Subscribe to RSS
DOI: 10.1055/s-0038-1666843
Creation and Use of an Electronic Health Record Reporting Database to Improve a Laboratory Test Utilization Program
Publication History
28 March 2018
26 May 2018
Publication Date:
11 July 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035026/201803/lookinside/thumbnails/10-1055-s-0038-1666843_180076ra-1.jpg)
Abstract
Objectives Laboratory-based utilization management programs typically rely primarily on data derived from the laboratory information system to analyze testing volumes for trends and utilization concerns. We wished to examine the ability of an electronic health record (EHR) laboratory orders database to improve a laboratory utilization program.
Methods We obtained a daily file from our EHR containing data related to laboratory test ordering. We then used an automated process to import this file into a database to facilitate self-service queries and analysis.
Results The EHR laboratory orders database has proven to be an important addition to our utilization management program. We provide three representative examples of how the EHR laboratory orders database has been used to address common utilization issues. We demonstrate that analysis of EHR laboratory orders data has been able to provide unique insights that cannot be obtained by review of laboratory information system data alone. Further, we provide recommendations on key EHR data fields of importance to laboratory utilization efforts.
Conclusion We demonstrate that an EHR laboratory orders database may be a useful tool in the monitoring and optimization of laboratory testing. We recommend that health care systems develop and maintain a database of EHR laboratory orders data and integrate this data with their laboratory utilization programs.
Keywords
data analysis - laboratory information systems - pathology - monitoring and surveillance - order entryProtection of Human and Animal Subjects
This study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects.
-
References
- 1 Berndtson K. Managers and physicians come head to head over cost control. Healthc Financ Manage 1986; 40 (09) 23-24
- 2 Becich MJ. Information management: moving from test results to clinical information. Clin Leadersh Manag Rev 2000; 14 (06) 296-300
- 3 Gornick M. Medicare patients: geographic differences in hospital discharge rates and multiple stays. Soc Secur Bull 1977; 40 (06) 22-41
- 4 Welch WP, Miller ME, Welch HG, Fisher ES, Wennberg JE. Geographic variation in expenditures for physicians' services in the United States. N Engl J Med 1993; 328 (09) 621-627
- 5 Zhi M, Ding EL, Theisen-Toupal J, Whelan J, Arnaout R. The landscape of inappropriate laboratory testing: a 15-year meta-analysis. PLoS One 2013; 8 (11) e78962
- 6 Kim JY, Dzik WH, Dighe AS, Lewandrowski KB. Utilization management in a large urban academic medical center: a 10-year experience. Am J Clin Pathol 2011; 135 (01) 108-118
- 7 Huck A, Lewandrowski K. Utilization management in the clinical laboratory: an introduction and overview of the literature. Clin Chim Acta 2014; 427: 111-117
- 8 Baron JM, Dighe AS. The role of informatics and decision support in utilization management. Clin Chim Acta 2014; 427: 196-201
- 9 Adler-Milstein J, Holmgren AJ, Kralovec P, Worzala C, Searcy T, Patel V. Electronic health record adoption in US hospitals: the emergence of a digital “advanced use” divide. J Am Med Inform Assoc 2017; 24 (06) 1142-1148
- 10 Adler-Milstein J, DesRoches CM, Kralovec P. , et al. Electronic health record adoption in US hospitals: progress continues, but challenges persist. Health Aff (Millwood) 2015; 34 (12) 2174-2180
- 11 Gold M, McLaughlin C. Assessing HITECH implementation and lessons: 5 years later. Milbank Q 2016; 94 (03) 654-687
- 12 Guo U, Chen L, Mehta PH. Electronic health record innovations: Helping physicians - one less click at a time. Health Inf Manag 2017; 46 (03) 140-144
- 13 Lammers EJ, McLaughlin CG. Meaningful use of electronic health records and medicare expenditures: evidence from a panel data analysis of U.S. health care markets, 2010-2013. Health Serv Res 2017; 52 (04) 1364-1386
- 14 Georgiou A, Vecellio E, Toouli G. , et al. Monitoring the impact of the electronic medical record on the quality of laboratory test ordering practices. Stud Health Technol Inform 2013; 188: 33-38
- 15 Georgiou A, Morse W, Timmins W, Ray S, Westbrook JI. The use of performance metrics to monitor the impact of CPOE on pathology laboratory services. Stud Health Technol Inform 2008; 136: 291-296
- 16 Petrides AK, Bixho I, Goonan EM. , et al. The benefits and challenges of an interfaced electronic health record and laboratory information system: effects on laboratory processes. Arch Pathol Lab Med 2017; 141 (03) 410-417
- 17 Mekhjian H, Saltz J, Rogers P, Kamal J. Impact of CPOE order sets on lab orders. AMIA Annu Symp Proc 2003; 931
- 18 Wright A, Sittig DF, Carpenter JD, Krall MA, Pang JE, Middleton B. Order sets in computerized physician order entry systems: an analysis of seven sites. AMIA Annu Symp Proc 2010; 2010: 892-896
- 19 Olson J, Hollenbeak C, Donaldson K, Abendroth T, Castellani W. Default settings of computerized physician order entry system order sets drive ordering habits. J Pathol Inform 2015; 6: 16
- 20 Zhang Y, Levin JE, Padman R. Data-driven order set generation and evaluation in the pediatric environment. AMIA Annu Symp Proc 2012; 2012: 1469-1478
- 21 Farrell CJ, Kirsch SH, Herrmann M. Red cell or serum folate: what to do in clinical practice?. Clin Chem Lab Med 2013; 51 (03) 555-569
- 22 Choosing Wisely Campaign. Available at: http://www.choosingwisely.org/societies/american-society-for-clinical-pathology/ . Accessed May 7, 2018
- 23 Jackson BR. Laboratory formularies. Clin Chim Acta 2014; 427: 151-153
- 24 Grisson R, Kim JY, Brodsky V. , et al. A novel class of laboratory middleware. Promoting information flow and improving computerized provider order entry. Am J Clin Pathol 2010; 133 (06) 860-869
- 25 Blechner M, Kish J, Chadaga V, Dighe AS. Analysis of search in an online clinical laboratory manual. Am J Clin Pathol 2006; 126 (02) 208-214
- 26 Keehan SP, Cuckler GA, Sisko AM. , et al. National health expenditure projections, 2014-24: spending growth faster than recent trends. Health Aff (Millwood) 2015; 34 (08) 1407-1417