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Research Letter
Less Is More
September 2015

A Decision Support Tool to Reduce Overtesting for Ceruloplasmin and Improve Adherence With Clinical Guidelines

Author Affiliations
  • 1Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 2Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
JAMA Intern Med. 2015;175(9):1561-1562. doi:10.1001/jamainternmed.2015.2062

Nondirected testing, simultaneously assessing a multitude of diseases, is a specific form of overtesting. This pattern of testing is expensive and generates false-positive test results.1 It is also common, particularly for the evaluation of liver disease.2,3 For example, elevated liver enzymes affect 7.9% of the US population, whereas Wilson disease, an inborn error of copper metabolism associated with liver injury, is routinely assessed along with viral hepatitis despite affecting only 0.003% of the US population.3-5

Guidelines suggest testing for Wilson disease with ceruloplasmin blood levels after excluding common liver diseases and, given the rarity of late-onset Wilson disease, recommends rarely testing patients older than 55 years.4 We conducted a prospective study to evaluate the effect of a decision support tool on ceruloplasmin use by measuring use rates 7 months before and 7 months after implementing an electronic pop-up in electronic medical record system at Beth Israel Deaconess Medical Center. The study reviewed records from October 1, 2013, through November 27, 2014.