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Problem
Each year, Boston Children's Hospital's providers order millions of laboratory tests. The value of ordering standard tests, such as complete blood counts, is well understood by providers. However, the recent explosion of genetic testing has resulted in a new generation of complex, expensive tests with few guidelines for use. Though many of the tests ordered are the correct tests to use, others may not be the most appropriate.
Solution
Mira B. Irons, MD, associate chief, Division of Genetics, and Mary Ellen Cortizas, JD, administrative director, Department of Laboratory Medicine, are leading a two-year project aimed at helping providers determine the most medically appropriate tests for our patients. The Bringing Expertise to Selecting Tests (B.E.S.T.) project, which is supported by the Provider-Payer Quality Initiative, represents a collaborative effort between Genetics, Laboratory Medicine and other specialties to reduce unnecessary testing while assuring that necessary tests are not missed.
The B.E.S.T. team will consult with Boston Children's specialists to assess test usage and develop decision support tools and algorithms that will be communicated directly at the point of order entry. Thus far, the team has analyzed 462 high-cost tests, accounting for nearly $11 million in total charges, and has identified the first targets for guideline development: tests that look for genetic causes of febrile seizure, celiac disease and developmental delays, as well as measurements of 6MP levels.
Results
The project's primary goal is to deliver timely information to help providers decide which tests are most clinically useful, while avoiding waste and improving cost-efficiency. Over the two-year project, the estimated charge avoidance is approximately $1 million. Future expansions will include the design and implementation of order sets and creation of an alert system for the monitoring of over 500 types of specialized tests.
More information: on.chbos.org/pv0412_best
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