How Training, Data, and EHRs Can Curb Unnecessary Testing

Needless tests can hike medical bills and place patients at greater risk of hospital-acquired illnesses. As far as value-based care goes, experts say, unwarranted medical assessments are a clear bust.

But a 3-pronged plan could help medical facilities limit the number of wasteful tests, cutting costs and improving outcomes along the way, according to a new report from researchers at some of the premier hospitals in the US and Canada. And they want to help other institutions adopt their promising strategy.

“Despite strong evidence for the negative effects of routine daily laboratory testing on patients, there remains a need for improved implementation of this high-value measure,” says Andrew Parsons, MD, MPH, of the University of Virginia School of Medicine and the senior author of the paper, published in JAMA Internal Medicine. “We want to do things for patients, not to patients.”

The researchers’ plan calls for healthcare facilities to design training modules to equip providers—from nurses to senior leadership—with evidence-based best practices, according to the announcement.

Medical testing should also be audited, giving those providers instantaneous feedback on their ordering patterns. From there, anonymized comparative data can better assist healthcare professionals as they adjust their modus operandi to boost care, according to the report.

Finally, hospitals must “harness the power” of electronic health records, the researchers note. “For example,” they write, “hospitals might limit the ability to order repetitive daily labs on a perpetual basis.”

Experts from the University of Virginia, the University of Michigan, the University of Toronto, the University of Pennsylvania, and Johns Hopkins University developed the guidelines with assistance from residents in training, according to the report. Their work is part of the High Value Practice Academic Alliance, which brings together more than 80 academic healthcare centers that aim to eliminate waste in medicine.

The researchers consider medical testing ripe for change because healthcare providers often order “routine daily” assessments of hospitalized patients, according to the report. Unless they determine those tests to be critical to care, the act is a “wasteful clinical practice that threatens the value of healthcare,” the authors write.

One example: Over-the-top blood testing can result in hospital-acquired anemia, they say. What’s more, that path leads to higher medical bills and unnecessary strain on testing infrastructure. Some patients can also find the action painful, an avoidable source of stress and discomfort.

So why does unnecessary testing occur in the first place? The researchers point to several reasons, from fear of litigation to an ignorance of the associated costs.

But hospitals can use data, best practices, and EHRs to overcome this burden without downgrading the level of care, the authors note.

“Although reducing repetitive laboratory testing may bend the cost curve,” they write, “patient safety should remain at the forefront of these efforts.”