Promoting improved utilization of laboratory testing through changes in an electronic medical record: experience at an academic medical center

TLDR

A five‑year case study at an academic medical center documents interventions aimed at improving laboratory test utilization. Interventions led to significant reductions in laboratory test orders, including a 36 % drop in serum albumin, 17 % in ESR, a 23 % decline in high‑cost send‑out tests, fewer mis‑orders of look‑alike tests, and fewer duplicate germline genetic and hepatitis B antigen orders after vaccination.

Abstract

This case study over time describes five years of experience with interventions to improve laboratory test utilization at an academic medical center. The high-frequency laboratory tests showing the biggest declines in order volume post intervention were serum albumin (36%) and erythrocyte sedimentation rate (17%). Introduction of restrictions for 170 high-cost send-out tests resulted in a 23% decline in order volume. Targeted interventions reduced mis-orders 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 2 weeks of hepatitis B vaccination.