Utilization Trends: Study Links EMR Prioritization to Over Ordering of Costly Lab Tests

Health systems under pressure to cut costs and improve care quality are looking for ways to rein in what they perceive to be overutilization of lab testing. Against this backdrop, a pair of new studies linking electronic medical record (EMR) order prioritization to testing overuse might have an impact on your lab business.

Impact of EMR Sequencing on Test Ordering
The study, published in the American Journal of Clinical Pathology, finds that reprioritizing the sequence of test names in EMR lab order search results can reduce overutilization of more expensive tests.

The study focuses on utilization by the Cleveland Clinic of complete blood count (CBC) with leukocyte differential (CBC-DIFF), which is frequently ordered in the emergency department. Even though the DIFF component doesn’t often impact clinical decision making, previous internal analysis showed that CBC-DIFF accounted for up to 98% of all CBC orders originating in the emergency department, compared with 53% of orders from the inpatient service.

“Performing a slightly more expensive test that will not offer the provider any additional information may appear harmless in the short term but can easily result in a large waste in resources over time,” writes lead author Michael Phelan, M.D., from the Cleveland Clinic in Ohio.

Reprioritization Curbs Overutilization
Phelan and colleagues conducted a two-stage performance improvement project and assessed its impact on CBC ordering during pre- and post-intervention periods. In addition to an educational component, the intervention included a simple reprioritization of CBC and CBC-DIFF in the EMR orders. Previously, CBC-DIFF was listed first.

Results: The educational intervention had little impact on utilization with the proportion of CBC tests performed before and after the intervention holding steady. By contrast, after the EMR intervention, CBC samples ordered increased sharply. “EMR optimization, in the form of the reprioritization of order entry search menu results to return overused tests at a lower rank when generic queries are used, can help reduce such waste,” concludes Phelan.

Takeaway: Relatively easy solutions, like EMR sequencing of tests can potentially curb unnecessary ordering of common lab tests.