New guidelines to reduce unnecessary lab testing focus on EHR prompts, clinician feedback

Doctor typing on laptop
EHR-enabled restrictions and clinician feedback using real-time data are part of new recommendations to reduce repetitive lab tests.

EHR-enabled prompts are one of three key recommendations issued by a group of researchers in the High Value Practice Academic Alliance to reduce unnecessary laboratory tests.

The new evidence-based guidelines recommend EHR-enabled restrictive ordering along with clinician training, and auditing and provider feedback to limit routine and often wasteful laboratory tests that account for approximately two-thirds of all medical decisions. The guidelines were published in JAMA Internal Medicine by researchers at some of the top medical institutions in the country, including John Hopkins, the University of Michigan Medical School, the University of Pennsylvania and Cedars-Sinai Medical Center.

Although EHRs represent just one portion of the guidelines, the authors note that isolated studies have shown that configuring EMRs to restrict repetitive lab tests or limit the number of lab tests physicians can order in a 24-hour period can reduce tests by 12-21%.

Reducing unnecessary lab tests has been a target in the Choosing Wisely campaign which aims to reduce wasteful tests or procedures that cost approximately $200 billion each year. Sutter Health has integrated more than 130 Choosing Wisely recommendations and saved about $66 million since 2011.

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Ultimately, a multipronged approach combining clinician education, feedback with real-time data on personal ordering patterns and EHR prompts offers the most impactful approach, with prior research indicating that in some instances, those three interventions reduced lab tests by 8% over three years, leading to more than $2 million in cost savings.

Lab tests may not be most expensive part of healthcare, but the group argues that a focus on over-testing can serve as a catalyst for a broader approach to limiting unnecessary care.

“Although reducing daily laboratory testing addresses only one aspect of hospitalized care, a change can have a profound effect on the institutional culture,” the authors wrote. “This intervention can catalyze a commitment to improve high-value practices across the whole enterprise, which ultimately will result in improved safety, satisfaction, and cost-effectiveness for all stakeholders.”