Changes to Lab Test Ordering in EHR Could Decrease Overtesting

Ordering gamma glutamyl transferase tests through the search engine function of an electronic health record (EHR) reduced orders from 36,000 to about 1,000 per month, according to the findings of a study published in the American Journal of Managed Care.

The research team found that ordering tests through the search engine function, rather than from two other lists that appear on the main screen of the EHR, led to a dramatic reduction in orders. The team returned the gamma glutamyl transferase test option to one of its original places on the main screen, which caused the numbers to spike to 18,000. When the test option returned to its original place in all the lists, the numbers jumped to more than 35,000.

The solution could lead to a reduction in costs.

Researchers set out to evaluate if changes in how laboratory requests are presented in the EHR would lead to less testing.

Gari Blumberg, M.D., from the family medicine department at Tel Aviv University, and the research team compared the numbers of gamma glutamyl transferase tests ordered at different times. The researchers changed the parameters on the main laboratory screen of the EHR.

Researchers at the laboratory at Leumit Health Services in Israel removed the testing option from the main screen in 2014. With the option removed, physicians could only order the test if it was specifically searched for.

After two months, the main screen option partially returned, then it went back to its original status.

When the gamma glutamyl transferase tests could only be ordered through the search engine function, Blumberg and the research team saw a 97.3% reduction in the number of orders.

While the number of test orders has increased since July 2015, less are ordered now compared to before the intervention. As of 2018, physicians ordered about 25 to 34 tests per 1,000 health maintenance organization members. Prior to the intervention, physicians ordered 51 tests per 1,000 members.

The study authors noted that there is a slight inconvenience when the test cannot be ordered on the main screen of the EHR. But using the search engine led to a dramatic decrease in the number of tests sent.

“Because the doctors are still able to choose the test should they feel it necessary by actively searching for it, it follows that the increased convenience was the most likely cause of the overordering, facilitated by the use of shortcuts,” the authors wrote.

The researchers wrote that while convenience is positive when it saves time, if it leads to overtesting, physicians do not gain much and are wasting money.

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