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TBase - an Integrated Electronic Health Record and Research Database for Kidney Transplant Recipients
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Reduction in Unnecessary Red Blood Cell Folate Testing by Restricting Computerized Physician Order Entry in the

Thomas E MacMillan1, Patrick Gudgeon2, Paul M Yip3

  • 1Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada; Division of General Internal Medicine, Department of Medicine, University of Toronto, Ontario, Canada; HoPingKong Centre for Excellence in Education and Practice, University Health Network, Toronto, Ontario, Canada.

The American Journal of Medicine
|May 6, 2018
PubMed
Summary

Restricting red blood cell (RBC) folate testing in electronic health records significantly reduced test orders by 94.4%. This intervention achieved substantial cost savings without negatively impacting folate deficiency diagnoses.

Keywords:
AppropriatenessForcing functionsLaboratory testingQuality improvementRed blood cell folate

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Area of Science:

  • Clinical Pathology
  • Health Informatics
  • Healthcare Management

Background:

  • Red blood cell (RBC) folate testing has limited clinical utility.
  • Previous efforts to curb unnecessary laboratory test orders have shown modest success.
  • Optimizing diagnostic test utilization is crucial for healthcare efficiency.

Purpose of the Study:

  • To evaluate the effectiveness of restricting RBC folate test orders within an electronic health record (EHR).
  • To assess the impact of EHR-based ordering restrictions on RBC folate testing rates.
  • To determine the clinical and economic consequences of limiting access to RBC folate tests.

Main Methods:

  • A retrospective observational study was conducted from January 2010 to December 2016.
  • Ordering of RBC folate tests was restricted to gastroenterology and hematology clinicians in June 2013.
  • The study included all inpatients and outpatients undergoing RBC folate or vitamin B12 testing.

Main Results:

  • RBC folate testing decreased by 94.4% post-intervention (493.0 to 27.6 tests/month).
  • The intervention led to significant cost savings, estimated over CAD $250,000 in 3 years.
  • No significant clinical impact on the diagnosis of folate deficiency was observed.

Conclusions:

  • Restricting RBC folate ordering in the EHR effectively reduced testing rates.
  • The intervention resulted in substantial cost savings.
  • Limiting RBC folate test orders did not adversely affect the diagnosis of folate deficiency.