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5 Simple Steps to Optimizing Test-Ordering Patterns in Oncology

Contributing Lab Leader: Lale White

5 Simple Steps to Optimizing Test-Ordering Patterns in Oncology
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Article highlights:

  • Pathology can enhance its contributions to care by building close relationships with surgery and the larger care team
  • Synergy with surgery rests on simple principles—but it all begins with a change of mindset
  • This not only helps surgeons, but can directly influence quality, safety, and efficiency of your pathology practice

LabLeaders contributor Lale White instituted a study analyzing the test-ordering patterns of oncologists. A banner example of LabacoEconomics in action, Lale’s study yielded eye-opening results that changed the way oncologists and pathologists practice—and helped to redefine the value of the lab.

Here, we detail specific steps you can take to initiate a similar study in your lab or institution.

Immediate and Enduring Value

 

Why undertake such a study in your lab? Mainly because a swift, smart analysis of test-ordering patterns can confer both immediate and downstream benefits to help your lab increase quality and reduce spending in the larger continuum of care.

Take a look at some of the positive differences a well-executed test-ordering pattern study might make.

Before

  • Oncologists and pathologists had "no time" for each other — little to no collaboration on test orders.
  • Pathologists routinely overrode oncologists' initial test orders.
  • Increased costs due to multiple therapy changes.
  • Long duration of treatment, repeat treatments, rehospitalizations.

After

  • Oncologists and pathologists consider their time together "well spent" — greater collaboration on test orders.
  • Pathologists agree with oncologists' initial tests 80-90% of the time.
  • Cost savings due to fewer therapy changes.
  • Shorter duration of treatment, fewer repeat treatments and rehospitalizations.

Big Results — Quickly

Initiating a study like this may seem like a long, drawn-out task. However, an effective pilot study can show positive results in a relatively short period of time.

An essential course of action

I think every lab should be interested in this, particularly in the new environment with ACOs and value-based pricing. This is exactly the type of thing they have to do, to demonstrate to a payer that the lab is doing the right thing and the health institution is ordering properly and making the right decisions. I think this is the type of thing that will really change the economic cost curve in healthcare and at the same time provide patients with the best outcomes. I almost feel like you have to go down this road to really make an impact.

Lale White

Executive Chairman and CEO

Xifin Software

Refining Test-Ordering in Five Simple Steps

You can implement a test-ordering pattern study in your lab or institution, simply by navigating through the five phases of Lale White's pilot.

Choose wisely

Make sure you choose a software company that does more than just review lab orders—they should have experience providing an ordering package.

You also want to select software and content-management partners that are as up-to-date as possible. Watch out for companies using standards like NCCN (National Comprehensive Cancer Network) and ASCO (American Society of Clinical Oncology)—they may be “behind-the-times.”

Phase 1 - Start soft

To initiate a study like this, you’ll first have to team up with the right partners:

  1. Software partner: Provides a package designed to optimize test-ordering

  2. Content-management and semantics analytics partners: Analyze billing data, diagnostic data, and EMRs

Finding optimal partners may require some effort—but it’s a critical step. (Note: XIFIN Software is a company that can offer help in this area.)

Phase 2 - Before you move forward, you’ll have to look back

You’ll want to review the types of genetic and molecular tests that have been ordered for specific patient conditions. When Lâle’s team did this (looking back at six months of data), they quickly uncovered suboptimal test-ordering ripe for improvement.

Pursue this information in your own institution, choosing a time frame appropriate to your situation. Share your findings with oncologists and pathologists. You may be surprised at their level of interest and how receptive they are to taking action to optimize test-ordering.

Phase 3 - Build trust

Once you’ve gained their buy-in, it’s time to get oncologists and pathologists comfortable with the new ordering software. The proper software is a powerful tool that can sift vast troves of data in real time to show what types of therapies are being selected in similar cases—and which ones are successful. The data allow oncologists and pathologists to make better decisions based on more information than they’ve ever had access to before.

On getting comfortable

We spent months getting this group comfortable with the data coming from the content manager. It’s not just about the software, it’s really about the data they’re getting back.

Lale White

Executive Chairman and CEO

Xifin Software

Phase 4 - Perform real-time analysis

Now it’s time to put the system into action. Oncologists should begin ordering tests using the software. As they do, the software will return a prioritized list of tests in as little as 10–15 seconds for the oncologist to consider.

As new test orders accrue, your content management and semantics analytics partners will analyze the new ordering patterns relative to the prior six months (or whatever time frame you’ve chosen). In no time, you may begin seeing results similar to those from Lale’s study.

With positive results, you will be in a position to approach your C-suite and gain their approval to pursue outcomes data. Do so, and then begin the ongoing process of collecting patient data to build a registry.

In the eyes of the institution

I think the institution sees the lab as a partner. They could go to any lab to get the tests done, but not all labs are in a position to provide the level of data, succinctly and timely, for this type of real-time analysis.

Lale White

Executive Chairman and CEO

Xifin Software

Phase 5 - Achieve real-world results

This is where the rubber really meets the road. An analysis of the registry can reveal real-world improvements in patient outcomes, traced back to diagnostic and therapy decisions made using the new system. This is invaluable, as it demonstrates you are practicing laboratory medicine and positively impacting the area that matters most in the emerging healthcare landscape: patient outcomes.

That’s LabacoEconomics in action.

Beyond Oncology

“The value in optimizing test-ordering patterns extends far beyond oncology,” according to Lale White. Indeed, any costly area of disease management stands to benefit from this type of analysis: diabetes, cardiovascular disease—you name it. This is especially true when genetic testing is involved, because of the need to educate physicians quickly in this new area and because it impacts smaller portions of the population. Huge clinical trials taking multiple years to generate actionable data are not feasible, nor desirable.

Seek out appropriate opportunities to improve test-ordering in your lab. And consider implementing a study similar to Lale’s, for its potential to educate physicians, elevate your lab’s status as a leader, and enhance patient outcomes.”

I think diagnostics — lab diagnostics specifically — provides the shortest-term ability to change the way healthcare is practiced in the easiest manner, because everything else requires so much more data analysis. And this is actually one of those things that can impact your facility almost immediately. That’s what our pilot showed.

Lale White

Executive Chairman and CEO

Xifin Software

Lale White

Executive Chairman and CEO

Xifin Software

Contributing Lab Leader

Lale White

Executive Chairman and CEO

Xifin Software

 

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