Challenges in Ordering and Interpreting Clinical Lab Tests
Challenges in Ordering and Interpreting Clinical Lab Tests
Background: The number and complexity of clinical laboratory tests is rapidly expanding, presenting primary care physicians with challenges in accurately, efficiently, and safely ordering and interpreting diagnostic tests. The objective of this study was to identify challenges primary care physicians face related to diagnostic laboratory testing and solutions they believe are helpful and available to them.
Methods: In this study, sponsored by the Centers for Disease Control and Prevention, a random sample of general internal medicine and family medicine physicians from the American Medical Association Masterfile were surveyed in 2011.
Results: 1768 physicians (5.6%) responded to the survey. Physicians reported ordering diagnostic laboratory tests for an average of 31.4% of patient encounters per week. They reported uncertainty about ordering tests in 14.7% and uncertainty in interpreting results in 8.3% of these diagnostic encounters. The most common problematic challenges in ordering tests were related to the cost to patients and insurance coverage restrictions. Other challenges included different names for the same test, tests not available except as part of a test panel, and different tests included in panels with the same names. The most common problematic challenges in interpreting and using test results were not receiving the results and confusing report formats. Respondents endorsed a variety of information technology and decision support solutions to improve test selection and results interpretation, but these solutions were not widely available at the time of the survey. Physicians infrequently sought assistance or consultation from laboratory professionals but valued these consultations when they occurred.
Conclusions: Primary care physicians routinely experience uncertainty and challenges in ordering and interpreting diagnostic laboratory tests. With more than 500 million primary care patient visits per year, the level of uncertainty reported in this study potentially affects 23 million patients per year and raises significant concerns about the safe and efficient use of laboratory testing resources. Improvement in information technology and clinical decision support systems and quick access to laboratory consultations may reduce physicians' uncertainty and mitigate these challenges.
Laboratory tests are essential tools for clinical diagnosis. Over the past 20 years, the number of laboratory tests available to clinicians has more than doubled to at least 3500 tests (ARUP Laboratories, Salt Lake City, Utah, personal communication). This complexity presents physicians with increasing challenges in accurately ordering and interpreting diagnostic tests and effectively using the results. These challenges are particularly acute for primary care physicians, who order the greatest variety of laboratory tests and order them during 30% to 40% of outpatient encounters.
Proposed solutions to improve the accuracy, efficiency, and safety of ordering clinical laboratory tests and interpreting the results include clinical decision support tools, trending of test results in electronic medical records (EMRs), condition-specific algorithms to help select tests, professional practice guidelines, and reflex laboratory testing. Many electronic resources have been developed to aid diagnostic decision making. Well-designed information technology (IT) decision support tools may improve physicians' diagnostic accuracy and efficiency and patient safety. Poorly designed decision support tools or conflicting practice guidelines, however, present barriers to accurate and effective test selection and interpretation.
In 2012, the Centers for Disease Control and Prevention's Clinical Laboratory Integration into Healthcare Collaborative (CLIHC), with support from the Altarum Institute, completed a national survey of family medicine and general internal medicine physicians to explore their degree of uncertainty when ordering and interpreting clinical laboratory tests, the challenges they face with laboratory diagnostic testing, and solutions to improve test utilization. Also of interest was the frequency with which primary care physicians initiate communication with laboratory professionals and the helpfulness of these consultations.
Abstract and Introduction
Abstract
Background: The number and complexity of clinical laboratory tests is rapidly expanding, presenting primary care physicians with challenges in accurately, efficiently, and safely ordering and interpreting diagnostic tests. The objective of this study was to identify challenges primary care physicians face related to diagnostic laboratory testing and solutions they believe are helpful and available to them.
Methods: In this study, sponsored by the Centers for Disease Control and Prevention, a random sample of general internal medicine and family medicine physicians from the American Medical Association Masterfile were surveyed in 2011.
Results: 1768 physicians (5.6%) responded to the survey. Physicians reported ordering diagnostic laboratory tests for an average of 31.4% of patient encounters per week. They reported uncertainty about ordering tests in 14.7% and uncertainty in interpreting results in 8.3% of these diagnostic encounters. The most common problematic challenges in ordering tests were related to the cost to patients and insurance coverage restrictions. Other challenges included different names for the same test, tests not available except as part of a test panel, and different tests included in panels with the same names. The most common problematic challenges in interpreting and using test results were not receiving the results and confusing report formats. Respondents endorsed a variety of information technology and decision support solutions to improve test selection and results interpretation, but these solutions were not widely available at the time of the survey. Physicians infrequently sought assistance or consultation from laboratory professionals but valued these consultations when they occurred.
Conclusions: Primary care physicians routinely experience uncertainty and challenges in ordering and interpreting diagnostic laboratory tests. With more than 500 million primary care patient visits per year, the level of uncertainty reported in this study potentially affects 23 million patients per year and raises significant concerns about the safe and efficient use of laboratory testing resources. Improvement in information technology and clinical decision support systems and quick access to laboratory consultations may reduce physicians' uncertainty and mitigate these challenges.
Introduction
Laboratory tests are essential tools for clinical diagnosis. Over the past 20 years, the number of laboratory tests available to clinicians has more than doubled to at least 3500 tests (ARUP Laboratories, Salt Lake City, Utah, personal communication). This complexity presents physicians with increasing challenges in accurately ordering and interpreting diagnostic tests and effectively using the results. These challenges are particularly acute for primary care physicians, who order the greatest variety of laboratory tests and order them during 30% to 40% of outpatient encounters.
Proposed solutions to improve the accuracy, efficiency, and safety of ordering clinical laboratory tests and interpreting the results include clinical decision support tools, trending of test results in electronic medical records (EMRs), condition-specific algorithms to help select tests, professional practice guidelines, and reflex laboratory testing. Many electronic resources have been developed to aid diagnostic decision making. Well-designed information technology (IT) decision support tools may improve physicians' diagnostic accuracy and efficiency and patient safety. Poorly designed decision support tools or conflicting practice guidelines, however, present barriers to accurate and effective test selection and interpretation.
In 2012, the Centers for Disease Control and Prevention's Clinical Laboratory Integration into Healthcare Collaborative (CLIHC), with support from the Altarum Institute, completed a national survey of family medicine and general internal medicine physicians to explore their degree of uncertainty when ordering and interpreting clinical laboratory tests, the challenges they face with laboratory diagnostic testing, and solutions to improve test utilization. Also of interest was the frequency with which primary care physicians initiate communication with laboratory professionals and the helpfulness of these consultations.
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