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This Article Full Text Full Text (PDF) 073908.Supplemental Data All Versions of this Article: clinchem.2006.073908v1 53/2/213    most recent Submit an electronic Letter to the Editor about this paper Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Poley, M. J. Articles by Rutten-van Mölken, M. P.M.H. Search for Related Content PubMed PubMed Citation Articles by Poley, M. J. Articles by Rutten-van Mölken, M. P.M.H. Related Collections Evidence Based Laboratory Medicine and Test Utilization Informatics and Statistics

Cost Consequences of Implementing an Electronic Decision Support System for Ordering Laboratory Tests in Primary Care: Evidence from a Controlled Prospective Study in The Netherlands

¹ Institute for Medical Technology Assessment (iMTA), Erasmus MC, Rotterdam, The Netherlands.
² Department of Pediatric Surgery, Sophia Children’s Hospital, Erasmus MC, Rotterdam, The Netherlands.
³ Institute of Medical Informatics (MIEUR), Erasmus MC, Rotterdam, The Netherlands.
⁴ Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.

^aAddress correspondence to this author at: institute for Medical Technology Assessment (iMTA), Erasmus MC, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. Fax 31-10-408-9092; e-mail m.poleij{at}erasmusmc.nl.

Background: The economic consequences of interventions to promote rational, evidence-based use of laboratory tests by physicians are not yet fully understood. We evaluated the cost consequences of a computer-based, guideline-driven decision-support system (CDSS) for ordering blood tests in primary care.

Methods: We installed the CDSS in 118 practices [159 general practitioners (GPs)] throughout The Netherlands and calculated the costs of the intervention in this group. During a period of 6 months before and 6 months after installation of the CDSS, the test-ordering behavior of 87 (109 GPs) of these 118 study practices was studied and the results were compared with those of a nonhistorical control group that did not receive the CDSS. In addition the costs of laboratory requests were calculated for both groups.

Results: Total intervention costs, comprising development costs and installation costs, amounted to 79 000 (670 per practice). Whereas the introduction of the CDSS did not affect the number of order forms submitted to the laboratories, it did reduce the number of blood tests per order form. As a result, the CDSS yielded mean savings on the costs of laboratory requests of 847 per practice per 6 months.

Conclusions: This study demonstrates that providing electronic decision support for ordering blood tests in primary care represents an economically promising concept. Savings on laboratory costs are achievable and not offset by disproportionally high intervention costs.

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