4 | DISCUSSION
This study suggests that the impact of nonintrusive CDSS should be evaluated for individual laboratory tests to ensure only effective alerts continue to be used so as to avoid increasing EHR fatigue. The CDSS can still be a low‐cost intervention for continuing educational efforts on appropriate ordering practices for selected laboratory tests. The folate results showed a significant pre‐existing trend of a decrease in the number of folate tests ordered per monthly admissions. This baseline decrease before the intervention was most likely associated with an increase in awareness from informal educational lectures within the department. The data did demonstrate a decrease in the number of HCV VL and genotype tests ordered per monthly admissions immediately after the intervention. However, given the few number of these tests being ordered, the clinical significance of this decrease is likely minimal. The pre‐existing trend of a decrease in T&S orders per patient days each month over the time period was maintained even after the intervention. The effect of the intervention on this laboratory test was diminished by the truncated postintervention time period.
Prior work has shown that noninterruptive notifications do not increase the appropriate utilization of baseline laboratory testing.12 Because we did not evaluate the appropriateness of individual patients' orders, whether the pre‐existing trends in reduction of folate and T&S orders specifically represented a reduction in unnecessary testing was outside of the scope of our analysis. The specific laboratory tests in this study were targeted at our institution, but nonintrusive messaging can continue educational efforts regarding the appropriate ordering of other tests as long as a clear message is displayed. In fact, targeting laboratory tests that have high volume and show no pre‐existing decreasing trends would be important.
