Sometimes small changes can make a big impact.

Last fall, Lancaster General Hospital’s Pathology Department added some simple guidance to Epic orders for Vitamin D deficiency testing. The guidance aims to reduce confusion associated with two similar-sounding tests -- 1.25 dihydroxy vitamin D and 25 hydroxy vitamin D – that differ significantly in clinical indication.
 

Lorenzo M. Galindo, M.D., said adding some simple guidance to Epic orders for Vitamin D deficiency testing has made a big impact.

Lorenzo M. Galindo, M.D., LG Health/Penn Medicine Medical Director of Laboratories and Chair of the LGH Pathology Department, said the 25 hydroxy vitamin D test is almost always the right choice when screening a patient for Vitamin D deficiency. The 1.25 hydroxy vitamin D test is only indicated for very specific clinical situations. But in many cases, the ordering physician simply checks both boxes.

Now, when a physician orders the 1.25 dihydroxy test for a Vitamin D deficiency screening, Epic prompts him or her to choose the 25 hydroxy text instead. After six months, utilization of the 1.25 dihydroxy test has dropped by half – from about 60 to 30 orders per month, mostly from nephrologists, Dr. Galindo said.

“When a physician opens Epic, he or she is confronted with 3,500 tests, many with similar-sounding names,” he said. “By making a very small change, we can make very big changes in ordering patterns.”

The new Epic guidance is part of LGH’s overall effort to reduce unnecessary costs by making it easier for physicians to order the right lab tests – and harder to order the wrong ones. Other strategies include developing computer-based algorithms to simplify diagnosis of complex diseases and conditions.
 
“As we make the transition to value-based care and a pay-for-performance model, we must practice medicine in a much more thoughtful and efficient way, to take unnecessary cost out of the system,” Dr. Galindo said.With this in mind, the role of the hospital-based pathologist is quickly changing, requiring a very active role in this process.”

  • LGH’s Diagnostics Committee, which was highlighted by the College of American Pathologists as an example of a laboratory utilization committee, is heavily involved in developing strategies to reduce laboratory testing overutilization. The five other featured committees included the Mayo Clinic, Cedars-Sinai Medical Center, Massachusetts General Hospital and the University of Michigan.

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