Laboratory testing is an essential part of modern healthcare, serving as a foundation for accurate diagnoses, effective treatment plans, and ongoing patient monitoring. However, inappropriate, redundant, or excessive laboratory testing can drive up costs, burden providers, and expose patients to unnecessary procedures. Genesis Reference Laboratories explains that this is where lab stewardship comes into play: a structured effort to ensure that laboratory testing is used appropriately, efficiently, and for the greatest benefit to patient care.
At the center of this effort lies the electronic health record (EHR), a tool that not only stores patient information but also supports clinical decision-making and provides a platform for guiding responsible lab utilization. By integrating lab stewardship principles into EHR workflows, healthcare organizations can strike a balance between accessibility to testing and the need to maintain high-quality, evidence-based care.
Understanding Lab Stewardship
Lab stewardship refers to the management of laboratory testing with the aim of:
- Reducing unnecessary or duplicative testing that does not contribute to improved outcomes.
- Improving test accuracy and relevance by aligning ordering practices with clinical guidelines.
- Ensuring patient safety by avoiding unnecessary risks tied to certain tests, such as radiation exposure or invasive sample collection.
- Lowering costs for both healthcare organizations and patients by streamlining laboratory utilization.
This discipline is often compared to antibiotic stewardship, where the goal is to use resources responsibly while preventing harm and ensuring efficacy. Lab stewardship programs encourage providers to think critically about which tests are necessary, when they should be ordered, and how results will directly influence patient care decisions.
The EHR as a Lab Stewardship Tool
The EHR has evolved far beyond a digital replacement for paper charts. Today’s EHRs are powerful clinical ecosystems capable of influencing provider behavior, providing decision support, and tracking utilization trends. Within lab stewardship initiatives, EHRs play several critical roles:
1. Clinical Decision Support Systems (CDSS)
EHRs often include decision-support modules that prompt providers during the test-ordering process. For example, if a physician attempts to order a test outside of recommended guidelines, the EHR can display an alert suggesting alternative approaches or questioning the necessity.
This not only discourages inappropriate testing but also educates providers at the point of care, reinforcing best practices in real time.
2. Order Sets and Pathways
Standardized order sets embedded in the EHR help streamline care while preventing unnecessary testing. For instance, when admitting a patient with chest pain, the EHR can present an evidence-based bundle of tests that aligns with national guidelines. By nudging clinicians toward recommended pathways, the EHR reduces variability in practice and curbs excessive or low-value testing.
3. Duplicate Test Alerts
A common issue in healthcare is duplicate testing, where the same laboratory test is ordered multiple times within a short period. EHRs can identify when a test was recently performed and issue a warning to providers. This avoids wasted resources and spares patients from redundant blood draws or other procedures.
4. Integration of Laboratory Guidelines
EHRs can integrate national and institutional guidelines directly into the ordering process. This means clinicians have instant access to the latest recommendations without needing to search external databases, ensuring that lab stewardship principles are seamlessly incorporated into routine workflows.
Enhancing Communication and Transparency
Beyond test ordering, EHRs improve communication between providers, labs, and patients. Test results are accessible across care teams, preventing unnecessary repeat orders when a patient transitions between providers or facilities. Moreover, patient portals allow individuals to view their own lab results, which encourages informed discussions and reduces requests for unnecessary re-testing.
In complex cases where multiple specialists are involved, EHR integration ensures that everyone has access to the same diagnostic information, strengthening collaboration and keeping testing aligned with stewardship goals.
Data Analytics for Continuous Improvement
One of the most powerful contributions of EHRs to lab stewardship lies in their data analytics capabilities. EHRs can track and analyze testing patterns across departments, physicians, or patient populations. This data enables organizations to:
- Identify trends in over- or under-utilization of certain tests.
- Monitor adherence to institutional or national guidelines.
- Provide feedback to clinicians regarding their ordering patterns.
- Benchmark performance against peers and highlight areas for improvement.
By leveraging these analytics, healthcare organizations can continually refine their stewardship strategies and measure the impact of interventions, such as updated order sets or educational initiatives.
Challenges in Leveraging EHRs for Lab Stewardship
While the benefits are clear, integrating lab stewardship into EHR systems is not without challenges.
- Alert Fatigue: Too many prompts and warnings can overwhelm providers, leading them to ignore important decision-support alerts. Designing intelligent, context-specific alerts is crucial.
- Customization and Maintenance: EHRs require continuous updates to reflect evolving guidelines and institutional priorities, which can be resource-intensive.
- Provider Resistance: Clinicians may perceive stewardship tools as restrictive or as an additional administrative burden. Engaging providers in the design and refinement of EHR workflows can mitigate this resistance.
- Interoperability Issues: When patients receive care across different systems, lack of interoperability can lead to missed opportunities to avoid duplicate testing.
Addressing these barriers requires thoughtful planning, leadership support, and ongoing training.
The Future of EHR-Driven Lab Stewardship
Looking ahead, advancements in health IT will further enhance the role of EHRs in lab stewardship. Artificial intelligence (AI) and machine learning algorithms are being integrated into EHR systems to predict which tests will be most useful for specific patients. Predictive models may help personalize test recommendations, identifying cases where non-standard testing is truly warranted.
Additionally, as interoperability standards improve, providers will gain a more holistic view of patient histories across systems, further reducing redundant or unnecessary testing. Patient engagement tools within EHRs will also evolve, empowering individuals to better understand their care and contribute to stewardship efforts.
Electronic health records are not just digital filing cabinets—they are essential instruments for guiding clinical decision-making and promoting responsible resource use. By embedding lab stewardship principles into EHR systems, healthcare organizations can reduce waste, improve patient safety, and foster more consistent, evidence-based care.
While challenges exist, the ongoing evolution of EHR technology promises to make lab stewardship more effective, data-driven, and patient-centered. Ultimately, the integration of stewardship into EHR workflows represents a powerful step toward achieving high-value healthcare that benefits both patients and providers.