Aligning Thrombophilia Testing With Evidence-Based Guidelines: The Impact of Clinical Decision Support Redesign in an Academic Medical Center

BACKGROUND: Thrombophilia testing is frequently overused despite limited clinical utility in most acute thrombotic settings and clear guideline recommendations, contributing to unnecessary health care utilization and costs. OBJECTIVE: To improve the appropriateness of thrombophilia testing through EHR-based clinical decision support. METHODS: Five thrombophilia PowerPlans containing outdated or inappropriate testing were revised into 4 evidence-based PowerPlans using current guidelines and local expert consensus. Orders were analyzed over 30 weeks before and after intervention for PowerPlan usage, inappropriate testing, ordering by provider type, and estimated laboratory charges. RESULTS: Appropriate testing remained stable, whereas nonevidence-based testing decreased from 19.0% to 12.6% (P = 0.00001), with ordering reduction across all provider groups. Postintervention, inappropriate PowerPlans orders decreased from 41.4% to 3.1%, with laboratory charges decreasing by $117 436 for nonevidence-based testing over 30 weeks. CONCLUSIONS: Updating PowerPlans reduced inappropriate thrombophilia testing and estimated laboratory charges without reducing appropriate testing, demonstrating the value of EHR-based interventions in promoting high-value care.