Comments on: EMR / Labs call for input

By: Aunt Susie

Aunt Susie — Mon, 17 Aug 2009 16:23:31 +0000

Not sure if this is an equal situation, but for a July 23 outpatient procedure, a chest x-ray and EKG were included in pre-admit process. At a different hospital, before major surgery on August 4, pre-admit accepted the records of those tests – after I asked if they could. Time will tell if I actually save much $, but I figure it freed up their personel and equipment for a few extra minutes that day.

By: doug

doug — Fri, 07 Aug 2009 06:53:35 +0000

Lyme Anti-Bodies. Once per year.

By: DFW ERdoc

DFW ERdoc — Mon, 03 Aug 2009 01:04:37 +0000

How about amylase, which studies have shown is not as sensitive or specific as lipase for pancreatitis, but is still ordered in conjunction with lipase? Stop those orders altogether, and you could save a good chunk of change when you look at how many abdominal pain workups are done every day in the ED, and how many physicians still order both when the amylase is not necessary….

By: Maria

Maria — Sun, 26 Jul 2009 21:07:02 +0000

Hep B and Hep C. RPR. PPD. (If all are positive.)

By: Greg P

Greg P — Sun, 26 Jul 2009 14:44:32 +0000

We really need this for the hospital in general, not just in the ED.

Would also add, perhaps with a timeframe, vitamin B12 level, thyroid profile, carotid duplex (yes, I’ve seen these ordered in the ED).

The other question is how to make use of this:
1. flash a warning
2. forbid it being ordered, or require a reason
3. simply track who is ordering excessively, with feedback later

If docs think this is an affront, I note in our newspaper today there is an article about some local docs being tossed out of Humana’s medicare plan for excessive ordering. So either we can police/educate each other, or wait for bureaucrats to do it.

Right now our hospital has all sort of guidelines to make sure certain things get done, like VTE prophylaxis, or various treatments for stroke. What we don’t have is something to look for doing things that were unnecessary/duplicative or knowing when to stop (like enoxaparin when the patient is up walking around). This is expensive.

By: Greg

Greg — Sun, 26 Jul 2009 13:42:56 +0000

Great idea. A simple way would be to look for a previous result when you order the test. If it finds one, it can tell you about it and ask you if you really want to order another one.

By: #1 Dinosaur

#1 Dinosaur — Sat, 25 Jul 2009 23:56:39 +0000

In addition to sickle cell screens, how about the other hemoglobinopathies? Don’t have to repeat multiple hemoglobin electrophoresis for every microcytic anemia.

By: CardioNP

CardioNP — Sat, 25 Jul 2009 22:50:39 +0000

How about HLA B27 and hemochromatosis genetic testing? BRCA 1 and 2?
(not much help in the ED, but presuming that the EMR is used by providers outside of the hospital)