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Clinician Report Cards

The EMR and/or LIS can be used to generate clinician lab report cards. A lab report card or score card provides clinicians with a few specific lab utilization metrics so they can see how they are ordering lab tests compared to their peers. A lab report card can be automatically generated and sent to the clinician to view when the clinician accesses a particular tab, tool, or screen within the EMR. Report cards could also be e-mailed or mailed as hard copies to clinicians and/or their department chiefs.
The UM team and the clinicians decide what content to include on the lab report card. One idea is to include a specific statistic of total tests ordered per patient visit. This statistic is normalized "per patient visit" so it should be comparable across multiple clinicians, even if some work part-time or see fewer patients. There are many options for tests to include on the report card or score card. The image on the right is a mock example of how six physicians are compared. In this case, all six physicians can see each others' scores by name. Making peer comparison data anonymous is less compelling when trying to drive change. If the clinical departments are amenable to it, include names of each ordering clinician. In this example, two common "barometer" tests are measured; a comprehensive metabolic panel (CMP) and a complete blood cell count (CBC). These two tests serve as a general gauge for all orders. The total orders per patient are also given. You may wish to also add a specific test that your UM team believes is being over- or under-utilized. In this example, vitamin-D total orders are given.
The purpose of these report cards is to identify outliers among departments. For example, Dr. Smith is a clear outlier for vitamin-D orders. Given that all these clinicians are in the same department and should be seeing the same types of patients, Dr. Smith should be educated as to when an order for vitamin-D is clinically indicated. It appears this physician is over-ordering this test.
Notice that Dr. Joel orders more tests per patient yet orders fewer CMP tests. Dr. Joel's colleagues or chief may want to discuss this with Dr. Joel to see what, if any, guidelines or algorithms he is using to account for this pattern. Perhaps Dr. Joel is using a different protocol that the other clinicians should also be using (or have ceased using).
Sharing this kind of data among peers has been shown to drive down outliers and normalize/standardize the participants' ordering behaviors.
The report card approach may not require any enforcement at all. Merely seeing where you fall relative to your clinical peers is often enough to change one's ordering practices. However, chiefs and supervisors could also view the cards and enforce utilization standards when needed. The report card allows them to easily see which clinicians they need to work with concerning their ordering habits.
Specific clinicians may be responsible for the majority of orders in a given department. It may be true for some tests that 10% of the physicians are responsible for 90% of the test volume. Uncovering who these clinicians are is important.
The data for the report card could be compiled monthly, quarterly, every 6 months, etc. Adding a laboratory report card function to your EMR is a clever and novel approach to addressing lab utilization issues.