Patient Care

Medical Groups Campaign to Avoid Unnecessary Tests

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Choosing Wisely campaign hopes awareness and technology will help save billions of dollars a year and improve care

Is that test really necessary?

That’s the multi-billion-dollar question the American Board of Internal Medicine (ABIM) Foundation wants physicians and their patients to discuss as part of a national dialogue on avoiding unnecessary or even harmful medical tests and procedures. Advances in medical technology, such as electronic health records and regional health information exchanges, are also being employed in the effort to reduce redundancy.

The ABIM Foundation launched its Choosing Wisely awareness campaign in December 2011 in an effort to reduce costs and improve care. It asked several medical specialty societies to compile lists of commonly performed tests and procedures that are unneeded or harmful.

So far, 25 medical societies with a combined membership of about 725,000 physicians – including the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics, and the American College of Obstetrics and Gynecology – have contributed to a list of about 130 procedures and tests that the organizations have determined are unnecessary, wasteful, or harmful. Seventeen organizations released lists in February.

The AAFP released two lists. Dr. Glen Stream, who chairs of the group’s board, said Choosing Wisely fits with the AAFP’s focus on using evidence-based data to help family physicians and their patients decide which tests and treatments are the right ones to do.

“It’s been estimated that one-third of healthcare delivered in the United States is unnecessary,” Stream told HealthBiz Decoded in an email. “Tests and procedures that lack evidence of their effectiveness put our patients at risk and drive up the cost of healthcare.”

One study estimated that eliminating just the five most overused clinical activities could save more than $5 billion a year.

Each medical organization participating in the campaign chose the items for its lists by reviewing data on the safety and usefulness of the test or procedure. The participating organizations agreed to make the data used to develop their recommendations available to the public.

Consumer Reports has joined the campaign as an advocate, and the consumer interest group has publicized Choosing Wisely in its print magazine and on its website. The AARP, Midwest Business Group on Health, Pacific Business Group on Health, and other organizations also support the awareness program.

The ABIM Foundation does not plan to do a qualitative study of whether the campaign is resulting in fewer unnecessary tests and procedures being performed. The point is to encourage discussions, said John Held, the ABIM Foundation’s director of communications.

“Choosing Wisely is focused on encouraging conversations between physicians and patients about avoiding unnecessary tests and procedures,” said Held in an email.

“We are not quantifying the amount of care delivered. We did not do pre- and post-utilization analyses of these tests or procedures. What we are doing is encouraging patients and providers to discuss if the test or procedure is needed, and we’ve seen a lot of momentum for that,” he said.

Health Information Exchanges Will Play Role

Health information technology will play a role in helping physicians avoid ordering duplicate and unnecessary tests­, while also ensuring that patients receive the tests and treatments that they do need, said Jack Buxbaum, vice president of health information exchange services for Xerox.

Health information exchanges, which are in the developmental stage, are online data networks that connect patients’ electronic health records from different health systems. For example, if a patient has a primary care doctor affiliated with one health system, but sees a specialist in another health system, the health information exchange allows the specialist to review the records from the patient’s primary care doctor.

“The health information exchange shares health history with patient consent,” said Buxbaum. “The physician will immediately see that the test has been done and see the results of that test.”

The heath information exchanges will not only alert doctors to tests that have already been done or aren’t needed; they will also inform doctors about tests or procedures that should be done, but haven’t been.

“The technology in health information exchanges can provide alerts and clinical decision support for any number of things, whether it is to provide an alert that helps avoid ordering a duplicate test, or a reminder to order a test that should be ordered, or even being warned when placing an order for a test that its results may be impacted by a medication the patient is currently taking,” said Buxbaum.

Daniel Wolfson, executive vice president of the ABIM Foundation, said electronic health records and health information exchanges will be useful tools to help doctors and their patients decide whether or not a test or procedure is necessary.

“It’s spot-on with Choosing Wisely,” said Wolfson. “Technology will play a very important role in implementing these recommendations.”