Brian R. Jackson, MD, MS, is medical director, Business Development, IT and Support Services, at ARUP Laboratories.
The American Board of Internal Medicine Foundation recently released a list of its “Top 12” Choosing Wisely recommendations. It based the rankings on evidence of success, defining successful recommendations as those that reduce the number of unnecessary tests and procedures by at least 10 percent. Interestingly, most of the services on the list were diagnostic tests, and five of the 12 involved utilization of clinical laboratories.
Brian R. Jackson, MD, MS
“It’s interesting to consider that out of over 80 specialty societies that have published recommendation lists within the Choosing Wisely program, only a couple are laboratory or pathology societies, notably the American Association of Blood Banks and the American Society of Clinical Pathology.”
Of the recommendations:
Four addressed use of clinical laboratory tests (vitamin D, repetitive complete blood counts and other tests, annual routine Pap screening, and preoperative testing in low-risk patients).
One addressed inpatient blood utilization.
Three addressed radiologic tests.
Three addressed prescription drugs.
One addressed telemetry outside the intensive care unit.
ABIM Foundation staff used journal articles, research-grant reports, and other reports and publications from multiple sources to compile the top-12 list.
It’s interesting to consider that out of more than 80 specialty societies that have published recommendation lists within the Choosing Wisely program, only a couple are laboratory or pathology societies, notably the American Association of Blood Banks and the American Society of Clinical Pathology. So why are laboratory tests (and blood products) overrepresented in the top-12 list? I see several possibilities.
One factor is that while laboratory and pathology organizations may be the top thought leaders (and cheerleaders) for improving laboratory utilization, other professional societies also appreciate the critical role of diagnostic testing throughout medicine, as well as the harms to patients when tests are misused. The lab-related recommendations in the top-12 list came from a large number of specialty societies, not just the lab societies. Another factor may be that many of the therapeutic recommendations within Choosing Wisely are worded in ways that could be difficult to measure (e.g., Don’t use oral antibiotics for treatment of atopic dermatitis unless there is clinical evidence of infection),whereas measurement of test utilization is often more straightforward. A third possibility (and my favorite, though I can’t claim solid evidence to back it up) is that we laboratory professionals have stepped up to a greater extent than many of our clinical colleagues to educate clinicians and develop systems to address overutilization. Regardless, it’s gratifying to see that our efforts are paying off, and that organizations such as Choosing Wisely are able to measure the impact. Laboratory utilization management is a critical component of value-driven healthcare, and laboratory professionals play a critical role in these programs.
By Brian R. Jackson, MD, MS, medical director, Business Development, IT and Support Services, at ARUP Laboratories. He directs informatics efforts at ARUP, including ARUP Consult®, charting, and software product management, and is an associate professor of pathology (clinical) at the University of Utah School of Medicine.
Don't miss Dr. Jackson’s podcast LabMind, in which he interviews subjects including Dr. Andrew Fletcher on the role pathologists could play in the healthcare systems of the future; cultural divides; inter-professional communication; and the unique contributions that laboratories and pathologists can bring to value-based healthcare.