Changing electronic formats is associated with changes in number of laboratory tests ordered

Area of Science:

• Clinical Laboratory Science
• Health Informatics
• Medical Economics

Background:

• Electronic health records (EHR) facilitate laboratory test ordering.
• The presentation of laboratory tests within EHR systems can influence physician ordering behavior.
• Gamma glutamyl transferase (GGT) is a liver enzyme test often subject to overuse.

Purpose of the Study:

• To determine if modifying the presentation of laboratory test requests in an EHR system would reduce the number of tests ordered.
• To assess the impact of EHR interface design on laboratory test utilization.

Main Methods:

• A quasi-experimental design was used, comparing laboratory test order volumes before and after changes to the EHR interface.
• Computerized laboratory data from Leumit Health Services in Israel were analyzed.
• The study focused on gamma glutamyl transferase (GGT) test orders during periods of altered EHR presentation.

Main Results:

• Ordering of GGT tests dramatically decreased from approximately 36,000 to 1,000 per month when the test was accessible only via a search function.
• Reintroducing the GGT test to the main screen increased orders to 18,000, and returning it to its original multiple locations further increased orders to over 35,000 per month.
• Currently, GGT is presented only within the liver tests batch on the main screen.

Conclusions:

• Reducing the convenience of ordering non-routine laboratory tests can significantly decrease their utilization.
• Physician ordering behavior is sensitive to the ease of access within EHR systems.
• While convenience in healthcare is beneficial, it must be balanced against the risk of overtesting and unnecessary resource utilization.