Improving Molecular Genetic Test Utilization through Order Restriction, Test Review, and Guidance  Jacquelyn D. Riley, Gary W. Procop, Kandice Kottke-Marchant, Robert Wyllie, Felicitas L. Lacbawan  The Journal of Molecular Diagnostics  Volume 17, Issue 3, Pages 225-229 (May 2015) DOI: 10.1016/j.jmoldx.2015.01.003 Copyright © 2015 American Society for Investigative Pathology and the Association for Molecular Pathology Terms and Conditions

Figure 1 Volume reductions and cost savings associated with clinical decision support tools, calculated from a monthly report of restricted test order attempts and their associated institutional costs. The Journal of Molecular Diagnostics 2015 17, 225-229DOI: (10.1016/j.jmoldx.2015.01.003) Copyright © 2015 American Society for Investigative Pathology and the Association for Molecular Pathology Terms and Conditions

Figure 2 Impact of clinical decision support tools (CDST) initiative (July to December 2012). A: Ambulatory test orders (n = 52). B: Inpatient test orders (n = 20). Nondeemed user reorder indicates that the user ordered the test (usually as a miscellaneous order, for which a CDST cannot be used) without using the recommended strategies of either referring the patient to clinical genetics or consulting with another deemed user who could place the order. No further orders represent cases where no additional attempts to order genetic testing and no referrals to clinical genetics were identified during that episode of care. The Journal of Molecular Diagnostics 2015 17, 225-229DOI: (10.1016/j.jmoldx.2015.01.003) Copyright © 2015 American Society for Investigative Pathology and the Association for Molecular Pathology Terms and Conditions

Figure 3 Orders modified and cost savings associated with genetic and genomic test review, September 2011 to December 2013, on the basis of institutional cost of canceled tests or the difference in cost between the original and the modified test order. The dramatic increase in both orders modified and cost savings from August 2012 coincides with the implementation of a more comprehensive and consistent review process using daily pending logs. The Journal of Molecular Diagnostics 2015 17, 225-229DOI: (10.1016/j.jmoldx.2015.01.003) Copyright © 2015 American Society for Investigative Pathology and the Association for Molecular Pathology Terms and Conditions

Figure 4 Outcome of 2013 genetic and genomic test review cases (n = 152). A: Type of order alteration. B: Associated cost savings. Cancel represents cases where no genetic testing was ordered. Change includes modifications in gene tested, method, or testing laboratory. Reflex specifically represents a change from multiple concurrent tests or a multigene panel to a strategy of reflexed testing. The Journal of Molecular Diagnostics 2015 17, 225-229DOI: (10.1016/j.jmoldx.2015.01.003) Copyright © 2015 American Society for Investigative Pathology and the Association for Molecular Pathology Terms and Conditions

Figure 5 Impact of genetic test utilization management initiatives on multigene test panel orders from 2007 to 2013. GGTR, genetic and genomic test review. The Journal of Molecular Diagnostics 2015 17, 225-229DOI: (10.1016/j.jmoldx.2015.01.003) Copyright © 2015 American Society for Investigative Pathology and the Association for Molecular Pathology Terms and Conditions