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Initiative seeks to streamline lab test ordering process

Mar. 12, 2015, 9:13 AM

A committee of physician leaders has embarked on a multi-year effort to take a close look at all types of lab work ordered at Vanderbilt University Medical Center (VUMC), and in the process do away with unnecessary or obsolete tests.

Last summer, VUMC leaders formed the Laboratory Formulary Committee and charged it with reviewing tests offered to patients, both those performed in-house and at outside labs. That work will lead to the creation of a laboratory formulary — a list of all available tests and rules for when they can be ordered.

“This committee is establishing important standards to simplify decisions surrounding laboratory tests in a manner that will provide the greatest value for the results provided versus the overall cost to our patients,” said C. Wright Pinson, MBA, M.D., deputy vice chancellor for Health Affairs and CEO of the Vanderbilt Health System.

The goal is to help streamline the process for ordering lab work across VUMC and promote cost effective medical care by reducing inappropriate or unnecessary testing.

“Physicians are facing a bewildering explosion in available laboratory tests, especially with regard to genetic testing,” said Gordon Bernard, M.D., associate vice chancellor for Research, who is chairing the committee. “Many of these tests are very expensive; often running into thousands of dollars. Further, they are increasingly difficult to select appropriately and interpret once the results are available.”

In addition to identifying tests that are obsolete or rarely ordered, the committee, which is a subcommittee of the Pharmacy, Therapeutics and Diagnostics Committee, is also reviewing all requests for new types of tests.

The new formulary will categorize tests as either unrestricted for ordering or tests that are restricted to certain users or clinical settings.

Examples of restrictions include tests that can be ordered only by a subspecialist or that can be ordered only on an outpatient basis.

Removing some of the tests from the ordering system will do more than just make it easier for care providers to know which test to order. Tests typically performed in-house also require the maintenance and storage of testing chemicals and equipment, space that could be potentially freed up for other uses.

“The direct costs of laboratory and pathology testing have risen exponentially over the last 10 years with the development of enhanced medical knowledge and new diagnostic tools,” said Mary Zutter, M.D., assistant vice chancellor for Integrative Diagnostics, who is helping lead the initiative. “Nationwide, laboratory formularies are being developed to guide cost-effective, evidence-based medicine, and VUMC is poised to lead in this area.”

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