Free, Open Source Tool Harnesses EHR Data to Assess, Improve Antibiotic Prescribing

Overprescribing of antibiotics has been an ongoing problem in medicine for a number of years. One study found that at least 28% of antibiotics prescribed in the outpatient setting are unnecessary,¹ and the total inappropriate antibiotic use, including unnecessary use and inappropriate selection, dosing and duration, may approach 50% of all outpatient antibiotic use, according to CDC and other studies.^2,3,4

Part of the challenge has been a limited understanding of prescribing practices by providers.

“Unfortunately, most clinicians lack awareness of their prescribing habits,” Holly Frost, MD, senior director, Center for Health Systems Research, Denver Health, associate professor, Pediatrics, University of Colorado School of Medicine, said. “One of the things that we can do to help them improve their prescribing habits is to show them their data and how it compares to other people.”

One of the ongoing issues has been not only the way antibiotics are prescribed but the follow-up time and effort to create reports to track antibiotic usage. Frost explains that she worked on a project that looked at 14 institutions across the United States and they found it took on average approximately 8 to 20 hours a month to develop these reports.

The development of a newer novel tool looks to aid in understanding prescribing practices efficiently. Denver Health and Hospital Authority developed their OASIS (Outpatient Automated Stewardship Information System) as part of a research study, and with support from The Pew Charitable Trusts.

According to the OASIS website, this is a freely available, easily modifiable statistical code that electronically abstracts data from the electronic health record (EHR), analyzes the data, and creates recurring reports on medical providers’ antibiotic prescribing habits individually and in comparison to their peers. The reports generated by OASIS are emailed to providers automatically at intervals of your choosing.

And OASIS is open to other institutions to use, explains Frost.

Denver Health uses OASIS primarily for two reasons. “We currently use it to send out reports to our clinicians on their antibiotic prescribing compared to their peers, and showing them how their prescribing has changed over time,” Frost said. “So this past winter, for example, we did it for ear infections, which is the most common reason kids are prescribed antibiotics. And we looked at are they prescribing the first line antibiotic, and are they prescribing it for the correct duration?”

They also use it to update clinicians on their antibiotic prescribing for respiratory conditions. They take into account the various respiratory conditions and how prescribing changes over time.

Although Denver Health has been using OASIS to track prescribing practices in the outpatient setting, Frost says this can also be used to track inpatient prescribing or even collect other data. “You could use it for other quality metrics that your organization is doing,” Frost said.

Contagion spoke to Frost who offered further insights on how OASIS works, how they are using it at her institution, and how it might be accessible to other institutions.

References
1.Hersh AL, King LM, Shapiro DJ, Hicks LA, Fleming-Dutra KE. Unnecessary Antibiotic Prescribing in US Ambulatory Care Settings, 2010-2015. Clin Infect Dis. 2021;72(1):133-137.

2.Centers for Disease Control and Prevention (CDC). Office-related antibiotic prescribing for persons aged ≤14 years — United States, 1993—1994 to 2007—2008. MMWR Morb Mortal Wkly Rep. 2011;60(34):1153-6.

3.Pichichero ME. Dynamics of antibiotic prescribing for children. JAMA. June 19, 2002;287(23):3133-5.

4.Shapiro DJ, Hicks LA, Pavia AT, Hersh AL. Antibiotic prescribing for adults in ambulatory care in the USA, 2007–09. J Antimicrob Chemother. 2014;69(1):234-40.