This spring Caleb Murphy, MD, MBA, won the $20,000 Grand Prize in the American College of Physicians’ (ACP) Innovation Challenge to continue his work to identify and reduce daily lab orders that are not medically necessary.
While in medical school at the University of Minnesota, Murphy was part of an effort to study the use of “team-based practice audits”—group reviews of patients’ hospital charts—as a tool for teaching residents about inappropriate complete blood count and electrolyte panel orders. This educational intervention, funded by a “Putting Stewardship into Medical Education and Training” grant from the ABIM Foundation, also calculated dollars wasted to show residents the financial impact of low-value care.
But the initiative ran into a problem, said Murphy, as there were no generally accepted guidelines for identifying inappropriate daily lab orders. The researchers who led the project, Drs. Jill Bowman Peterson and Alisa Duran, used the Society of Hospital Medicine (SHM) Choosing Wisely recommendation against ordering unnecessary daily labs as a starting point to develop the Minnesota Lab Appropriateness (MLAB) Criteria, which define conditions for when it is appropriate to order daily labs in hospitalized patients. The University of Minnesota Division of General Internal Medicine and Alliance for Academic Internal Medicine (AAIM) High Value Care Workgroup assisted by providing critical feedback.
After presenting and receiving interest in the MLAB Criteria at the 2017 Society of General Internal Medicine (SGIM) annual meeting, Murphy decided to pursue funding to automate the process of applying the criteria to ensure there was an efficient way to utilize them in practice.
As part of his proposal for the ACP’s Innovation Challenge, Murphy focused on how the MLAB criteria could be integrated into the electronic medical record (EMR) as a clinical decision support tool to inform physicians of potentially inappropriate lab orders. Internists and mentors, including Drs. Terrence Adam, Becky Markowitz, and Daniel Wheeler, helped with the proposal, which was selected to win at the ACP’s annual meeting in April 2018.
“We thought this was a good target for the intervention since we know that 25 percent of lab orders in the US might be unnecessary and there is not a great way to define what is appropriate,” Dr. Murphy said. “There are medical and financial costs for both patients and hospitals to think about, especially when false positives occur. I am excited to see how this can benefit hospitals around the country.”
Adam, Markowitz and Murphy are currently working towards the long-term goal of developing a functioning decision support tool to test in clinical settings. Adam will lead the next stage of the project, developing medical logic for the tool that will be adaptable for different EMR systems. In the meantime, Murphy also recently graduated from University of Minnesota-Twin Cities and started his internal medicine residency at University of Nevada-Las Vegas.
“I was really proud to make it to the finals of the ACP competition,” he said. “I received amazing mentorship along the way and an important part of the experience for me was the collaboration. Many internists and internal medicine organizations have shared their resources and expertise to push this project forward.”