BloodLink: Computer-based Decision Support for Blood Test Ordering; Assessment of the effect on physicians' test-ordering behavior

Requesting blood tests is an important aspect of the health care delivered by the general practitioner in The Netherlands. About three to four percent of the patients encounters with Dutch general practitioners result in the physician requesting blood tests, which is lower than in many other European countries. Although test ordering is limited to three to four percent of patients encounters with the general practitioner, the use of diagnostic tests in general practice, has known an overwhelming growth in the years behind. Physicians' use of blood tests, however, is not always appropriate. General practitioners are taught test ordering when training in hospitals before settling down in general practice. Hospital morbidity, however, is different from morbidity patterns in general practice. Appropriate test ordering panels in hospital settings, therefore, are not always appropriate for primary care. Nevertheless, general practitioners use these test panels, once taught, automatically in the primary care setting. Uncertainty and the desire not to miss a diagnosis stimulate the use of blood tests. Excessive and inappropriate test ordering is not only expensive but also may even add to the uncertainty by generating unexpected abnormal or false positive values. The use of blood tests may thus even increase uncertainty and stimu late further unnecessary diagnostic investigations. It is important, therefore, that once the decision to obtain blood tests has been made, appropriate test ordering is adhered to. Influencing this heuristic test-ordering behavior has proven to be difficult.

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