Deriving value from health information technology: impact of prior clinical information from an accessible electronic health record on laboratory and radiology testing in a pediatric population

Abstract

Repetition by clinicians of the same or similar tests with a given patient is common and varies by patient age. However, not all repeat tests are necessary or appropriate for care. Outcomes associated with over-testing include unnecessary emotional hardship and economic cost that may justify efforts to eliminate unnecessary or potentially redundant tests. Limited evidence suggests that the presence of an electronic health record (EHR) may reduce potentially redundant medical tests by making previous test results accessible to clinicians at the point of care. This population-based research characterizes multiple test instances of the same test in a pediatric population, including significant risk factors associated with repeat testing. Using a guideline-based criteria for classifying problematic repeat lead tests, we demonstrate the effect that multiple health system use by patients has on the incidence of problematic repeat lead testing. The results suggest that approximately 50% of repeat lead testing performed in the population was of questionable clinical value. Lead tests repeated within the same health system where a clinician had reasonable access to prior test results had significantly lower odds of being problematic.