SIDM Columnist: Devery Howerton, PhD
Clinical laboratory testing is critical for evaluating numerous patient conditions and for developing accurate diagnoses. Incorrect test ordering and other gaps in the testing process have been shown to contribute to errors in diagnosis.1 Selecting the appropriate laboratory tests can be challenging. Clinicians can choose from thousands of tests and test menus continue to expand. Contributing to the rapid growth in tests are advances in the understanding of pathophysiology and technological innovations and methods that can evaluate biological materials to the molecular and ion levels. Applications of these technologies allow the development of tests for the identification and/or quantitation of numerous genomic variations, infectious agents, metabolites, toxins, peptides, etc. that were not available just a few years ago. The sheer number of tests from which to choose can be daunting, but when compounded with confusing test names and abbreviations, selecting the appropriate test can be quite a challenge.
A workgroup of the Clinical Laboratory Integration into Healthcare Collaborative (CLIHCTM) sponsored by the Centers for Disease Control and Prevention (CDC), recently published "Decoding laboratory test names: a major challenge to appropriate patient care.”2 This article points out that test selection challenges are due in part to two factors: 1) the multiplicity of names for a single test and 2) the complexity of the names, including some test names that are inappropriate or imprecise. Tests may be named for the person who discovered them, the disease with which they were originally associated, or the substance being detected or measured. Most test names have multiple variations and each laboratory develops abbreviated test codes that vary across the country. This nomenclature problem is not simply due to the increase in more esoteric testing, but applies to commonly ordered, routine laboratory tests, such as those for routine chemistry, infectious disease serology, and coagulation.
Clinicians need tools and laboratory professionals to assist them with appropriate test selection. As electronic health records become more widely used, clinical decision support tools using algorithms that can guide test selection at the point of care are becoming available in some locations. These algorithms can be embedded into the computerized physician order entry systems. Another source of information for clinicians is websites of some larger reference laboratories, such as the Mayo Medical Laboratories and ARUP Laboratories that include test menus, test algorithms and guidelines identifying tests and describing how they should be used.(3-4) Laboratories are typically staffed to provide clinical consultation to answer questions and guide appropriate test selection. However, in a recent survey of 1700 primary care physicians conducted by the CDC, more than half the respondents thought the multiplicity of tests and test names were "somewhat” to "extremely” problematic for appropriate test selection, but they rarely sought assistance from the laboratory staff (D. Howerton, unpublished data, March 2013). A collaborative effort among laboratory professionals, clinicians, informatics specialists, and policy makers is needed to alleviate challenges in appropriate laboratory test utilization through systems development that may include sophisticated search technology tools, clinical decision support tools, and easier access to knowledgeable laboratory professionals.
- Smith ML, Raab SS, Fernald DH, et al. Evaluating the connections between primary care practice and clinical laboratory testing. A review of the literature and call for laboratory involvement in the solutions. Arch Pathol Lab Med. 2013;137:120-125.
- Passiment E, Meisel J, Fontanesi J, Fritsma G, Aleryani S, Marques M. Decoding laboratory test names: a major challenge to appropriate patient care. Jl Gen Intern Med. 2013;28(3):453-458.
- ARP Consult. The Physician’s Guide to Laboratory Test Selection and Interpretation. http://www.arupconsult.com/Algorithms/or.html Accessed March 7, 2013.
- Mayo Clinic Mayo Medical Laboratories. Interpretive Handbook. http://www.mayomedicallaboratories.com/interpretive-guide/index.html?alpha=A Accessed March 7, 2013.
Devery Howerton, PhD is Director, Division of Laboratory Science and Standards, US Centers for Disease Control and Prevention. She can be reached at DHowerton@cdc.gov .
Disclaimer: The findings and conclusions in this article are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.