Changes in Frequency of Laboratory Test Ordering Options in Epic
Effective June 12, 2012, there will changes in how frequently certain laboratory tests can be set up for repetitive ordering in Epic. This will include some analytes that change slowly physiologically, such that there is rarely clinical need to monitor daily or more frequently. An analysis of test ordering patterns reveals significant over-utilization of testing which can cause iatrogenic blood loss, excess labor, and time spent reviewing testing. For example, approximately 20,000 albumin orders per year at UIHC appear to be clinically unnecessary.
These changes will not impact ability to do one time orders (e.g., in response to changing clinical status) but simply to limit the options in setting up repetitive testing.
These changes were approved by the Hospital Advisory Committee (HAC).
The specific changes are as follows:
(a) Limit repetitive ordering of albumin, thyroid stimulating hormone (TSH, including TSH reflexed to free thryoxine), HbA1C, and drug of abuse-urine screening panels to the following options:
| Once |
| Once AM |
| Once PM |
(b) Limit repetitive ordering of the complete blood count (CBC) to the following options:
| Daily |
| Daily AM |
| Daily PM |
| Once |
| Once AM |
| Once PM |
| Now then every 24 hours |
| Every 12 hours |
| Every 8 hours |
(c) Limit repetitive ordering of erythrocyte sedimentation rate (ESR) to the following options:
| Every 48 hours |
| Every 72 hours |
| Once |
| Once AM |
| Once PM |
(d) Limit repetitive ordering of the basic metabolic panel (BMP) and differential portion of the complete blood count (CBC) to the following options:
| Daily AM |
| Daily PM |
| Every 48 hours |
| Every 72 hours |
| Once |
| Once AM |
| Once PM |
Questions should be directed to Matthew Krasowski, MD, PhD, medical director of the Clinical Chemistry Laboratory (384-9380, matthew-krasowski@uiowa.edu).