The Right Tests Through Utilization Management - Part 2

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In the first post of this series we stressed how essential a partnership between the clinicians and laboratory leadership has become.  In this post we will focus on the best way for you to develop a successful program utilizing a multidisciplinary approach.  This approach should involve the clinician, the laboratory, and clinically engaged pathologists. 

Your process for lab test utilization management actually starts when the clinicians begin to consider what tests are needed to evaluate a given patient or group of patients — whether for diagnosis, follow-up of specific disease processes, and or therapeutics. The guidelines should have been developed by the clinicians working together with the laboratory.  
After the test order or specimen is received in your laboratory, you play a more active role in the test decision process.  You do this through the use of algorithms, test guidelines, and the mutually agreed upon test formularies.
Your 5 Step Process
1. Create a team of healthcare professionals in the organization to develop and implement test ordering guidelines.
Build your diverse team composed of clinicians, pathologists and laboratorians who will establish guidelines used to facilitate test ordering.  These guidelines can be incorporated into appropriate algorithms for disease workup, order sets for follow up of specific chronic processes, etc (1).
2. Provide information on the use of specific analytes. 
This may include clinical indications, overall value of the test, test indications - all readily available for the ordering clinician to access.
3. Design ordering system to provide ready access to the guidelines.  
This can include data from prevously ordered tests that can contribute to the decision making process.
4. Use test formularies patterned after the pharmaceutical model. 
The laboratory test formulary is used to limit access to certain costly tests and often requires authorization from a specialist, subspecialist, or laboratory committee before a particular test can be ordered.
5. Auditing results.
This is a critical step in the utilization process. The laboratory generates a tremendous amount of data. When analyzed, this data can reveal how a test is being used, whether the intended outcome of a utilization process is being achieved, and where problems exist. The audit process can also identify which guidelines are not working as planned or need modifications or revisions.
Check back next week to review the expectaions you should have of your reference laboratory in this process.
To read Part 1 and Part 2 of the series click on the links below. 
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RESOURCES: 1 LABS ARE VITAL. In/Appropriate Laboratory Test Utilization. September 16, 2013.

Laboratory Management, Laboratory Operations, lab test utilization, test utilization, laboratory test utiliazation

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About the author

Dr. John Daly

John T. Daly, M.D. received his MD degree at Weill Cornell University Medical College, performed his internship and residency in Anatomic and Clinical pathology at Duke University Medical Center and a residency in Forensic Pathology at the Office of the Chief Medical Examiner in Chapel Hill, N.C. He is board certified in anatomic, clinical and forensic pathology. Through the course of his career, Dr. Daly has had extensive experience directing and advising laboratories of all sizes including physician office practices, Federal Health Clinics, surgical centers, Community Hospitals and the integrated academic health system clinical laboratories of Duke Medicine. He retired as Director of Laboratories of Duke Medicine, and continues his affiliation as a member of the emeritus staff.


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