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Variations due to confusing test nomenclature are likely to be more of a problem in larger health care systems, especially those that have acquired hospitals with different EHRs, Dr. Haghi says, but institutions of any size could apply the heat map tool in many ways. “Just look at variability in, let’s say, the inpatient ordering patterns of ICU attendings in one hospital. That’s the awesome thing about it—it can be tailored to specialty, to a location within the hospital, or to a patient population. It just depends on how you sort the information from your LIS.”

The heat map is a built-in feature of Excel, and setting it up requires no particular expertise, says Dr. Ziemba. “I would say designing the workflow for the first time involves some trial and error, but after that it’s trivial,” he explains. “It doesn’t require any background in pathology or informatics. I think anyone who has used pivot tables in Excel and follows the instructions [in the Journal of Pathology Informatics article] would be able to do it successfully.”

When using the heat map, Dr. Chang points out, it’s important to remember that not every variation indicates a problem, and discovering differences in ordering patterns should not lead to finger-pointing. “If you’re different, it doesn’t necessarily mean you’re wrong; it just means we should ask questions,” he explains. “Sometimes the proficiency test, as well as these utilization maps, will suggest that the person who is different from everyone else is ahead of the curve because they’ve realized something, incorporated something new into their practice, that everyone else is catching up to. So the fundamental model is how can we have a conversation that isn’t about blaming people but that is more about finding the best practice.”

Dr. Haghi concurs. “As pathologists and owners of this data, it’s our responsibility to provide feedback to the providers, and I think all of that comes down to opening up a dialogue,” she says. “We’re basically going department to department, showing them that we have this capability. We want to present it to them as a collaborative tool.” The response from clinicians has been largely positive, she adds.

Yet Dr. Chang offers a word of caution. Before introducing the technology to providers, he advises, learn how the business unit is organized and figure out its motivations and priorities. If providers are overwhelmed, he explains, “their immediate response, if you’re not careful in how you approach it, is ‘what are you going to tell me I’m doing wrong now?’ And, of course, there’s no road forward there to making progress. The key is understanding who’s amenable to change and how to incorporate that.”—Jan Bowers

Dr. Aller teaches informatics in the Department of Pathology, University of Southern California, Los Angeles. He can be reached at raller@usc.edu. Hal Weiner is president of Weiner Consulting Services LLC, Eugene, Ore. He can be reached at hal@weinerconsulting.com.