Table 2 Changes to electronic medical record affecting laboratory test ordering
Variable | Intervention | Date(s) of intervention |
|---|---|---|
Allowable frequencies for repetitive ordering of laboratory tests | Customized to tests | July 2012 |
Review of electronic order sets | All order sets with laboratory tests reviewed by pathology (pathology informatics and medical director) prior to release to production environment | September 2009 |
Duplicate ordering of tests | • Expanded duplicate checking to catch overlap of testing (e.g., glucose ordered individually at same time as basic metabolic panel that also included glucose order) | • October 2009 |
• Instituted Best Practice Alert warning for attempt at duplicate orders of germline genetic tests | • January 2011 | |
Send-out test warnings | • Removed generic send-out test prompt | May to July 2012 |
• Instituted specific warnings with hard-stops customized to tests to include one or more of the following: | ||
- High cost and very high cost warnings | ||
- Long turnaround time warnings | ||
- Genetic counseling prompt | ||
- Reflex testing warning (if applicable) | ||
Restriction of tests requiring approval (formulary) | Instituted restrictions on 170 tests that required pathologist or clinical specialist approval prior to ordering | July 2012 |
- 164 tests required pathologist approval | ||
- 4 tests required infectious disease attending approval | ||
- 2 tests required neurology attending approval | ||
Interventions targeting specific tests | Instituted based on review (see Table 3) | Various times 2009-2012 |
Laboratory test charges | Posted in EMR for most tests (either as discrete charges or range of possible charges) | July 2012 |