Advertisement

Journal of General Internal Medicine

, Volume 28, Issue 3, pp 453–458 | Cite as

Decoding Laboratory Test Names: A Major Challenge to Appropriate Patient Care

  • Elissa Passiment
  • James L. Meisel
  • John Fontanesi
  • George Fritsma
  • Samir Aleryani
  • Marisa Marques
Perspectives

Abstract

Clinical laboratory tests have no value if clinicians cannot quickly order and obtain the results they need. We found that efforts to obtain even the most commonly ordered tests are often derailed by excessively complex nomenclature. Ordering the right laboratory tests is critical to diagnosis and treatment, but existing mechanisms for entering lab orders actively interfere with physicians’ efforts to provide good clinical care. Rather than simplifying lab orders, the advent of computerized physician order entry (CPOE) systems—generally programmed by non-clinicians—has introduced new and vexing practical problems. Medical laboratories have filled their test menus, whether paper or electronic, with bewildering nomenclature and abbreviations, and have failed to appreciate the dangers of assigning perilously similar names to different tests. The efficient and efficacious patient care demanded by the quality care initiative requires progress beyond traditional solutions, such as convening naming conventions, to the development of innovative software with intelligent, real-time, clinically driven search functions that will allow these programs to help rather than hinder physicians.

KEY WORDS

laboratory tests nomenclature communication naming protocol health care costs 

Notes

Acknowledgements

This report was supported in part from a contract (GS-10F-0261K) funded by the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry.

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry.

The use of trade names in this report is for identification purposes only and does not imply endorsement by the Centers for Disease Control and Prevention (CDC) or the U.S. Department of Health and Human Services.

This information is the exclusive property of the federal government; however, we are searching for partners to continue development of this information. Please contact the author if you are interested in partnering on this project.

Conflict of Interest

Dr. Meisel has a financial interest in Medvance Solutions, Inc., which facilitates the communication of clinical laboratory results from physicians to patients.

