In the age of Obamacare, cost-reduction and quality improvement that really works

COLUMBIA, Mo 11/29/13 (Beat Byte) -- While Republicans and Democrats fight about which government bureaucracy can deliver the best health care at the lowest cost, University of Missouri researchers have redesigned the way physicians order patient tests to make electronic medical records smarter and more efficient. 

Their research promises to omit unnecessary expenses and improve diagnostic quality.

"Ordering numerous lab tests can result in unnecessary testing and can cause physical discomfort and financial stress to patients," said Victoria Shaffer, an assistant professor of health sciences in the MU School of Health Professions and psychological sciences.  "We found that by changing the way electronic order set lists were designed, we could significantly alter both the number and quality of lab tests ordered by clinicians."

Shaffer and fellow researchers studied three ways physicians can select lab tests:  opt-in; opt-out; and pre-selected.

The methods are among "a wide variety that could improve medical lab test ordering software and ensure that only the most appropriate, relevant lab tests for patients are ordered, while saving money," she explained.

The opt-in method is entirely open-ended:  physicians type in tests they think necessary on a blank screen, standard protocol in most hospitals and clinics.   The opt-out method reverses the process:  physicians de-select lab tests that are irrelevant to their patient.   The third approach pre-selects tests based on expert recommendations.
The pre-selected and opt-out methods out-performed the standard opt-in protocol.  The opt-out method increased costs -- by about $71 per patient -- but improved quality.   The pre-selected approach also improved quality, but reduced costs. 

Given these results, Shaffer sees an important way to move toward the healthcare Holy Grail:  better quality at a lower cost.   Software designers simply need to work more closely with the medical professionals who use their products.  

"Problems with these software systems often occur because information technology (IT) experts design the software with minimal input from the people who use it," Shaffer said.  "IT experts and medical professionals should work together to design these systems to reach optimal performance, which results in the best care for patients." 

Their study was published in the journal Health Psychology.