Ola H. Elgaddar MD, PhD, MBA, CPHQ, LSSGB
Association of Egyptian-American Scholars
There have been days when clinicians used to choose among 20 common laboratory tests that were used to diagnose almost all clinically presented conditions. Nowadays, and with the expansion of the available laboratory test arrays, selection among offered tests is becoming a debatable issue. Utilization management (UM) is the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of the applicable health benefits plan. Laboratory test utilization can be defined as a strategy for performing appropriate laboratory and pathology testing, with the goal of providing high quality, cost-effective patient care.
Though the issue of UM in general and lab test utilization in particular, is a world-wide problem, its impact is definitely more obvious in areas with limited resources like Egypt. When resources are limited and demand exceeds supply, allocation becomes a problem.
Addressing the issue of lab test utilization requires asking several questions, namely; is the right patient at the right time or not? In order to answer these questions, it is a wise approach to go through the “lab test life cycle” starting from test ordering pre-analytical phase, analytical test processing and finally, result reporting . Each phase should be carefully studied, and all stakeholders should be involved in order to tackle the utilization problem. Several factors might arise such us the pre-test probability, the use of electronic medical records, online test ordering, and of course, the involvement of laboratory scientists in the selection process.
There have been successful trials in some world class centers to officially establish laboratory formulary. Lab tests are put in several tires, and it is clearly stated that off-formulary tests would no longer be available. Long discussions are needed to decide whether this is a good solution or not, and to determine its applicability in our country.
Another available option, that will also need combined clinicians – laboratorians effort, is the establishment of guidelines and algorithms for every medical condition. Getting acceptance on these algorithms could solve the everlasting issue of resource allocations and lab tests utilization.
This article was published in 3alamaltanmya
sponsored by Future Builders International Academy
Led by Dr.Maha Fouad