If a tool offers cost data on tests, will doctors pay attention?

The hypothesis is that if doctors know the cost of the tests they're ordering, they'll order fewer tests. Similarly, if they know how much the medications they're prescribing cost, they'll look for less expensive alternatives.

The problem? They usually don't have that cost information, especially at the point of care.

But when physicians had the facts, a large, academic hospital in Texas saved $430,444 in 71 days.

That hospital did it, in part, by using IllumiCare's Smart Ribbon. The ribbon—a virtual strip of information, displayed on the edge of the electronic health record—gives providers cost and risk information about labs, medications and radiology tests in real time, offering up suggestions for lower-cost alternatives (when they exist).

At Baylor Scott and White Medical Center-Temple, for instance, the software has been built to appear as a rectangle on the screen that stays visible for about eight seconds over the Epic EHR, during which time a provider can click on or hover over it to keep it on screen.

The facility is using the technology thanks in part to IllumiCare's work with the Texas Hospital Association's Center for Technology Innovation.

Savings data weren't available, but for patients seen by physicians using the ribbon, cost and utilization have fallen without any negative effects on outcomes, Temple's chief medical officer, Dr. Stephen Sibbitt, said. And Baylor Scott and White physicians cut down on ordering tests the ribbon provides information about.

While other companies also offer cost information at the point of care, IlllumiCare is one of only a few to provide that information regardless of EHR brand and to provide more than just prescription-cost information.

“When you show providers things like how much a radiology test costs and the amount of radiation and the estimated cancer risk, they tend to be more judicious when ordering the test,” IllumiCare CEO G.T. LaBorde said.

As the provider navigates through the patient record, the IllumiCare software, which works on many EHRs, uses HL7 standards and authentication techniques already in place to analyze patient data in the EHR. Then, it automatically displays relevant information to the provider.

Baylor Scott and White will eventually take analytics one step further, giving providers cost information so they can compare themselves to their peers. If a clinician sees a patient with pneumonia, for instance, the ribbon will display how that provider compares to others in terms of costs for patients with pneumonia. “Physicians don't want to be negative outliers in any regard, and so they course-adjust,” Sibbitt said.

Key to that point will be convincing physicians to stick with the tool. “At some point, it may end up being something you tend to shrink (on screen) unless you have a specific question,” said Dr. Austin Metting, a Temple physician.

It's crucial to make the information in the ribbon compelling but also deliver it in a way that fits seamlessly into existing workflows, said John Kelly, principal business adviser for software firm Edifecs. Otherwise, he said, “how long does it take a physician to start to ignore a ribbon on the screen?” He compared it to the television chyron ribbon that so many of us have learned to ignore.

There may also be another deterrent in what patient advocates would consider a win. Reducing the number of tests physicians order theoretically could ding a hospital's bottom line, Kelly said. “For a hospital in some kind of risk-based contract, this would be a good thing,” he said. Otherwise, it's decreasing their revenue without any kind of incentive to make up for that hit.

There's also debate whether cost information matters at all. While some studies have shown the data leads to fewer tests and cheaper medications, others have shown no such effects. A 2017 study in JAMA Internal Medicine showed that giving providers price information in the EHR about inpatient lab tests didn't significantly change their ordering patterns.