The Promise and Pitfalls of Computerized Provider Alerts for Laboratory Test Ordering.
"asasasasassasasasasasdasdasdfasdfasdfasdfasdfasdfasdffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff" The above expletive was typed as "justification" to override an alert message recently implemented in a computerized provider order entry (CPOE)2 system designed to reduce unnecessary repeat laboratory testing. Similar permutations of the home keys "asdf" were also observed. These responses provide clear evidence that the alert was not always welcomed by providers, but they do not clarify whether the failure was due to provider intransigence or poor alert design. In this issue of Clinical Chemistry Moyer et al. describe the implementation and findings of a CPOE alert designed to reduce unnecessary repeat ordering of 3 tests ionized calcium (iCa) serum magnesium (Mg) and N terminal pro brain natriuretic peptide (NT proBNP) in 5 intensive care units at a single institution (1) Unlike the above example, their alert demonstrated considerable success, with decreases in test volumes of 28% 48% in the 90 days following the introduction of the alert. It provides a model for large clinical systems to effectively introduce evidence based decision making tools into laboratory ordering practices. It is no secret that laboratory tests are overordered in the clinical environment; a recent metaanalysis demonstrated that tests are overused by 20.6% on average (2) The ordering of unnecessary tests on such a massive scale may impact not only direct healthcare costs, but also patient safety, and may lead to unnecessary follow up investigation and iatrogenic blood loss due to excess phlebotomy (3) Unfortunately, in large hospitals with high patient volumes, it would be impractical for laboratory directors to evaluate every test individually for appropriateness, and even more difficult to convince providers to change ordering practices. Meeting other evidence based quality objectives in laboratory ordering is similarly labor intensive. One increasingly popular method
Clinical chemistry