Role of Informatics and Decision Support in Utilization Management
Research type: Review
Published date: 2014
Information systems, coupled with advanced informatics resources, play a pivotal role in optimizing utilization management within clinical laboratories. This article delves into the strategic deployment of informatics tools, highlighting their ability to enhance the appropriateness of test selection and results interpretation. Through a comprehensive review, we explore various information systems such as computerized provider order entry (CPOE) systems, laboratory information systems (LISs), electronic health records (EHRs), laboratory middleware, knowledge management systems, and data analysis tools. The discussion also encompasses specific utilization strategies that laboratories can employ, drawing examples from both our institution and relevant literature. Additionally, we explore the emerging applications of decision support technologies and their potential to refine test utilization, personalize laboratory diagnosis, and augment the diagnostic value of laboratory testing.
Crucial Link between Laboratories and Clinicians
Clinical laboratories and the clinicians they serve are connected through information systems that facilitate communication and collaboration. Utilization management, a responsibility often associated with laboratory directors, involves ensuring that patients receive the most appropriate laboratory tests for their clinical and diagnostic needs. Despite this responsibility, many test ordering decisions are made by clinicians without direct consultation with the laboratory. Informatics tools bridge this gap, enabling the implementation of utilization initiatives and improving communication between laboratories and clinicians.
The Growing Importance of Decision Support
With the evolving landscape of diagnostic technologies, including genomic assays, decision support for laboratory testing becomes increasingly vital. The complexity and sheer volume of available tests make informed selection challenging for busy clinicians with limited time per patient. Informatics tools, such as decision support systems, offer a solution to these challenges. By providing real-time guidance and leveraging statistical approaches to identify patterns in clinical and laboratory data, these tools contribute to proper diagnosis and treatment.
Informatics Tools for Utilization Management
Computerized Provider Order Entry (CPOE):
CPOE systems enable clinicians to electronically input orders for laboratory tests and diagnostic studies. The adoption of CPOE systems has been on the rise, driven in part by legislation incentivizing their use. These systems streamline the ordering process, contributing to the efficiency of utilization management.
Laboratory Information Systems (LISs):
At the core of clinical laboratories, LISs manage specimen and information flow. Rule-based interpretive comments within LISs improve result interpretation and influence future test selection. They serve as a valuable tool for enhancing utilization management within laboratories.
Health Information Systems (HIS):
HIS, often synonymous with electronic medical records (EMR), represents the primary interface for clinicians. Displaying results within HIS impacts test utilization by providing clinicians with user-friendly access to relevant information.
Middleware:
Middleware systems sit between LIS and laboratory analyzers, coordinating functionalities like auto dilution and reflex testing. These systems enhance workflow and utilization by implementing rule-based protocols that may be challenging to execute with the instrument or LIS alone.
Knowledge Management Systems:
Laboratory handbooks and knowledge management systems offer clinicians essential information for appropriate test selection. These resources provide details on clinical indications, interpretive advice, interferences, and other crucial factors influencing test utilization.
Systems for Data Analysis:
Effective utilization management relies on data analysis systems to gather insights into test volumes, ordering provider variations, and indications for testing. Understanding these parameters is crucial for designing utilization metrics and improvement initiatives.
Emerging Applications of Decision Support:
Looking forward, the development of clinical decision support systems will likely focus on providing patient-specific advice and support. These systems aim to personalize laboratory diagnosis and offer tailored recommendations for test ordering based on individual patient profiles.
Conclusion:
In conclusion, informatics technologies are instrumental in the effective management of utilization, ensuring the appropriate use of laboratory resources. The continuous growth and implementation of CPOE and HIS indicate an expanding role for informatics in utilization management. Laboratories, through informatics approaches, have the opportunity not only to optimize their resources but also to positively impact overall hospital and healthcare resource utilization. As decision support technologies continue to evolve, the future holds exciting prospects for refining test utilization and enhancing the diagnostic value of laboratory testing.
