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Software Design Found to Influence Lab Test Choices

Blood test (NIH)

(National Institutes of Health)

A psychologist at University of Missouri in Columbia found the design of software used by physicians influences their choice of diagnostic tests when admitting new patients to hospitals, with implications for the quality of patient care and health care costs. Victoria Shaffer in Missouri’s Department of Health Sciences, with Adam Probst from Baylor Scott & White health system and Raymond Chan from Children’s Mercy Hospitals and Clinics in Kansas City, published their findings in a recent issue of the journal Health Psychology (paid subscription required).

Shaffer and colleagues investigated the way physicians interact with electronic health systems, specifically when ordering lab tests, in this case for pediatric patients at the time of their admission to a hospital. The study examined three ways software often used in the admissions process automatically presents the choice of tests to physicians:

– Opt-in, where no tests are selected, and the admitting physician must choose one or more tests from a list.

– Opt-out, where all test choices are marked, and the physician must turn off the selections not considered relevant.

– Expert recommendations, where a few tests are pre-selected based on judgments of experts in pediatrics.

In the study, 72 providers at a pediatric hospital were asked to review six fictitious cases, with two cases randomly assigned to each type of software design, and the order of the cases varied each time.

The results show the clinicians using software with the opt-out design ordered three more lab tests on average than their medical colleagues using opt-in or expert-recommendations software. Physicians using the expert-recommendations design, however, ordered more tests than colleagues ordering tests with the opt-in system.

The way lab tests are chosen with software, says Shaffer and associates, has financial impacts. They estimate that the opt-out design with all choices pre-selected as the default adds an extra $71 in costs per patient. The expert-recommendations design with just a few pre-set choices may result in fewer tests selected, but also the need to get experts to agree on the recommended choices, which also adds costs to the software.

The results indicate, however, that having at least some pre-set selections increases the likelihood tests recommnded by pediatric experts would be selected. “Essentially we found that including default selections, either with the opt-out method or the recommended method,” says Shaffer in a university statement, “increased the quality of lab tests the clinicians ordered. That is, clinicians ordered more tests recommended by pediatric experts with these methods.”

Shaffer believes software can be better designed if the IT experts and end-users — this case, medical professionals — work together more in the design process. “A wide variety of methods exist that could improve medical lab test ordering software,” notes Shaffer, “and would ensure that only the most appropriate, relevant lab tests for patients are ordered while saving money in the long run.”

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