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

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.

[1]  G Hultén,et al.  Large Differences in Laboratory Utilisation between Hospitals in Sweden , 2000, Clinical chemistry and laboratory medicine.

[2]  J. Grimshaw,et al.  Effect of a practice-based strategy on test ordering performance of primary care physicians: a randomized trial. , 2003, JAMA.

[3]  H C Sox,et al.  Modifying test-ordering behavior in the outpatient medical clinic. A controlled trial of two educational interventions. , 1985, Archives of internal medicine.

[4]  David W. Bates,et al.  Position Paper: A Proposal for Electronic Medical Records in U.S. Primary Care , 2003, J. Am. Medical Informatics Assoc..

[5]  S. Emerson,et al.  The impact of requisition design on laboratory utilization. , 2001, American journal of clinical pathology.

[6]  C J McDonald,et al.  The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. , 1990, The New England journal of medicine.

[7]  N. Tryding,et al.  Effects of an education programme to change clinical laboratory testing habits in primary care. , 1999, Scandinavian journal of primary health care.

[8]  A. Lyon,et al.  Strategies to promote rational clinical chemistry test utilization. , 1996, Clinical biochemistry.

[9]  D. Bates,et al.  Does the computerized display of charges affect inpatient ancillary test utilization? , 1997, Archives of internal medicine.

[10]  P Axt-Adam,et al.  Influencing Behavior of Physicians Ordering Laboratory Tests: A Literature Study , 1993, Medical care.

[11]  P M Broughton,et al.  Modifying the request behaviour of clinicians. , 1992, Journal of clinical pathology.

[12]  A H Wu.  Improving the utilization of clinical laboratory tests. , 1998, Journal of evaluation in clinical practice.

[13]  J. R. Beck,et al.  Common diagnostic test panels for clinical evaluation of new primary care outpatients in Japan: a cost-effectiveness evaluation. , 1999, Clinical chemistry.

[14]  C. Naylor,et al.  Do we know what inappropriate laboratory utilization is? A systematic review of laboratory clinical audits. , 1998, JAMA.

[15]  M H Liang,et al.  Techniques to improve physicians' use of diagnostic tests: a new conceptual framework. , 1998, JAMA.

[16]  T. Pysher,et al.  Chemistry Test Ordering Patterns after Elimination of Predefined Multitest Chemistry Panels in a Children's Hospital , 1999, Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society.

[17]  J T Hindmarsh,et al.  A strategy to promote rational clinical chemistry test utilization. , 1995, American journal of clinical pathology.

[18]  T. Bodenheimer,et al.  Electronic technology: a spark to revitalize primary care? , 2003, JAMA.