A platform focusing on the tests requested by GPs has been designed by the EBM DataLab at the University of Oxford to identify inappropriate testing, address under-use of tests, and improve patient care.
Modelled on the popular OpenPrescribing.net, used by 130,000 users per year to view insights into drugs prescribed by GPs, this prototype pathology benchmarking tool uses data from hospital labs to give GPs insights, such as drifting practice, and give them the opportunity to improve patient care and get better value for the NHS.
England sees 1.12 billion tests per year, costing £2.2 billion, 35-45% of which are requested from primary care, such as blood tests for diagnosis, ongoing monitoring of health conditions, and screening. Testing rates are increasing rapidly and there is huge, often unwarranted variation in testing rates. However, reviewing this increasing volume of test results can take up a substantial chunk of GP time. But more importantly, greater testing can increase the number of false positives, or chance findings, which have no clinical significance. In addition, the under-use of appropriate tests can cause diagnoses to be missed or delayed.
Most GPs currently receive little or no feedback on how many tests they order compared to their colleagues. Beyond useful feedback for clinicians, this variation in practice is of value for all NHS users to explore and understand. Quality improvement studies aiming to reduce certain test use have previously demonstrated the potential to reduce costs and patient harm without impacting outcomes.
The team has created an easily accessible and interactive platform which will be available at OpenPathology.net to show testing rates for individual GP practices and compare them to population trends. The infrastructure securely imports, stores, and analyses pathology datasets and displays the testing rates and standard measures for each major test type, such as for haemoglobin, potassium, liver function, thyroid function and vitamin D.
Users are able to create custom measures including any combination of tests, broken down at their chosen level – practice, CCG, or result category – allowing them to explore and visualise the data, applying their own expertise and local knowledge to make insights into pathology testing activity.
As more trusts submit data OpenPathology will support more practices, trusts, and managers in reflecting on their practice, facilitating changes, and make more robust conclusions around common issues. Increased access to data and discussion around issues with pathology will lead to increased research and harmonisation of practice in pathology testing.