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The Electronic Medical Record (EMR) as a Utilization Tool, Continued

In addition to intelligently creating preference lists and smart-order sets for clinicians, the EMR can do many other things to improve utilization. As software continues to improve there is increasing potential for the EMR in lab utilization. Some ideas for using the EMR include:
  • Display the relative cost of the test. This not only helps clinicians to be mindful of resources, it also can help inform patients who may have co-pays or deductibles.
  • When certain questionable or obsolete tests are ordered, program a pop-up window to direct the physician to the proper test. Example: if a physician tries to order 1,25 OH-vitamin-D the physician should be redirected with a message that says "This test is only indicated in special cases as a second-tier vitamin-D test in patients with renal disease. For routine use, order 25-OH-vitamin-D."
  • Have the EMR prohibit excessive order frequencies. Example: if an A1c was ordered three days ago, another provider cannot put in a new A1c order unless they override the warning or unless it is dated 30 days after the present order.
  • Have an alert show when a clinician orders a test that is included on another test panel that has already been ordered. Example: a hospitalist tries to order a serum creatinine. An alert informs the hospitalist that a basic metabolic panel was run four hours ago that included a creatinine.
  • Provide links to clinical guidelines or resources when a test is ordered (to help clinicians interpret the test or decide if it is the right test).
  • The EMR can provide reminders for certain tests (like PAP smear, lipids, A1c for diabetics, etc.). These can be programmed into the EMR so that needed lab tests get auto-ordered when patients meet date, age, or other criteria.
  • The EMR can flag certain patients for later review.

As health care organizations transition to EMRs, the potential for laboratory utilization management is greatly increased.