Okay folks, I’m going to call on your wisdom and ask that you help me improve our EMR.
I noticed right after our EMR started, with Rh testing: I would look in past labs to see if my patient (pregnant with vaginal bleeding) had a documented Rh. Yes, it turns out, many had had more than 5 (even when positive), because we had no way to access those prior tests. Now we do, with the EMR.
I want to take this a step further, and make a list of tests we can start ‘flagging’ that don’t need to be repeated because some things don’t change. No sense doing the same thing over and over if the result’s going to be the same.
Here’s my first pass:
- Rh (if positive)
- G6PD
- HIV (if positive)
- Sickle Cell screens
- All those heritable clotting disease tests (Factor V Leiden, Protein C, Protein S, etc).
I wouldn’t restrict anyone’s’ ability to re-order (confirmatory test) but would have the prior result pop up in the ordering box for that test. Usually these are re-ordered in ignorance that it was done before.
Here’s a place an EMR can actually contribute to cost savings!
Please put your recommendations for other tests that don’t need repeating in the comments. I’ll make a compilation post when other recommendations peter out.
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)
In addition to sickle cell screens, how about the other hemoglobinopathies? Don’t have to repeat multiple hemoglobin electrophoresis for every microcytic anemia.
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.
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.
Hep B and Hep C. RPR. PPD. (If all are positive.)
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….
Lyme Anti-Bodies. Once per year.
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.