Informatics, analytics, and decision support in utilization management

Abstract

Informatics underlies some of the most effective laboratory utilization management tools. For example, computerized provider order entry systems often offer clinical decision support functionality that utilization management teams can leverage to provide clinicians “just-in-time” test-ordering advice and alerts. Likewise clinical and production data can be extracted from laboratory and clinical information systems and analyzed to identify utilization improvement opportunities, guide utilization management strategies, and monitor the impact of utilization management initiatives. This chapter will review applications of informatics to utilization management. More specifically, the chapter will begin with a discussion of clinical decision support, including testing guidelines and algorithms, and various types of electronic alerts. It will also include some discussion of the information systems that underlie many types of decision support. The chapter will next discuss data analytics and will describe strategies to develop informative utilization metrics and use them to measure the impact of utilization management initiatives. Likewise, it will discuss the use of analytics to identify misutilization, target utilization improvement initiatives, and provide valuable feedback to clinicians. The chapter will conclude with a discussion of practical considerations.