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Utilization management and information technology: adapting to the new era
Summary
Overuse of clinical laboratory services requires effective, long-term solutions. Real-time utilization management (UM) enabled by information technology (IT) offers a new paradigm for clinical laboratories and managed care organizations.
Area of Science:
- Health Services Research
- Clinical Laboratory Science
- Health Information Technology
Background:
- The overuse of clinical laboratory services is a persistent issue with limited long-term solutions.
- CLS, Inc., owned by HIP Health Plan of New York, faces challenges with clinical laboratory service utilization.
Purpose of the Study:
- To review past utilization management (UM) strategies.
- To explore the impact of information technology (IT) advancements on UM.
- To propose a new paradigm for real-time UM in clinical laboratories.
Main Methods:
- Literature review of utilization management approaches.
- Analysis of information technology developments.
- Conceptualization of a real-time UM model.
Main Results:
- Past UM remedies have often lacked long-term effectiveness.
- Information technology advancements present opportunities for real-time UM.
- A new paradigm for real-time UM is feasible.
Conclusions:
- Real-time utilization management is a viable new paradigm for clinical laboratories.
- The choice of IT systems is critical for implementing real-time UM.
- This approach has significant implications for future clinical laboratory operations.