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Optimize Your Electronic Medical Record to Increase Value: Reducing Laboratory Overutilization


Eliminating electronic health record features that facilitate over-utilization is likely to be a safe and effective method of reducing hospital costs.


The purpose of this study is to decrease overutilization of laboratory testing by eliminating a feature of the electronic ordering system that allowed providers to order laboratory tests to occur daily without review.


We collected rates of utilization of a group of commonly ordered laboratory tests (number of tests per patient per day) throughout the entire hospital from June 10, 2013 through June 10, 2015. Our intervention, which eliminated the ability to order daily recurring tests, was implemented on June 11, 2014. We compared pre- and postintervention rates in order to assess the impact and surveyed providers about their experience with the intervention.


We examined 1,296,742 laboratory tests performed on 92,799 unique patients over 434,059 patient days. Before the intervention, the target tests were ordered using this daily recurring mechanism 33% of the time. After the intervention we observed an 8.5% (P <.001) to 20.9% (P <.001) reduction in tests per patient per day. The reduction in rate for some of the target tests persisted during the study period, but not for the 2 most commonly ordered tests. We estimated an approximate reduction in hospital costs of $300,000 due to the intervention.


A simple modification to the order entry system significantly and immediately altered provider practices throughout a large tertiary care academic center. This strategy is replicable by the many hospitals that use the same electronic health record system, and possibly, by users of other systems. Future areas of study include evaluating the additive effects of education and real-time decision support.


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-Eduardo Iturrate, MD, MSW, FHM, Lindsay Jubelt, MD, MS1, Frank Volpicelli, MD, Katherine Hochman, MD, MBA, FHM

This article originally appeared in the February 2016 issue of The American Journal of Medicine.

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