title: Altering a computerized laboratory test order form rationalizes ordering of laboratory tests in primary care physicians.
abstract: BACKGROUND
  To reduce physicians' inappropriate laboratory requests for their patients, administrators have used methods such as modifying a laboratory request order form with an agreed requesting protocol for the most common diagnoses in primary health care.
  
  
  OBJECTIVE
  To study the effects of removing the erythrocyte sedimentation rate (ESR) and aspartate transaminase (AST) which are considered of limited clinical value for primary care clinical decision-making from a computerized laboratory test order form. These tests were removed to another new view from the electronic laboratory menu where the physicians, instead of just ticking the desired test from the list, had to do 4-8s extra work by writing down the abbreviation to order the test.
  
  
  METHODS
  An observational controlled prospective study based on a before-after design was performed by removing AST and ES from the laboratory test order form of the computerized laboratory system for all primary care in the city of Helsinki, Finland. The numbers of annual and monthly use of AST and ESR and their controls, alanine transaminase (ALT) and C-reactive protein (CRP) ordered by General practitioners (GPs) was recorded over an eight-year period: four years before and a four years after the removal of AST and ES.
  
  
  RESULTS
  Removing AST and ESR from the computerized laboratory test order form decreased their use by up to 90%, whereas the use of the control tests increased throughout the follow-up period. The variation in use of these removed tests also decreased.
  
  
  CONCLUSIONS
  Removing a laboratory test from a computerized laboratory test order form may significantly reduce GPs' use of the laboratory test. Further studies are needed, however, to ensure the safety of this type of intervention.
authors.affiliation: Department of Primary Health Care Laboratory Services, Helsinki University Central Hospital, Laboratory Services (HUSLAB), Paciuksenkatu 29, P.O. Box 720, 00027 HUS Helsinki, Finland. Electronic address: katri.seppanen@hus.fi.
authors.forename: Katri
authors.initials: K
authors.lastname: Seppänen
authors.affiliation: Department of General Practice and Primary Healthcare, University of Helsinki, and Unit of Primary Health Care, Helsinki University Central Hospital, (HUS), Tukholmankatu 8 B, P.O. Box 20, 00014 Helsinki, Finland. Electronic address: timo.kauppila@fimnet.fi.
authors.forename: Timo
authors.initials: T
authors.lastname: Kauppila
authors.affiliation: Department of General Practice and Primary Healthcare, University of Helsinki, and Unit of Primary Health Care, Helsinki University Central Hospital, (HUS), Tukholmankatu 8 B, P.O. Box 20, 00014 Helsinki, Finland. Electronic address: kaisu.pitkala@helsinki.fi.
authors.forename: Kaisu
authors.initials: K
authors.lastname: Pitkälä
authors.affiliation: Department of General Practice and Primary Healthcare, University of Helsinki, and Unit of Primary Health Care, Helsinki University Central Hospital, (HUS), Tukholmankatu 8 B, P.O. Box 20, 00014 Helsinki, Finland. Electronic address: hannu.kautiainen@medcare.fi.
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.affiliation: Health Center of City of Helsinki, Siltasaarenkatu 13, P.O. Box 1, 00099 City of Helsinki, Finland. Electronic address: raija.puustinen@helsinki.fi.
authors.forename: Raija
authors.initials: R
authors.lastname: Puustinen
authors.affiliation: Health Center of City of Helsinki, Siltasaarenkatu 13, P.O. Box 1, 00099 City of Helsinki, Finland. Electronic address: antti.iivanainen@helsinki.fi.
authors.forename: Antti
authors.initials: A
authors.lastname: Iivanainen
authors.affiliation: Department of Primary Health Care Laboratory Services, Helsinki University Central Hospital, Laboratory Services (HUSLAB), Paciuksenkatu 29, P.O. Box 720, 00027 HUS Helsinki, Finland. Electronic address: tiina.maki@hus.fi.
authors.forename: Tiina
authors.initials: T
authors.lastname: Mäki
mesh_terms: D000465:Algorithms; D002984:Clinical Laboratory Information Systems / Q000706:statistics & numerical data*; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data*; D004282:Documentation / Q000706:statistics & numerical data*; D006801:Humans; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D015203:Reproducibility of Results; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review
keywords: Alanine transaminase; Aspartate transaminase; C-reactive protein; Computerized laboratory test order form; Erythrocyte sedimentation rate; Laboratory test