"Lab" Test Utilization Done Wrong

JMC is always thinking about our critical role in support of healthcare – Bonny Lewis Van’s experiences with a sick pet lead to retrospective on clinical test utilization:

Two weeks, $700 and one poor old shaved dog later I learned a valuable lesson in Clinical Laboratory Test Utilization. As a Clinical Chemist I have been beating the drum of appropriate test utilization since I was a Fellow. I am not alone, as every major clinical laboratory association has been promoting the role of the clinical lab and laboratorian in proper test utilization and cost containment. As pressures continue to mount to contain healthcare costs, lab testing is an “easy” target.

Then how did I miss several checkpoints along the way, $700 in out of pocket diagnostics costs and a dog with a shaved abdomen? He’s fine, nothing wrong. But I did not follow my own training, nor the prevailing sentiment in the field of clinical laboratory medicine to use testing only when it is 1. useful, 2. likely to be actionable and 3. informative to care.

Appropriate test utilization is especially critical in my clinical specialty area-Genomics. Molecular diagnostics are a paradox. The initial investment and test costs are high, but the promised benefits are thought to be greater.

But there is hope! Healthcare Informatics can help. Clinical Decision Support tools can provide just in time information for providers to guide clinical decision making. Evidence-based decision-trees built from case-specific outcomes can personalize and improve the quality of care. And health information exchanges can decrease unnecessary duplicative testing and imaging.

Adapted from an original post on the AACC Artery:

https://artery.aacc.org