Digital Pathology Blog

The Rule of 70s – Does it Still Apply?

iStock_000010309319_Large_web.jpgThere is a decades-old theorem first derived at the Mayo Clinic that although based on little actual data has been popularized over the years stating:

  • 70% of patients in a hospital have laboratory data.
  • 70% of clinical data points (objective information) come from laboratory data.
  • 70% of clinical healthcare decisions result from laboratory tests.
  • These data account for less than 5-10% of healthcare costs.

This is a lot of bang for the buck. Imagine 70% of objective information assisting in 70% of healthcare decisions for as little as 5% of total healthcare expenditures.

I first heard these statistics popularized at informatics meetings by pathology informaticians such as Bruce Friedman and Mike Becich in the mid 90’s.

Have these statistics changed in the world of electronic medical records (EMR)? Now there is a lot more electronic data that once was limited to paper-based charts separate from computer results for laboratory data. With radiology data now available in the EMR, as well as cardiology, endoscopy, pulmonary and more, does the laboratory data still account for 70% of all information forming the basis for a treatment or management decision?

20 years later it seems there is a lot more data in an electronic form which probably dilutes how much the laboratory data constitutes the entire dataset in an EMR. There is also an issue of how much is “useful” laboratory data considering the overutilization of laboratory tests (e.g. daily CBCs or serum chemistries in “stable patients”) or inappropriate tests. With EMR systems, it is easier than ever to order more labs by simply checking boxes or pulling up the entire laboratory menu and having a smorgasbord of tests to order, whether they are clinically indicated or not.

Nonetheless, CBCs, chemistries, serologies, microbiology studies and anatomic pathology data do comprise a significant amount of objective and actionable data points affecting patient management.

My sense is that less than 70% of objective data in the EMR is now derived from the laboratory alone for the reasons above with other tests and procedures now recorded in the electronic chart.

However, with the addition of digital pathology images into the EMR as well as associated genomic data as those tests increase, we as laboratorians will easily account for even more than 70% of objective data used to make more than 70% of healthcare decisions.

Perhaps instead of The Rule of 70s it will be The Rule of 90s. But will the costs remain below 10% of healthcare expenditures?


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Posted by Keith Kaplan, MD, Chief Medical Officer on Tue, Dec 08, 2015 @ 02:28 PM