title: Promoting improved utilization of laboratory testing through changes in an electronic medical record: experience at an academic medical center.
abstract: This case study over time describes five years of experience with interventions to improve laboratory test utilization at an academic medical center. The high-frequency laboratory tests showing the biggest declines in order volume post intervention were serum albumin (36%) and erythrocyte sedimentation rate (17%). Introduction of restrictions for 170 high-cost send-out tests resulted in a 23% decline in order volume. Targeted interventions reduced mis-orders involving several "look-alike" tests: 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D; manganese, magnesium; beta-2-glycoprotein, beta-2-microglobulin. Lastly, targeted alerts reduced duplicate orders of germline genetic testing and orders of hepatitis B surface antigen within 2 weeks of hepatitis B vaccination.
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA. mkrasows@healthcare.uiowa.edu.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Krasowski
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.|Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Chudzik
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Dolezal
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Steussy
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Gailey
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Koch
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
authors.forename: Sara B
authors.initials: SB
authors.lastname: Kilborn
authors.affiliation: Stead Family Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Darbro
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
authors.forename: Carolyn D
authors.initials: CD
authors.lastname: Rysgaard
authors.affiliation: Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
authors.forename: Julia A
authors.initials: JA
authors.lastname: Klesney-Tait
mesh_terms: D000046:Academic Medical Centers / Q000592:standards*; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000592:standards*; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000592:standards*; D058996:Quality Improvement / Q000592:standards*