How EHR Could Change Medical Testing Protocols

EdwardKeiperWasted Spending on Medical Tests

By Edward Keiper, President and CEO of Velocity

The call to action has been issued. One of the primary sources of wasted spending is in medical tests that turn out to be unnecessary, and even worse, risky. Two dozen organizations affiliated with the American Board of Internal Medicine Foundation’s Choosing Wisely campaign have called for curtailment in expensive diagnostic testing, such as lab work and imaging that may not tell the story any more accurately than a skilled diagnostician.

But on the other side of the debate are thousands of healthcare providers who are practicing defensive medicine, because no one ever got sued for ordering unnecessary tests. In a “better safe than sorry” play, the problem may be more deeply rooted in psychology than liability.

It’s estimated that in the US, $3 trillion went to overall health spending in 2012, and possibly a third of that number, close to a trillion dollars, was wasted on unnecessary services and other items like excessive administrative costs and fraud.

In research originally published in Health Psychology, Victoria Shaffer, assistant professor of health sciences in the University of Missouri School of Health Professions, working with Adam Probst, a human factors engineer at Dallas-based Baylor Scott & White Health, and Raymond Chan, MD, a pediatrician at Children’s Mercy Hospitals and Clinics in Kansas City, Mo., explored the theory that the way electronic medical systems present lab tests can actually influence the number and kinds of diagnostics ordered.

Shaffer and her group examined how physicians chose lab tests by presenting three different order lists. An opt-in version with no tests preselected, found on most electronic health records, stood in contrast to an opt-out variation, in which physicians deselected tests that weren’t clinically relevant. The third version showed only a few pre-selected tests that were based on professional recommendations.

The outcome? Health care providers chose three more tests when using the opt-out version than the opt-in or recommended variations. Physicians also ordered a greater number of expert-recommended tests on the third variation of the order list.

Like every other decision making procedure, many factors figure into the process and some, like the psychology of decision-making, are more opaque than others. But the good news is that well designed electronic health records (EHR) can lead the way to a new paradigm – and lower costs – by creating forms that prompt the clinician to consider all the options before checking boxes.

This article was originally published in the Velocity blog and is republished here with permission.