsuits, meaning that taxpayers will be paying more as a result!

So what are the answers to fighting defensive medicine?  Although this study focused on Florida, I am certain that you will find similar results in every state. The results might not be as profound as they proved to be in Florida — one third of overall costs is high — but any defensive medicine cost should be unacceptable.  I know Florida physicians are banding together to reform liability laws as the answer.  However, I believe another prescription to this ailment can be uniformity order sets for the most chronic, prevalent conditions.

Imagine if EHRs, upon receiving certain diagnoses, utilized a clinical decision support tool which automatically creates a certain order set for that diagnoses.  Imagine further that these order sets are agreed upon uniformally within the medical community, hence eliminating any unnecessary tests and care plans that are not a part of that order set. Defensive medicine will become a thing of the past, health care costs will go down and outcomes will likely improve! This could be the best prescription for an ailment, even greater than focusing on liability laws and tort reform!

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