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UVA Researchers Recommend Using EHRs for Reduced Medical Testing

Researchers at UVA recommend suggest using EHRs for reduced medical testing, such as limiting repetitive lab test ordering.

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By Kate Monica

- Researchers at the University of Virginia (UVA) Health System and other universities have developed a plan to cut unnecessary medical testing in an effort to save money and improve patient safety, satisfaction, and health outcomes in part by using EHRs.

Hospital staff frequently perform routine lab tests on hospitalized patients. However, researchers suggest automatically testing patients is wasteful and potentially threatening to patient safety when medical testing is not a necessary part of treatment.

For example, researchers pointed out that excessive blood testing can lead to hospital-acquired anemia, increased medical costs, and additional unnecessary testing. Furthermore, this kind of testing is painful for patients being pricked with a needle, and could negatively impact patient satisfaction.

“Despite strong evidence for the negative effects of routine daily laboratory testing on patients, there remains a need for improved implementation of this high-value measure,” said UVA School of Medicine Assistant Professor Andrew Parsons, MD. “Our aim is to assist other institutions that would like to promote this high-value practice as a quality-improvement effort.”

Researchers acknowledge there are several causes for excessive testing, including fear of litigation and lack of knowledge of the costs involved in testing. Still, healthcare providers can cut testing without negatively impacting patient safety or quality of care.

“Although reducing repetitive laboratory testing may bend the cost curve, patient safety should remain at the forefront of these efforts,” the researchers wrote.

As part of a new paper published in the Journal of the American Medical Association (JAMA) Internal Medicine, researchers developed the following recommendations to reduce excessive testing: 

  • Design and implement educational efforts to train care providers in better practices. Evidence should be provided that demonstrates the safety and effectiveness of those practices. This educational effort should range from bedside nurses all the way up through senior hospital leadership.
  • Audit testing and provide feedback to those ordering the tests. By giving health care providers real-time feedback on their ordering patterns, they can adjust those patterns to optimize care. Anonymized comparative data should be provided as well, the researchers urge.
  • Harness the power of electronic medical records to limit unnecessary testing. For example, hospitals might limit the ability to order repetitive daily labs on a perpetual basis.

These recommendations operate along guidelines established by UVA Health System’s Be Safe initiative. The initiative developed by UVA Executive Vice President for Health Affairs Richard M. Shannon, MD outlines standards to drive learning and improvement surrounding patient safety issues.

The newest published research and recommendations is the third initiative by the High Value Practice Academic Alliance to improve healthcare by reducing excess. The alliance includes more than 80 academic medical centers.

“Unlike traditional clinical practice guidelines that describe best-practice objectives, these papers are designed to guide medical centers through the process,” Parsons said. “Each paper is being co-authored by experienced quality-improvement faculty from multiple academic medical centers that have safely reduced unnecessary practice.”

Researchers from the University of Michigan, the University of Toronto, the University of Pennsylvania, and Johns Hopkins University also assisted in developing the guidelines.

The Choosing Wisely campaign launched by the American Board of Internal Medicine (ABIM) foundation and Consumer Reports also aims to reduce medical test ordering by prompting providers to identify and cut back on five tests or procedures that frequently prove ineffectual.

Earlier this year, the nationwide initiative proved effective in cutting costs and reducing instances of patient harm through modifications in physician EHR use.

One campaign participant—Cedars-Sinai Medical Center in Los Angeles—reduced test ordering through an alert built into the physician EHR workflow. The alert notified doctors when ordering tests or drugs that did not align with 18 Choosing Wisely campaign recommendations.

Within the first year of implementing the electronic alert system, the medical center saved $6 million in spending. 

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