Docs Using EMR Data Order Fewer Lab Tests

Posted on December 2, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new study has concluded that when doctors viewed lab test cost data in an EMR, they decreased their order rates for certain tests, cutting the overall cost of lab tests meaningfully, according a story in Healthcare IT News.

The Atrius health study, published in the Journal of General Internal Medicine, found that docs who reviewed lab test cost data decreased their ordering rates for certain tests and saved up to $107 per 1,000 per month. The study also found that lab test utilization decreased by up to 5.6 lab orders per 1,000 visits  per month, HIN reported.

The study, which was led by Daniel Horn of  Massachusetts General Hospital’s Division of General Medicine, surveyed 215 primary care docs at Atrius Health. Physicians in the intervention group got up-to-date information on lab costs for 27 individual tests when they placed e-orders. There was also a control group of physicians who didn’t get the information.

Researchers saw significant decreases in ordering rates for five out of 27 high and low cost lab tests, and a decrease in utilization for all 27 tests, though not all shifts were statistically significant. Meanwhile, 49 percent of doctors felt that they had enough information to make their ordering decisions.

Thomas Sequist, MD, Atrius Health director of research and co-author of the study, said these findings suggest that seeing lab data in EMRs could scale up in big ways. For example, he notes, in a large physician practice managing 20,000 visits per month, that’s $2,140 per month and more than $25,000 per year.

This isn’t the only evidence that access to lab test costs and info reduces ordering. A study published last year in the Archives of Internal Medicine concluded that during the period between January 1, 1999  and Dec. 31, 2004, during the test of a health information exchange, there was a 49 percent reduction in number of tests for patients with recent off-site tests.

That being said, other studies — such as this one appearing in Health Affairs — have found that doctors who see earlier tests and images actually tend to order more follow up tests.

It seems clear that this is an important area for further study, as needless tests are a big cost driver. In the mean time, we’ll have to make do with contradictory evidence.