REFERENCES

  1. 1.
    Surks MI, Chopra IJ, Mariash CN, Nicoloff JT, Solomon DH. American thyroid association guidelines for use of laboratory tests in thyroid disorders. JAMA. 1990;263:1529–1532.PubMedCrossRefGoogle Scholar
  2. 2.
    Laboratory Support to HIV Diagnosis and Monitoring of Antiretroviral Therapy. WHO Project 2004; http://www.searo.who.int/LinkFiles/BCT_Reports_HLM-384.pdf accessed September 30, 2012.
  3. 3.
    Emons MF. Integrated patient data for optimal patient management: the value of laboratory data in quality improvement. Clin Chem. 2001;47(8):1516–20.PubMedGoogle Scholar
  4. 4.
    Sucov A, Bazarian JJ, deLahunta EA, Sillane L. Test ordering guidelines can alter ordering patterns in an academic emergency department.Google Scholar
  5. 5.
    Shalev V, Chodick G, Heymann AD. Format change of a laboratory test order form affects physician behavior. Int J Med Inform. 2009;78(10):639–44.PubMedCrossRefGoogle Scholar
  6. 6.
    Miyakis S, Karamanof G, Liontos M, Mountokalakis TD. Factors contributing to inappropriate ordering of tests in an academic medical department and the effect of an educational feedback strategy. Postgrad Med J. 2006;82(974):823–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Valenstein PN, Walsh MK, Stankovic AK. Accuracy of send-out test ordering: a College of American Pathologists Q-Probes study of ordering accuracy in 97 clinical laboratories. Arch Pathol Lab Med. 2008;132(2):206–10.PubMedGoogle Scholar
  8. 8.
    Perraro F, Rossi P, Liva C, Bulfoni A, et al. Inappropriate emergency test ordering in a general hospital: preliminary reports. Qual Assur Health Care. 1992;4(1):77–81.PubMedGoogle Scholar
  9. 9.
    Laposata M, Dighe A. “Pre-pre” and “post-post” analytical error: high incidence patient safety hazards involving the clinical laboratory. Clin Chem Lab Med. 2007;45(6):712–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Shmerling RH, Delbanco TL. How useful is the rheumatoid factor? An analysis of sensitivity, specificity, and predictive value. Arch Intern Med. 1992;152(12):2417–20.PubMedCrossRefGoogle Scholar
  11. 11.
    Ratnoff OD, Margolius A Jr. Hageman trait: an asymptomatic disorder of blood coagulation. Trans Assoc Am Physicians. 1955;68:149–54.PubMedGoogle Scholar
  12. 12.
    Inoue Y, Nakamura J. Codes and names for clinical laboratory tests and shared interlaboratory databases. Rinsho Byon. 1997;45(6):577–80.Google Scholar
  13. 13.
    Pontet F, Magdal PU, Fuentes-Arderiu X. Petersen U, X, et al. Clinical laboratory sciences data transmission: the NPU coding system. Joint Committee on Nomenclature, Properties and Units (C-SC-NPU) of the IFCC and IUPAC. Stud Health Technol Inform. 2009;150:265–9.PubMedGoogle Scholar
  14. 14.
    Nomenclature announcement: Redefined Nomenclature for Members of the Carcinoembryonic Antigen Family1. Experimental Cell Research. 1999; 252: 243–249Google Scholar
  15. 15.
    Larsen P, Alexander N, et al. Revised nomenclature for tests of thyroid hormones and thyroid-related proteins in serum. Arch Pathol Lab Med. 1988;112:132.Google Scholar
  16. 16.
    Wright IS. Special report: the nomenclature of blood clotting factors. Can Med Assoc J. 1962;86:373–374.PubMedGoogle Scholar
  17. 17.
    Huff SM, Rocha RA, McDonald CJ, et al. Development of the Logical Observation Identifier Names and Codes (LOINC) vocabulary. J Am Med Inform Assoc. 1998;5(3):276–92.PubMedCrossRefGoogle Scholar
  18. 18.
    McDonald CJ, Huff SM, Suico JG, et al. LOINC, a universal standard for identifying laboratory observations: a 5-year update. Clin Chem. 2003;49(4):624–33.PubMedCrossRefGoogle Scholar
  19. 19.
    McDonald CJ, Huff SM, Suico JG, Hill G, Leavelle D, Aller R, Forrey A, Mercer K, DeMoor G, Hook J, Williams W, Case J, Maloney P. LOINC, a universal standard for identifying laboratory observations: a 5-year update. Clin Chem. 2003;49(4):624–33.PubMedCrossRefGoogle Scholar
  20. 20.
    http://loinc.org/ accessed September 30, 2012.
  21. 21.
    http://loinc.org/background, accessed September 30, 2012.
  22. 22.
    Wang AY, Barrett JW, Bentley T, et al. Mapping between SNOMED RT and clinical terms version 3: A Key Component of the SNOMED CT development process. Proc AMIA Symp. 2001; 741–745.Google Scholar
  23. 23.
    http://www.ihtsdo.org/snomed-ct/ accessed September 30, 2012.
  24. 24.
    Baorto DM, Cimino JJ, Parvin CA, Kahn MG. Using Logical Observation Identifier Names and Codes (LOINC) to exchange laboratory data among three academic hospitals. Proc AMIA Annu Fall Symp. 1997;96–100.Google Scholar
  25. 25.
    NISTIR 7432: Common Industry Specifications for Usability Requirements, Information Access Division, Information Technology Laboratory, National Institute of Standards and Technology, June 2007.Google Scholar

Test directories of other major reference laboratories (references)

  1. 26.
    Vanderbilt Pathology Laboratory Services. www.LabVU.com, accessed September 30, 2012.
  2. 27.
    ARUP Laboratories. www.aruplab.com, accessed September 30, 2012.
  3. 28.
    Lab Tests on Line. www.labtestsonline.org, accessed September 30, 2012.
  4. 29.
    Mayo Medical Laboratories. http://www.mayomedicallaboratories.com, accessed September 30, 2012.

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Elissa Passiment
    • 1
  • James L. Meisel
    • 2
  • John Fontanesi
    • 3
  • George Fritsma
    • 4
  • Samir Aleryani
    • 5
  • Marisa Marques
    • 6
  1. 1.American Society for Clinical Laboratory ScienceTysons CornerUSA
  2. 2.Hospital Medicine Unit Section of General Internal Medicine Boston University Medical CenterBostonUSA
  3. 3.Center for Management Science in Health University of California, San Diego, Medical SchoolLa JollaUSA
  4. 4.Fritsma Factor, Precision BioLogicDartmouthCanada
  5. 5.Department of PathologyVanderbilt University Medical CenterNashvilleUSA
  6. 6.The University of Alabama at Birmingham Division of Laboratory MedicineBirminghamUSA

Personalised recommendations