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

To evaluate if changes in how laboratory test requests are presented in the electronic health record (EHR) would lead to less testing.

Computerized laboratory data were used to compare the numbers of tests ordered before and after each change was introduced.

Leumit Health Services (a health maintenance organization [HMO] in Israel) has a central laboratory that serves HMO members in 340 clinics all over the country. We were able to compare the numbers of gamma glutamyl transferase (GGT) tests ordered during different periods of time during which the ways of presenting the parameters on the main laboratory screen of the EHR were changed.

A dramatic reduction in orders occurred when GGT tests could be ordered only by the search engine function, instead of being ordered from 2 other lists that appear on the main screen-from about 36,000 to about 1000 per month. When the GGT test option was added back to just 1 place on the main screen, the numbers jumped back to 18,000, and when GGT returned to its original place in all the lists, back to more than 35,000. Since then, the GGT test is available on the main screen only in the batch of liver tests.

A slight decrease in the convenience of ordering a laboratory test that is not indicated for routine screening led to a dramatic decrease in the number of test orders sent. Convenience is a positive thing when it saves precious time, but if it leads to overtesting, we shall not have gained much.