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Geisinger Implements EHR Alerts, Reduces Costly Lab Orders


Key takeaways:

  • Laboratory testing is known to be a source of potential waste and overutilization.
  • PINC AITM Clinical Decision Support alerts provide insight into high-cost labs.
  • High-cost lab alerts arm providers with the knowledge of true costs, which helps them make better decisions and achieve better results.

For more on this topic:

Healthcare organizations are increasingly looking for ways to reduce spending. A key target is eliminating waste – spending that could be cut without harming patients or lowering the quality of care. Laboratory testing is widely recognized as a major source of potential waste and overutilization. Many expensive tests are ordered unnecessarily. Geisinger Health System is actively working to reverse that behavior and lower total costs of care.

Monitoring High-Cost Lab Tests

As part of their overall effort to more appropriately utilize labs, Geisinger believed that they needed to help educate clinical decision makers about just how much those reflex orders were costing the healthcare system.

To do so, they turned to PINC AITM Clinical Decision Support to integrate high-cost lab alerts into the electronic medical record (EMR). These alerts, developed by Stanson Health, utilize PINC AITM technology to send instant notification to a provider if a lab order exceeds a threshold of $500 or $1000. However, the alert will never overwrite clinical judgement if the provider decides the patient is better off with the more expensive test. Clinical judgement always remains with the provider.

“The alerts provided an easy way to quickly identify tests that were often esoteric and should require some additional thought by the clinician prior to being ordered,” said Dr. Jordan Olson, Division Chief of Clinical Pathology Informatics at Geisinger. “We didn't want to stop clinicians from ordering these tests when they were needed, but we wanted to make sure that clinicians gave it a second thought before they proceeded to do so.”

Small Changes Make a Big Impact

After implementing PINC AI’s solution, Geisinger saw positive results with a decrease in unnecessary and expensive lab orders. A great example of this decrease in high-cost test utilization was demonstrated with the Hepatitis C Genotype PCR test. When EHR order data was reviewed from mid-2019 through end of 2021, a 62 percent decrease in overall order volume of the Hepatitis C Genotype PCR test was observed over that time. The Geisinger team credits much of that due to the implementation of the high-cost lab alert to raise awareness of the cost factor.

“The nice thing with these alerts is this is a way to help our clinicians learn,” said Olson. “We see a sustained decrease in the ordering of expensive tests because clinicians learn to not even place the order for these tests after a while.”

The alerts also aided the Geisinger team with their goal to reduce variation in care and ensure that patients were receiving the right test the first time. Although the results received by Geisinger were favorable, they were also surprising. Initially, some staff were wary about implementing the alerts due to fear it would become a nuisance and cause alert fatigue. “Some members of the team at first didn’t think the alerts were going to make a difference – they had this idea that clinicians are going to order what they want regardless of the information gained by a provider from an alert,” said Olson.

However, the alerts became a small change that made a big and lasting impact. “When we actually got the data back, it was unexpected to see the magnitude. We expected a few percent change, but we saw much bigger, a much larger change than that,” said Olson.

In building on the success of the four live high-cost lab alerts, Geisinger also turned on a similar alert notifying providers that they were ordering a send-out test on an inpatient, which is often an inappropriate order for that patient venue. “Being able to put some alerts in to drive appropriate utilization has been a morale boost for the Lab & IT group,” said Olson.

What’s Next

Reducing waste in healthcare is not a simple task but implementing high-cost lab alerts can help make a difference. Financial transparency allows providers to make beneficial changes in healthcare spending.

With these alerts, providers are armed with the knowledge of true costs which aids them in making informed decisions to achieve positive outcomes. As Geisinger continually expands their test menu, the health system will work to keep the alerts up to date. They plan to monitor which high-cost lab alerts need to be added and which they can get rid of.

“We've seen a lot of success with the alerts that we've gotten from Stanson and Premier,” said Olson. “Honestly, I've found a lot of value in them, so we want to continue to roll them out, continue to build on that success.”

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