Our results help to elucidate the tasks and roles required of FPs to make integration of a palliative care approach into the care continuum possible.

Context.-Inappropriate laboratory test ordering has been shown to be as high as 30%. This can have an important impact on quality of care and costs because of downstream consequences such as additional diagnostics, repeat testing, imaging, prescriptions, surgeries, or hospital stays.Objective.-To evaluate the effect of computerized clinical decision support systems on appropriateness of laboratory test ordering.Data Sources.-We used MEDLINE, Embase, CINAHL, MEDLINE In-Process and Other Non-Indexed Citations, Clinicaltrials.gov, Cochrane Library, and Inspec through December 2015. Investigators independently screened articles to identify randomized trials that assessed a computerized clinical decision support system aimed at improving laboratory test ordering by providing patientspecific information, delivered in the form of an on-screen management option, reminder, or suggestion through a computerized physician order entry using a rule-based or algorithm-based system relying on an evidence-based knowledge resource. Investigators extracted data from 30 papers about study design, various study characteristics, study setting, various intervention characteristics, involvement of the software developers in the evaluation of the computerized clinical decision support system, outcome types, and various outcome characteristics.Conclusions.-Because of heterogeneity of systems and settings, pooled estimates of effect could not be made. Data showed that computerized clinical decision support systems had little or no effect on clinical outcomes but some effect on compliance. Computerized clinical decision support systems targeted at laboratory test ordering for multiple conditions appear to be more effective than those targeted at a single condition.(Arch Pathol Lab Med. 2017;141:585-595; doi: 10.5858/ arpa.2016-0115-RA) A fter years of persistent increase, laboratory test ordering has become the highest-volume medical act. In the United States 1 and Europe, 55 the annual increase in the use of laboratory tests averaged around 5% during the last decade. Medicare 2 spending for clinical laboratory testing has peaked at almost $10 billion, accounting for 1.7% of the total health care budget. However, it has been estimated that when including non-Medicare spending, the figures for the United States are up to 7 times higher.3 In Europe, laboratory spending accounted for 1.8% of total health care spending in 2012, totaling E17 billion. Overuse of laboratory test ordering has been shown to be at 20%. 4 Even though reducing the overuse of laboratory testing may not seem very important in relation to the whole of health care spending, the true benefits are to be found in reducing downstream costs.5 These downstream activities include additional diagnostics such as repeat testing or imaging, prescriptions, surgeries, and hospital stays. Besides reducing costs, improving appropriate laboratory test ordering improves the quality of care by avoiding false-positive results and accidental findings of unknown significance, 6 and is not ass...