University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Physician Assistant Studies - DMSc


Elyse J Watkins, DHSc, PA-C, DFAAPA



The purpose of this article is to bring awareness to the issues that arise with the overuse of diagnostic testing and how efforts are being made to curb unnecessary testing and improve value. Multiple databases were explored with search terms “Choosing Wisely”, “overuse”, “EMR”, “testing”, “appropriate use criteria” and “decision support”. There have been multiple recommendations from the Choosing Wisely© initiative that provide guidelines regarding the appropriateness of testing and that implementation of these recommendations can directly affect the volume of tests ordered and the value of care.

The electronic medical record (EMR) has made it easier to order tests, however, there is no safeguard in place to ensure that testing is appropriate. Medicare Part B paid $7.1 billion for 433 million lab tests in 2017.1 The Choosing Wisely Campaign©, started in 2012 by the American Board of Internal Medicine (ABIM) Foundation, was meant to encourage discussions between patient and clinician to decrease the frequency of unnecessary testing, through patient engagement, education and the use of evidence-based medicine.2 Over 70 specialties have put forth recommendations regarding their most frequently overused tests.2 Clinical decision support tools based on the Choosing Wisely© recommendations provide physician assistants and other clinicians point of care information to improve the value of testing, educate patients on evidence-based guidelines, and engage patients in the decision making process.


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