Abstract
Background: Inappropriate use of laboratory diagnostic tests lowers quality and raises costs of care. Our study was designed to find whether a reduction in testing could be obtained by the simple strategy of changing the set-up of the check-box laboratory order form that is embedded in a computerized medical record.
Methods: A prospective intervention study was carried out at Maccabi Healthcare Services (MHS), an Israeli HMO that has used a computerized medical record since 1992. The MHS central data repository retains complete historical records of patient demographic data, physician data, laboratory results, using the patient’s unique national identification number. In May 2005 we changed the order form and reduced the number of tests that can be ordered from 51 to 26 using a check-box form. Twenty-seven tests were removed from the form and two tests were added. Changes in physician’ test ordering were then studied.
Results: While tests that were added or retained on the computerized laboratory order form showed an increase of 17% and 64% in number of tests ordered per visit compared to the period prior to intervention, tests that were removed showed a reduction of 7% in test ordering and a further reduction of 28% in the subsequent year.
Conclusions: Changes in format of laboratory test order forms may be a powerful tool to improve appropriateness of testing. A thoughtfully built test ordering form can save unnecessary tests and can reinforce clinical guidelines for the performance of some preventive testing and follow-up. Electronic health records can be utilized for implementing policy.
- Received September 11, 2008.
