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The Impact of Structured Laboratory Routines in Computerized Medical Records in a Primary Care Service Setting

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Abstract

Inappropriate laboratory ordering is a problem affecting medical systems worldwide. An intervention was called for as a result of increasing laboratory costs. Thus, we aimed to assess the impact of introducing computerized laboratory routines to a computerized primary care setting. The study included 380 primary care physician practices of Clalit Health Service (HMO) southern district (CHS-SD) in Israel, caring for 470,000 members. Consensus laboratory routines order sets were electronically introduced into all physicians’ computerized medical record (CMR) software, after consensus and internal marketing process. The primary findings were that a previously observed annual increase in laboratory test utilization was stopped, a 2% reduction in total number of tests and a 4% reduction in the total number of tests per age adjusted person was observed. In conclusion the wide use of CMRs and communication technology combined with an appropriate organizational process can be used to increase appropriate utilization of laboratory tests.

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References

  1. van Walraven, C., and Naylor, C. D., Do we know what inappropriate laboratory utilization is? JAMA 280:550–558, 1998.

    Article  PubMed  Google Scholar 

  2. Axt-Adam, P., van der Wouden, J. C., and van der Does, E., Influencing behavior of physicians ordering laboratory tests: A literature study. Med. Care. 31(9):784–94, 1993.

    PubMed  Google Scholar 

  3. Hindmarsh, J. T., and Lyon, A. W., Strategies to promote rational clinical chemistry test utilization. Clin. Biochem. 29(4):291–299, 1996.

    Article  PubMed  Google Scholar 

  4. Wu, A. H., Improving the utilization of clinical laboratory tests. J. Eval. Clin. Pract. 4(3):171–181, 1998.

    Article  PubMed  Google Scholar 

  5. Verstappen, W. H., van der Weijden, T., Sijbrandij, J., Smeele, I., Hermsen, J., Grimshaw, J., and Grol, R. P., Effect of a practice-based strategy on test ordering performance of primary care physicians: A randomized trial. JAMA 289(18):2407–2412, 2003.

    Article  PubMed  Google Scholar 

  6. Solomon, D. H., Hashimoto, H., Daltroy, L., and Liang, M. H., Techniques to improve physicians’ use of diagnostic tests. JAMA 280:2020–2027, 1998.

    Article  PubMed  Google Scholar 

  7. Lyon, A. W., Greenway, D. C., and Hindmarsh, J. T., A strategy to promote rational clinical chemistry test utilization. Am. J. Clin. Pathol. 103(6):718–724, 1995.

    PubMed  Google Scholar 

  8. Larsson, A., Biom, S., Wernroth, M. L., Hulten, G., and Tryding, N., Effects of an education programme to change clinical laboratory testing habits in primary care. Scand. J. Prim. Health Care 17(4):238–243, 1999.

    Article  PubMed  Google Scholar 

  9. Marton, K. I., Tul, V., and Sox, H. C. Jr., Modifying test-ordering behavior in the outpatient medical clinic. A controlled trial of two educational interventions. Arch. Intern. Med. 145(5):816–821, 1985.

    Article  PubMed  Google Scholar 

  10. Tierney, W. M., Miller, M. E., and McDonald, C. J., The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N. Engl. J. Med. 322(21): 1499–1504, 1990.

    PubMed  Google Scholar 

  11. Bates, D. W., Ebell, M., Gotlieb, E., Zapp, J., and Mullins, H. C., A proposal for electronic medical records in U.S. primary care. J. Am. Med. Inform. Assoc. 10:1–10, 2003.

    Article  PubMed  Google Scholar 

  12. Pannall, P., Marshall, W., Jabor, A., and Magid, E., A strategy to promote the rational use of laboratory tests. IFCC education and management division committee on rational laboratory use. International federation of clinical chemistry. J. Int. Fed. Clin. Chem. 8(1):16–19, 1996.

    PubMed  Google Scholar 

  13. Gama, R., Nightingale, P. G., Broughton, P. M., Peters, M., Ratcliffe, J. G., Bradby, G. V., and Berg, J., Modifying the request behavior of clinicians. J. Clin. Pathol. 45(3):248–249, 1992.

    PubMed  Google Scholar 

  14. Emerson, J. F., and Emerson, S. S., The impact of requisition design on laboratory utilization. Am. J. Clin. Pathol. 116(6):879–884, 2001.

    Article  PubMed  Google Scholar 

  15. Pysher, T. J., Bach, P. R., Lowichik, A., Petersen, M. D., and Shields, L. H., Chemistry test ordering patterns after elimination of predefined multitest chemistry panels in a children’s hospital. Pediatr. Dev. Pathol. 2(5):446–453, 1999.

    Article  PubMed  Google Scholar 

  16. Takemura, Y., Ishida, H., Inoue, Y., and Beck, J. R., Common diagnostic test panels for clinical evaluation of new primary care outpatients in Japan: A cost effectiveness evaluation. Clin. Chem. 45:1752–1761, 1999.

    PubMed  Google Scholar 

  17. Larsson, A., Palmer, M., Hulten, G., and Tryding, N., Large differences in laboratory utilisation between hospitals in Sweden. Clin. Chem. Lab. Med. 38(5):383–389, 2000.

    Article  PubMed  Google Scholar 

  18. Mayer, M., Unnecessary laboratory tests in diagnosis and treatment. Harefuah 120(2):66–69, 1991. (Hebrew).

    PubMed  Google Scholar 

  19. Bodenheimer, T., and Grumbach, K., Electronic technology: A spark to revitalize primary care? JAMA 290(2):259–264, 2003.

    Article  PubMed  Google Scholar 

  20. Bates, D. W., Kuperman, G. J., Jha, A., Teich, J. M., Orav, E. J., Ma’luf, N., Onderdonk, A., Pugatch, R., Wybenga, D., Winkelman, J., Brennan, T. A., Komaroff, A. L., and Tanasijevic, M. J., Does the computerized display of charges affect inpatient ancillary test utilization? Arch. Intern. Med. 157(21):2501–2508, 1997.

    Article  PubMed  Google Scholar 

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Correspondence to Daniel A. Vardy.

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Vardy, D.A., Simon, T., Limoni, Y. et al. The Impact of Structured Laboratory Routines in Computerized Medical Records in a Primary Care Service Setting. J Med Syst 29, 619–626 (2005). https://doi.org/10.1007/s10916-005-6130-4

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  • DOI: https://doi.org/10.1007/s10916-005-6130-4

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