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JGIM Twitter Journal Club

 , May 27, 2014

Instructions for JGIM Twitter Journal Club

We are starting a journal club on Twitter based a recent article published in the Journal of General Internal Medicine. We will use the medical education hashtag (#meded) for this event. Please follow these 4 easy steps to join in.


  1. Make sure you have a Twitter account and know how to log in.  If you don't have one you can sign up for one at
  2. On Thursday, June 5, 2014 at 9.00 PM EST, go to
  3. Sign in to your Twitter account.
  4. When you click “Authorize App”, you will return to the tweetchat page.
  5. Enter meded in the hashtag box at the top and click “Go”.

Now you will be able to view all posts with the #meded hashtag as they appear in real-time. All of your posts during the chat will also be tagged with #meded so that you can contribute to the discussion.

For our first journal club, we will gather on June 5 at 9:00 PM (Eastern Standard Time) to discuss:

The impact of cost displays on primary care physician laboratory test ordering. Horn DM, Koplan KE, Senese MD, Orav EJ, Sequist TD. J Gen Intern Med. 2014 May;29(5):708-14.


Physicians are under increased pressure to help control rising health care costs, though they lack information regarding cost implications of patient care decisions.


To evaluate the impact of real-time display of laboratory costs on primary care physician ordering of common laboratory tests in the outpatient setting.


Interrupted time series analysis with a parallel control group.


Two hundred and fifteen primary care physicians (153 intervention and 62 control) using a common electronic health record between April 2010 and November 2011. The setting was an alliance of five multispecialty group practices in Massachusetts.


The average Medicare reimbursement rate for 27 laboratory tests was displayed within an electronic health record at the time of ordering, including 21 lower cost tests (< $40.00) and six higher cost tests (> $40.00).


We compared the change-in-slope of the monthly laboratory ordering rate between intervention and control physicians for 12 months pre-intervention and 6 months post-intervention. We surveyed all intervention and control physicians at 6 months post-intervention to assess attitudes regarding costs and cost displays.


Among 27 laboratory tests, intervention physicians demonstrated a significant decrease in ordering rates compared to control physicians for five (19 %) tests. This included a significant relative decrease in ordering rates for four of 21 (19 %) lower cost laboratory tests and one of six (17 %) higher cost laboratory tests. A majority (81 %) of physicians reported that the intervention improved their knowledge of the relative costs of laboratory tests.


Real-time display of cost information in an electronic health record can lead to a modest reduction in ordering of laboratory tests, and is well received. Our study demonstrates that electronic health records can serve as a tool to promote cost transparency and reduce laboratory test use.

We will address the following questions during the Journal Club:

1: What potential role might cost displays within electronic medical records have on reducing healthcare costs? 
2: How should clinicians integrate cost information into decision-making?
3: How can we best teach trainees about cost and prepare them to deliver high-value care? 
4: What would be possible unintended consequences of showing the cost of tests to house staff?

Please join the authors, the JGIM editorial staff, and your colleagues around the world for a lively chat about this study and its implications for clinical practice and medical education.  Click the icon below to add a reminder to your calendar.


Tabor Flickinger and Neil Mehta