American Society for Clinical Pathology Names Its Champions

The American Society for Clinical Pathology (ASCP) joins the American Geriatrics Society, American Academy of Pediatric Ophthalmology and Strabismus, and American Medical Society for Sports Medicine in recognizing its members as Choosing Wisely Champions. Announced earlier this year, the Choosing Wisely Champions program is an initiative of the ABIM Foundation to recognize clinicians who are leading efforts to reduce overuse and waste in health care.

ASCP’s Choosing Wisely Champions include teams from three institutions and two individual physicians:

• Massachusetts General Hospital, Department of Pathology
• Cedars-Sinai Health System
• Geisinger Health System
• Dana Altenburger, MD, FASCP, FCAP
• Ilan Rubinfeld, MD, MBA

Massachusetts General Hospital, Department of Pathology

The Division of Laboratory and Molecular Medicine within the Department of Pathology at the Massachusetts General Hospital (MGH) hosts a highly active, division-wide laboratory utilization management (UM) program that includes participation from all division faculty.

• In his role as a Medical Director in the MGH Core Lab, Dr. Jason Baron has developed data-mining approaches to identify tests that are frequently misused and as well as metrics to monitor utilization and guide utilization improvement initiatives.
• As Director of the MGH Core Laboratory, Dr. Anand Dighe often leverages the hospital’s computerized provider order entry systems to improve utilization. He has also developed strategies to optimize clinician test selection and electronic clinical decision support for laboratory test ordering.
• John Branda, Associate Director of the MGH Microbiology Laboratory, leads UM efforts to optimize in-house and sendout microbiology testing. Dr. Branda has developed and implemented numerous testing algorithms, reflex protocols, guidelines and educational initiatives.

Cedars-Sinai Health System

As Senior Vice President, Chief Clinical Transformation Officer, Scott Weingarten, MD, MPH, oversaw Cedars-Sinai Health System’s integration of more than 100 “implementable” (i.e., a computer would have to understand the recommendation) Choosing Wisely recommendations into its electronic health record system. The health system created alerts for ordering providers throughout the hospital, medical group and many of its private practice physicians.

Cedars-Sinai first implemented the vitamin-D screening recommendation and found reasonable acceptance by physicians to the alert. By looking at cancelled orders and decreased rate of ordering per 1,000 patients, annualized cost savings of over $400,000 were found from the single vitamin-D recommendation alone. These and many other recommendations have been translated into day-to-day practice. In the aggregate, Cedars-Sinai has seen an annualized cost savings of more than $6 million and improved the quality and safety of care from implementing Choosing Wisely recommendations across the health system.

Ellen Klapper, MD, Medical Director, Division of Transfusion Medicine Cedars-Sinai Medical Center, Department of Pathology, has collaborated with specialists throughout the hospital to come to a consensus to use evidence-based, best-practice guidelines for utilization for all blood components. These guidelines were subsequently integrated into the electronic medical record system, and best-practice alerts were created that pop up and notify the ordering provider should the patient fall outside of those guidelines.

These efforts have led to a sustained reduction in transfusions outside the established guidelines, translating into improved patient safety as unnecessary transfusions have the potential to expose the patient to known risks, without evidence of benefit. The laboratory has also introduced several processes into the electronic ordering system to reduce duplicate and unnecessary test requests.

Geisinger Health System

Conrad Schuerch, MD, Chairman Dept. of Lab Medicine
Kelly Baldwin, MD, Neurology
Brandi Bradrick, Laboratory Financial Manager
Jeanene Contreras, Core Laboratory Manager
Harold Harrison, MD, PhD, Clinical Pathology Director
N Sertac Kip, MD, PhD, Molecular Pathology
Troy Klinger, Program Director IT
Philip Krebs, Director Medical Policy and Appeals, Geisinger Health Plan
Diana Kremitske, MS, MHA, MT (ASCP), VP Laboratory Operations
Jordan E Olson, MD, Director of Laboratory Pre-analytics
Dean Parry, RPh, AVP Pharmacy Clinical Informatics
Bonnie Salbert, DO, Pediatric Genetics
Wayne Short, SCPM, Laboratory IT Program Director
Patricia Tsang, MD, Laboratory Medical Director
Marc Williams, MD, Director Genomics Medicine Institute
Mike Weaver, MT (ASCP), Analytical Specialist, Referred Testing
Bret Yarczower, MD, Sr. Medical Director, Geisinger Health Plan

The Geisinger Medical Laboratories has tackled various test utilization opportunities in anatomic and clinical pathology using a variety of modalities to effect change. Among these efforts are routine review of test utilization data, provider education and feedback, accessible consultative services from pathologists, communication tools, test preauthorization processes linked in the electronic health record (EHR), reflex testing protocols, decision support and order set tools in the EHR, and elimination of select inpatient standing orders. Additionally, blood management tactics supported by a system Transfusion Medical Director and hospitalist infrastructure produced remarkable results in reducing blood transfusions.

Dana Altenburger, MD, FASCP, FCAP

As Chair of the Advocate BroMenn Medical Center’s Blood Utilization Committee, Dr. Altenburger has decreased inpatient blood product usage by 46% over the past three years. In conjunction with local allergists, she has reduced screening batteries for allergy testing.

Aligning with cardiologists, she has eliminated:

• CK-MB testing for myocardial infarction;
• Virtually all 1, 25-OH vitamin D tests (in lieu of 25 Vitamin D) unless certain criteria are met;
• Certain coagulopathy testing ( i.e. MTHFR) and the work up for clotting disorders for patients who develop a first episode of deep vein thrombosis (DVT) in the setting of a known cause;
• Hypercoagulable testing for in patients with acute thrombotic events, delaying this until the appropriate outpatient venue.

She has also nearly eliminated the erythrocyte sedimentation rate (ESR), replacing it with C-reactive protein (CRP) test.

Ilan Rubinfeld, MD, MBA

As Associate Chief Medical Officer at Henry Ford Health System, Dr. Rubinfeld has spearheaded several laboratory-related initiatives and projects, including his roles in the system-wide Medical Laboratory Formulary Committee (MLFC) and Laboratory Utilization Taskforce (LUTF) and integrating them with the health system’s EPIC councils.

Dr. Rubinfeld has met personally with every leader in nursing and operations and on the physician council to advocate the merits of appropriate test utilization. This synergistic combination of laboratory and system resources has allowed for the calculation of both upstream and downstream costs and benefits, capturing the metrics and rapid deployment of solutions in EPIC. Going beyond system resources and by leveraging Stanson Analytics tool to work with EPIC, LUTF, under Dr. Rubinfeld’s leadership, will coordinate and serve as the node for implementation of more than 70 laboratory testing-related Choosing Wisely recommendations across the health system.