Simple EHR changes can significantly impact lab utilization

Tweaking the menu in an electronic health record can have a direct impact on ordering patterns for laboratory testing, according to a new case study published in BMC Medical Informatics and Decision Making.

The researchers, from the University of Iowa Hospital Clinics and elsewhere, noted concerns with laboratory testing utilization, including overutilization, underutilization and incorrect test ordering.

They studied the effects of changes to the EHRs and computerized physician order entry (CPOE) to lab testing and ordering in a 711-bed academic medical center over a five-year period. Following the installation of the EHR, the academic medical center put interventions in place over time to promote better, more cost-effective utilization of lab testing, such as limits on selectable frequency of ordering lab tests, posting of lab test charges in the CPOE order entry, restricting the sending out of tests and expanding the checking for duplicative tests.

The researchers found that the interventions caused a major impact on lab testing.

"The high-frequency laboratory tests showing the biggest declines in order volume post intervention were serum albumin (36 percent) and erythrocyte sedimentation rate (17 percent). Introduction of restrictions for 170 high-cost send-out tests resulted in a 23 percent decline in order volume," they reported. "Targeted interventions reduced misorders involving several 'look-alike' tests: 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D; manganese, magnesium; beta-2-glycoprotein, beta-2-microglobulin. Lastly, targeted alerts reduced duplicate orders of germline genetic testing and orders of hepatitis B surface antigen within two weeks of hepatitis B vaccination."

EHRs have been showing promise in reducing unnecessary tests and providing more accurate care, especially when the system has been redesigned and reprogrammed to impact and influence users.

The researchers concluded that even simple changes in the EHR and CPOE can be effective in utilization management.

To learn more:
- read the study (.pdf)