In both of these areas, health-care systems will need to develop programs to engage ordering clinicians in appropriate decision-making.
Clinicians should be invited to participate in evidence-based guideline development.
Where there is no evidence,
clinical leadership should develop consen susbased guidelines
and monitor adherence to modify the guideline as needed.
Once a guideline is established,
decision support should be added to ordering systems.
Such decision support should advise clinicians on the appropriateness of the test as well as the inter valat which it is being tested.
Repeat tests should be flagged.
Lab systems should be designed to produce physician-level variation reports to identify unwarranted variation in lab utilization and identify physicians who are outliers.
Such physicians should be engaged in non-punitive ways
and educated on guidelines.
Ultimately, pay for performance incentives
will need to include measures of value and efficiency including appropriateness of lab test ordering.