The effect of an electronic health record choice architecture intervention on efficient diuretic use: A research report

Abstract Introduction Oral metolazone and intravenous (IV) chlorothiazide have comparable diuretic efficacy and safety, although IV chlorothiazide is significantly more expensive. The use of electronic health record (EHR)‐based choice architecture interventions on the efficient use of diuretics remains unexplored. Objectives We aimed to evaluate the impact of an EHR‐based choice architecture intervention on efficient chlorothiazide utilization at two United States institutions and highlight potential annual cost savings. Methods Institution 1 implemented an educational intervention on August 1, 2020, followed by an EHR‐based intervention on January 1, 2021. Institution 2 implemented the EHR intervention alone on March 8, 2023. The EHR intervention prompted clinicians to consider switching to oral metolazone, emphasizing cost differences and similar efficacy. We compared mean weekly administrations and estimated rate ratios (RRs) and 95% confidence intervals (CIs) for the use of IV chlorothiazide for pre‐ versus post‐EHR intervention using interrupted time series analyses at each institution. Results At Institution 1, mean weekly IV chlorothiazide administrations decreased from 42.3 ± 21.9 at baseline to 16.4 ± 13.7 post‐EHR intervention ( p < 0.001), with an estimated annual cost savings of $175 000. At Institution 2, mean weekly administrations decreased from 20.3 ± 21.9 to 10.7 ± 5.7 ( p = 0.04), with an estimated annual cost savings of $65 000. Interrupted time series analyses showed a significant reduction in IV chlorothiazide use associated with the EHR intervention (Institution 1: RR 0.56; 95% CI 0.33, 0.91; Institution 2: RR 0.45; 95% CI 0.31, 0.65). Conclusion The EHR‐based interventions demonstrated significant reductions in IV chlorothiazide use and potentially substantial cost savings at two separate institutions, highlighting their potential as a scalable strategy to improve efficient diuretic utilization.