A simple electronic decision support tool can reduce unnecessary testing conducted as part of nondirected assessments. A pop-up screen in electronic ordering systems significantly reduced testing for rare conditions commonly included with nondirected testing for liver disease, according to a research letter published June 1 in JAMA Internal Medicine. The researchers say this intervention is likely applicable in other clinical scenarios. Elevated liver enzymes are estimated to affect nearly eight percent of the U.S. population. Resulting workups often test for viral hepatitis as well as Wilson disease, an inborn error of copper metabolism that affects 0.003 percent of the U.S. population and rarely presents with late onset. Initial Wilson disease diagnosis occurs based on ceruloplasmin blood levels. In the current study, researchers evaluated the effect of a decision support tool on ceruloplasmin test utilization by measuring use rates seven months before and after implementing an electronic pop-up in the electronic medical record system at Beth Israel Deaconess Medical Center (October 1, 2013 through November 27, 2014). Ceruloplasmin was ordered 448 times (mean times per day, 2.12) before implementation of the electronic pop-up. The researchers found that after implementation orders significantly dropped to 219 (mean times per day, 1.04). For comparison […]