As our healthcare system continues transitioning to value-based care, laboratory professionals are encouraged to find their place in supporting proactive care models. This change means focusing on a broader scope of laboratory stewardship and being aware of the value of the laboratory’s contribution in addition to quality lab result reporting.
Overutilization & Underutilization
As part of effective laboratory stewardship, laboratories need to actively advise providers about the best test choices. Currently, we see significant levels of both underutilization and overutilization of laboratory tests that could be eliminated with laboratory professional consultation and intervention.
Overutilization often occurs at the initial patient evaluation, as providers may choose a “shotgun” approach and order several unnecessary tests. A study at the University of California, San Francisco Medical Center found that a large majority of tests being ordered do not have a significant impact on patient care. By using specific patient criteria to justify lab test orders, they reported a $2 million savings by improving test utilization.1
Looking to underutilization, a vital component of early chronic disease care that can save healthcare dollars is the increased utilization of diagnostic lab services. Clinical laboratory testing plays a pivotal role in identifying chronic conditions, accurately characterizing a particular disease, and helping clinicians devise the most appropriate treatment plans.
All too often, the incorrect or less ideal set of lab tests are ordered. Laboratory stewardship means that the lab steps up and interjects their knowledge to improve test ordering and usage. One step many laboratories have taken is implementation of a laboratory formulary, where laboratory professionals and pathologists play the role of gatekeeper and help manage their test menu appropriately. The formulary utilizes lab knowledge to advise who can order tests and when, and to identify tests that require laboratory intervention and review.
Other Utilization Efforts: Alerts & Algorithms
Duplicate testing alerts and testing algorithms are other tools laboratories can use to help ensure best test orders. At the University of Mississippi Medical Center, in order to reduce unnecessary testing, duplicate testing alerts were implemented in the EHR. By implementing this one change (for BMP and CBC), providing this information to the provider at the time of order, they were able to save an annualized total of $146,675.2
Utilize Your LIS for Laboratory Stewardship
There are abundant tools available in your LIS that support laboratory stewardship programs. For example, advanced data mining and rules-based technology can help you analyze your utilization and patient data, as well as set up testing algorithms, reminders, and autoverification.
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Orchard White Paper, Effective Test Utilization: A Laboratory's First Step in Contributing to the New Healthcare Model
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