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Using the Electronic Health Record to Understand and Minimize Overuse.

In the current US health care system, a major priority is addressing the cost of care, which exceeds that of all other nations. One of the most attractive areas to target is “overuse,” “unnecessary health care,” or “lowvalue care,” defined as care that provides little or no benefit to patients. These services account for substantial health care expenditures and may cause harm. Yet many factors contribute to overuse, including expansion of technology, physician payment schemes that encourage utilization, indication creep, patient expectations, and concerns about litigation. Several important initiatives have addressed the issue of overuse, including the “Less Is More” series initiated by JAMA Internal Medicine in 20101 and the American Board of Internal Medicine’s “Choosing Wisely” educational initiative, launched in 2012 (Daniel B. Wolfson, MHSA, ABIM Foundation, written communication, September 26, 2016). For the latter, the board has assumed a central role and has facilitated professional bodies to produce lists of unnecessary tests, procedures, and treatments. Along with a communications