The effect of a test ordering software intervention on the prescription of unnecessary laboratory tests - a randomized controlled trial

• Published in: BMC medical informatics and decision making Vol. 17; no. 1; p. 20
• Main Authors: Martins, Carlos Manuel Silva, da Costa Teixeira, Andreia Sofia, de Azevedo, Luís Filipe Ribeiro, Sá, Luísa Maria Barbosa, Santos, Paulo Alexandre Azevedo Pereira, do Couto, Maria Luciana Gomes Domingues, da Costa Pereira, Altamiro Manuel Rodrigues, Hespanhol, Alberto Augusto Oliveira Pinto, da Costa Santos, Cristina Maria Nogueira
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20-02-2017; BioMed Central
• Subjects: Analysis; Clinical decision making; Clinical medicine; Clinical trials; Communications systems; Comparative analysis; Decision support systems; Decision Support Systems, Clinical - standards; Diagnostic Tests, Routine - standards; Drugs; Electrocardiography; Electronic health records; Family Practice; Health care policy; Health facilities; Healthcare industry software; Humans; Informatics; Intervention; Laboratories; Medical tests; Patient safety; Physicians; Practice Patterns, Physicians' - standards; Prescribing; Primary Health Care - standards; Software; Task forces; Unnecessary Procedures; Uric acid; United States > US; Portugal; Decision making, computer-assisted; Decision support systems, clinical; Primary health care; Evidence-based practice; Preventive health services
• ISSN: 1472-6947; 1472-6947
• DOI: 10.1186/s12911-017-0416-6

The way software for electronic health records and laboratory tests ordering systems are designed may influence physicians' prescription. A randomised controlled trial was performed to measure the impact of a diagnostic and laboratory tests ordering system software modification.
Participants were family physicians working and prescribing diagnostic and laboratory tests. The intervention group had a modified software with a basic shortcut menu changes, where some tests were withdrawn or added, and with the implementation of an evidence-based decision support based on United States Preventive Services Task Force (USPSTF) recommendations. This intervention group was compared with usual software (control group). The outcomes were the number of tests prescribed from those: withdrawn from the basic menu; added to the basic menu; marked with green dots (USPSTF's grade A and B); and marked with red dots (USPSTF's grade D).
Comparing the monthly average number of tests prescribed before and after the software modification, from those tests that were withdrawn from the basic menu, the control group prescribed 33.8 tests per 100 consultations before and 30.8 after (p = 0075); the intervention group prescribed 31.3 before and 13.9 after (p < 0001). Comparing the tests prescribed between both groups during the intervention, from those tests that were withdrawn from the basic menu, the intervention group prescribed a monthly average of 14.0 vs. 29.3 tests per 100 consultations in the control group (p < 0.001). From those tests that are USPSTF's grade A and B, intervention group prescribed 66.8 vs. 74.1 tests per 100 consultations in the control group (p = 0.070). From those tests categorised as USPSTF grade D, the intervention group prescribed an average of 9.8 vs. 11.8 tests per 100 consultations in the control group (p = 0.003).
Removing unnecessary tests from a quick shortcut menu of the diagnosis and laboratory tests ordering system had a significant impact and reduced unnecessary prescription of tests. The fact that it was not possible to perform the randomization at the family physicians' level, but only of the computer servers is a limitation of our study. Future research should assess the impact of different tests ordering systems during longer periods.
ISRCTN45427977 , May 1
2014 (retrospectively registered).