Beqaj Safedin, Shrestha Rojeet, Hamill Tim
Medical Database, Inc, Irvine, CA, United States.
Patient Choice Laboratories, Indianapolis, IN, United States.
Interact J Med Res. 2025 Feb 11;14:e46007. doi: 10.2196/46007.
Physicians could improve the efficiency of the health care system if a reliable resource were available to aid them in better understanding, selecting, and interpreting the diagnostic laboratory tests. It has been well established and widely recognized that (1) laboratory testing provides 70%-85% of the objective data that physicians use in the diagnosis and treatment of their patients; (2) orders for laboratory tests in the United States have increased, with an estimated volume of 4-5 billion tests per year; (3) there is a lack of user-friendly tools to guide physicians in their test selection and ordering; and (4) laboratory test overutilization and underutilization continue to represent a pervasive source of inefficiency in the health care system. These inappropriate test orders not only lead to slower or incorrect diagnoses for patients but also add a significant financial burden. In addition, many ordered tests are not reimbursed by Medicare because they are inappropriate for the medical condition or were ordered with the incorrect International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnostic code, not meeting the medical necessity. Therefore, current clinical laboratory test ordering procedures experience a quality gap. Often, providers do not have access to an appropriate tool that uses evidence-based guidelines or algorithms to ensure that tests are not duplicated, overused, or underused. This viewpoint lays out the potential use of an automated laboratory clinical decision support system that helps providers order the right test for the right disease and documents the right reason or medical necessity to pay for the testing.
如果有可靠的资源来帮助医生更好地理解、选择和解释诊断实验室检查，他们就能提高医疗保健系统的效率。已经充分证实并广泛认可的是：（1）实验室检查提供了医生用于诊断和治疗患者的70%-85%的客观数据；（2）美国实验室检查的订单量有所增加，估计每年有40亿至50亿次检查；（3）缺乏方便用户的工具来指导医生进行检查选择和开单；（4）实验室检查的过度使用和使用不足仍然是医疗保健系统中普遍存在的低效率根源。这些不恰当的检查订单不仅会导致患者诊断延迟或错误，还会增加巨大的经济负担。此外，许多开出的检查项目医疗保险不予报销，因为它们对病情不合适，或者是按照错误的《国际疾病分类及相关健康问题统计分类》第十次修订版诊断代码开出的，不符合医疗必要性。因此，当前的临床实验室检查开单程序存在质量差距。通常，医疗服务提供者无法获得使用循证指南或算法的合适工具，以确保检查不会重复、过度使用或使用不足。本文观点阐述了自动化实验室临床决策支持系统的潜在用途，该系统可帮助医疗服务提供者针对正确的疾病开出正确的检查，并记录进行该项检查的正确理由或医疗必要性。
