Two Lab Tests are Better than One

A friend of mine was telling me a story about the challenge she experienced with the health care system following some side-effects of a recent pregnancy.  Apparently, her primary doctor referred her to a specialist for further consultation on the minor complications.  However, upon arrival at the specialist’s office she was told by the nurse that she needed to have a pregnancy test performed before any further analysis could be done.  Her response, of course, was that the sole reason for her visit was to discuss the side-effect of her current pregnancy.  The nurse acknowledged, but stated that her medical records have no documentation or proof of her status.  Consequently, although she was five months and noticeably “showing” an additional lab test needed to be performed.  This is one of the more ridiculous examples of how the US health care system continues to be fraught with waste and inefficiency.  And although I suspect this specific scenario does not occur with a great deal of frequency, there are numerous cases in which duplicate lab tests or radiology images are ordered. 

As discussed in my posts last month, patient’s medical records exist primarily on paper today in the US.  Consequently, the records do not travel with patients as they visit different providers such as specialists or emergency care locations.  Often physicians need access to data such as prescription medications, family history, discharge notes, lab tests and radiology images to make an accurate clinical diagnosis.  In the absence of a complete medical record, physicians may be unaware that a particular test has been performed.  Or if they are aware, they may not have access to the results or associated radiology images.  In such a scenario, physicians are prone to order a redundant test in order to gather the information they require.  

Example Radiology Image (of Homer Simpson)

Duplicate lab testing is more widespread than you might expect.  A study by the Center for Information Technology Leadership (CITL) found that 14.3% of all lab orders were considered duplicative or unnecessary due to the existence of a similar test having been performed recently.  One way to significantly reduce redundant and duplicative lab testing is through the use of Electronic Health Records (EHR).  Electronic records would provide physicians with access to all of patient’s health information at the point of care.  EHRs would include demographics, insurance plans, legal documents, privacy requests, prescription medications, past surgeries, lab tests and radiology images.  With electronic records, information becomes portal and available on demand to whatever provider needs the data to make a decision.

Duplicate testing is just one of the many inefficiencies related to processing lab test and radiology orders in the US health care system.  For example, another challenge is controlling expenses associated with the tests.  Lab order forms rarely include pricing, because, the costs vary depending upon the insurance company used and the patient’s benefits plan.  Consequently, physicians may unintentionally order an expensive test rather than seeking out less costly mechanisms to gather the necessary information.  Electronic records would provide access to a patient’s insurance profile and the corresponding price schedule enabling physicians to better assess costs at the point of care.

Controversy abounds over how to fix the US Health Care System

Another root cause of inefficiency in the area of laboratory and radiology images is that most physicians’ offices have to outsource these tests to 3rd party providers.  Smaller practices lack the capital, resources or space to host the lab equipment in-house.  The process of scheduling, ordering and reporting on each lab test performed by a 3rd party may seem insignificant for one individual request.  However, multiplied across the hundreds of thousands of lab orders placed daily across the US, the aggregated costs are quite considerable. 

Consider the costs for a placing an individual order with a 3rd party lab or imaging center.  Paper-based lab or radiology forms must be filled out by providers then mailed or faxed to the lab at a cost of $10.00.  The lab must then re-key the order form into the administrative systems they use at a cost of $12.50.  Once completed the lab results must be mailed back to the provider at a cost of $7.90 who must insert them into the patient’s records at a cost of $9.25.  Often when test results are not received in a timely manner the provider will phone the lab to obtain the information verbally.  Electronic transmission would eliminate all of the clerical work to print, mail and file the lab orders and results.  Furthermore, it would substantially reduce inbound inquiry calls to labs from providers by accelerating the transmission of results.  The process for radiology images is similar to that for laboratory tests. 

Health Care – One of Obama’s Top Policy Issues

The CITL study concluded that a total $31.8B in costs could be reduced by establishing full provider-to-laboratory interoperability.  An additional $26.2B could be eliminated by automating provider-to-radiology interactions.  The Obama administration has made health care reform one of the key tenets of its administration.  The American Recovery and Reinvestment Act (ARRA) allocated substantial funding to providers for the purposes of building Health Information Exchanges (HIEs).  As a result over 200 regional HIEs have emerged in recent years to facilitate lab-to-provider interoperability and sharing of medical records.  In theory, the creation of these HIEs with the ability to share EHR would eliminate the 14% of redundant lab tests that occur today.  But I wouldn’t short the stocks of LabCorp or Quest Diagnostics just yet.  Although, federal funding has been allocated there still remains quite a bit of work to be done before the US health care system is fully interoperable and wired.  For more details on the progress of various regional health information exchanges see my earlier posts.