How to Avoid Unnecessary Tests? EHRs Can Help

In the numerous debates that lawmakers have had about health care, particularly as Congress continues to consider the future of the Affordable Care Act (ACA), there seems to be at least one thing that both sides of the aisle can agree on: there’s far too much wasteful spending on health care. A key contributor to those wasted dollars is the approximately $200 to $800 million (researchers vary in their estimations) that is spent each year on unnecessary laboratory tests and other unwanted medical procedures. But how can providers and health systems help to cut back on the waste? As Fierce Healthcare and others first reported, a new set of evidence-based guidelines published in JAMA Internal Medicine offer recommendations for hospitals seeking to scale back on tests. “Routine daily laboratory testing of hospitalized patients reflects a wasteful clinical practice that threatens the value of health care,” the authors assert. “Health care professionals and administrative leaders should carefully strategize and optimize efforts to reduce daily laboratory testing.”

The 10 authors, who are based at institutions including the Johns Hopkins School of Medicine and the University of Michigan School of Medicine, emphasize that the impacts of unnecessary tests and procedures go far beyond financial costs. For one, they can increase the risk of conditions such as hospital-acquired anemia (sometimes caused by excessive blood draws). The authors also note that tests have significant effects on clinical outcomes. “Although laboratory expenditure often represents less than five percent of most hospital budgets, the impact is far-reaching given that laboratory tests influence nearly 60 percent to 70 percent of all medical decisions,” they explain.

How, then, can hospitals begin to cut back? Among the recommendations that the authors provide: programming patients’ electronic health records (EHRs) to restrict the number of tests and procedures that can be pre-ordered within a certain time period—essentially, requiring clinicians to provide justification for ordering certain procedures. The authors note that studies piloting such EHR reconfiguration have shown reductions of between 12 and 21 percent in the number of tests ordered. Also among their recommendations: better training of clinicians throughout hospitals, based on relevant evidence and data; and the establishment of clear, straightforward goals for the reduction of testing. They point to the work that the Choosing Wisely campaign (an initiative that “aims to promote conversations between clinicians and patients” about evidence-based, non-duplicative care), for one, has been doing to combat unnecessary tests and procedures, and ultimately express optimism about hospitals’ potential to cut back on waste. “Efforts to reduce the frequency of laboratory orders can improve patient satisfaction and reduce cost without negatively affecting patient outcomes,” they assert.

Click here to read the Fierce Healthcare article on the guidelines for avoiding unnecessary lab tests and procedures.

Click here to read the JAMA Internal Medicine abstract of the article offering guidelines on avoiding unnecessary lab tests and procedures (full article requires subscription). 

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