In a previous article Collaboration between Clinicians and Laboratories Critical to New Healthcare Model I discussed the need for laboratorians to work directly with clinicians to develop appropriate protocols  and decision support tools for not only ordering test but also in providing interpretation of the results.

There are many examples and existing tools being used today that clinicians should be demanding from their laboratories to assist in ordering and interpreting laboratory results. Today I will discuss three of those common tools.

A Complete test catalog and interpretative information

The laboratory’s online test catalog needs to be up-to-date and should include interpretative information for each test, appropriate references and cost of the laboratory test. There needs to be a clarification of the test’s usage when there is a similarity in test names. For example, The Clinical Laboratory Integration into Health Care Collaborative, a CDC funded committee with a focus on appropriate laboratory utilization, recognized 18 different titles for Vitamin D related tests, many of which were synonyms. The test catalog should provide easy access to clarifications between tests.

Test Formulary 

A laboratory test formulary is similar to a pharmacy formulary.  It contains a compendium of tests orderable by the practice.  Many Health Systems have these in place; however, I would contend that a group practice can develop its own formulary of tests with identifiers of which practitioners can order which tests.  In the development of a formulary, it is essential that each constituency or sub-group have a voice in the development. Some hospitals and health systems utilize a three tiered formulary; tier 1 tests can be ordered by all providers; tier 2 tests are restricted to sub-specialists and tier 3 includes undefined tests, which may be ordered under certain circumstances.  While decisions on tiers are implemented by the laboratory, the actual placement of the tests should be determined by a representative group of practicing clinicians. Apart from ensuring good ordering practices, such a formulary can lead to considerable cost savings.

Bundled Ordering

Bundled ordering is the ability to order multiple tests simultaneously with one order.  It may be used for standing orders, order sets for specific disease work ups, pre-office visit testing, pre-operative work-up. etc.  Bundled ordering saves time and may well save the patient multiple phlebotomy trips.  As new analytes become available and as diagnosis and treatment guidelines are modified by advances in current clinical knowledge, the bundles must be reviewed regularly (e.g. annually) to be certain they are still relevant and appropriate.  Atrium Health, a 6 group practice with 1000+ physicians in Massachusetts, reported $500 thousand in annual savings by using evidence based guidelines to develop pre-visit lab tests based on age, medications and prior diagnoses.

Test catalogs, formularies and bundled ordering are three simple and effective ways that the laboratory can collaborate with clinicians to ensure appropriate decisions are made in ordering tests and resources are optimized to eliminate unnecessary costs. In a future post I will explore some other tools that can help the laboratory and clinicians collaborate to create an effective model of laboratory utilization in the new healthcare model.