title: The effect of a test ordering software intervention on the prescription of unnecessary laboratory tests - a randomized controlled trial.
abstract: The way software for electronic health records and laboratory tests ordering systems are designed may influence physicians' prescription. A randomised controlled trial was performed to measure the impact of a diagnostic and laboratory tests ordering system software modification.
  
  
  
  Participants were family physicians working and prescribing diagnostic and laboratory tests. The intervention group had a modified software with a basic shortcut menu changes, where some tests were withdrawn or added, and with the implementation of an evidence-based decision support based on United States Preventive Services Task Force (USPSTF) recommendations. This intervention group was compared with usual software (control group). The outcomes were the number of tests prescribed from those: withdrawn from the basic menu; added to the basic menu; marked with green dots (USPSTF's grade A and B); and marked with red dots (USPSTF's grade D).
  
  
  
  Comparing the monthly average number of tests prescribed before and after the software modification, from those tests that were withdrawn from the basic menu, the control group prescribed 33.8 tests per 100 consultations before and 30.8 after (p = 0075); the intervention group prescribed 31.3 before and 13.9 after (p < 0001). Comparing the tests prescribed between both groups during the intervention, from those tests that were withdrawn from the basic menu, the intervention group prescribed a monthly average of 14.0 vs. 29.3 tests per 100 consultations in the control group (p < 0.001). From those tests that are USPSTF's grade A and B, intervention group prescribed 66.8 vs. 74.1 tests per 100 consultations in the control group (p = 0.070). From those tests categorised as USPSTF grade D, the intervention group prescribed an average of 9.8 vs. 11.8 tests per 100 consultations in the control group (p = 0.003).
  
  
  
  Removing unnecessary tests from a quick shortcut menu of the diagnosis and laboratory tests ordering system had a significant impact and reduced unnecessary prescription of tests. The fact that it was not possible to perform the randomization at the family physicians' level, but only of the computer servers is a limitation of our study. Future research should assess the impact of different tests ordering systems during longer periods.
  
  
  
  ISRCTN45427977 , May 1st2014 (retrospectively registered).
authors.affiliation: Family Medicine Unit, Social Sciences and Health Department of the Faculty of Medicine of Porto, Porto, Portugal. carlosmartins20@gmail.com.|Unidade de Medicina Geral e Familiar, Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. carlosmartins20@gmail.com.
authors.forename: Carlos Manuel Silva
authors.initials: CM
authors.lastname: Martins
authors.affiliation: DCC- Faculty of Sciences, SQIC at Institute of Telecommunications, University of Porto, Porto, Portugal.
authors.forename: Andreia Sofia
authors.initials: AS
authors.lastname: da Costa Teixeira
authors.affiliation: Centre for Research in Health Technologies and Information Systems (CINTESIS), Information Sciences and Decision on Health Department (CIDES), Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Luís Filipe Ribeiro
authors.initials: LF
authors.lastname: de Azevedo
authors.affiliation: Family Medicine Unit, Social Sciences and Health Department of the Faculty of Medicine of Porto, Porto, Portugal.
authors.forename: Luísa Maria Barbosa
authors.initials: LM
authors.lastname: Sá
authors.affiliation: Family Medicine Unit, Social Sciences and Health Department of the Faculty of Medicine of Porto, Porto, Portugal.
authors.forename: Paulo Alexandre Azevedo Pereira
authors.initials: PA
authors.lastname: Santos
authors.affiliation: Family Medicine Unit, Social Sciences and Health Department of the Faculty of Medicine of Porto, Porto, Portugal.
authors.forename: Maria Luciana Gomes Domingues
authors.initials: ML
authors.lastname: do Couto
authors.affiliation: Centre for Research in Health Technologies and Information Systems (CINTESIS), Information Sciences and Decision on Health Department (CIDES), Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Altamiro Manuel Rodrigues
authors.initials: AM
authors.lastname: da Costa Pereira
authors.affiliation: Family Medicine Unit, Social Sciences and Health Department of the Faculty of Medicine of Porto, Porto, Portugal.
authors.forename: Alberto Augusto Oliveira Pinto
authors.initials: AA
authors.lastname: Hespanhol
authors.affiliation: Centre for Research in Health Technologies and Information Systems (CINTESIS), Information Sciences and Decision on Health Department (CIDES), Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Cristina Maria Nogueira
authors.initials: CM
authors.lastname: da Costa Santos
mesh_terms: D020000:Decision Support Systems, Clinical / Q000592:standards*; D003955:Diagnostic Tests, Routine / Q000592:standards*; D005194:Family Practice; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D019564:Unnecessary Procedures
keywords: Decision making, computer-assisted; Decision support systems, clinical; Evidence-based practice; Preventive health services; Primary health care