Clinical Laboratory Integration into Healthcare Collaborative (CLIHC)
The Centers for Disease Control and Prevention (CDC) convened seven Institutes from 1984 to 2007 on critical issues in clinical laboratory practice. These institutes brought together national and international experts to consider the role(s) of the clinical laboratory in providing quality testing services for improved patient outcomes. The Clinical Laboratory Integration into Healthcare Collaborative (CLIHC) was subsequently established by CDC’s Division of Laboratory Systems (DLS) to study important “gaps” identified in the institutes and to develop solutions to optimize the effective use of laboratory services for better patient care. CLIHC’s current focus explores the challenges clinicians face for appropriate laboratory test selection and result interpretation. Solutions for these challenges will improve utilization of laboratory services and a reduce diagnostic and treatment errors and delays.
Anticoagulation Manager (ACM App)
Blood clots affect 900,000 Americans each year and determining the correct type and dosage of anticoagulant drug can be challenging. This can often lead to diagnostic errors when prescribing anticoagulants. The Anticoagulation Manager (ACM) is a free mobile application developed through the collaborative efforts of the CDC and the Georgia Institute of Technology. ACM is a resource for clinicians guiding the utilization of the appropriate laboratory testing and administering the appropriate anticoagulant drug in the correct dosage and at the right frequency to patients. The application provides consolidated, evidence-based, and accurate information for clinicians. It is intended to decrease the number of errors made by clinicians when ordering laboratory testing and administering anticoagulant drugs. Download the application hereExternal.
Partial Thromboplastin Time (PTT App)
CDC’s PTT AdvisorExternal offers clinicians a tool to quickly select the appropriate follow-up tests to evaluate patients with a prolonged partial thromboplastin time (PTT) laboratory result and a normal prothrombin time (PT) laboratory result. PTT Advisor will run on your iPhone, iPod touch or iPad. PTT Advisor has been created by CDC in collaboration with experts in diagnostic coagulation with a collective experience of more than 50 years in the field.
The 2012 CLIHC national surveyExternal of 1700 internal and family medicine physicians revealed numerous challenges in laboratory service utilization.
Test selection challenges included:
- multiple or confusing test names for the same test
- diverse testing panels with the same name
- differing practice guidelines
- communicating with laboratory professionals
Challenges in result interpretation identified in the survey included:
- variation in laboratory normal values and reporting format
- previous results not readily available
- lack of timely reporting
- results inconsistent with patient’s symptoms
Suggested solutions included:
- CPOE with electronic suggestions for appropriate test ordering
- clinical algorithms/pathways to guide test selection
- interpretive comments
- reflex testing
Communication with laboratory professionals is of particular concern because it was the least frequent among the various ordering and interpretation tactics used in dealing with the challenges. However, when clinicians did consult with laboratory professionals, the majority found it useful. Overuse, underuse, and misuse of laboratory tests may be reduced and patient care improved, if the methods deemed “useful” by the survey respondents can be available to more physicians.
CLIHC training offering continuing education:
This podcast is designed to improve the use of laboratory services and facilitate collaborative clinical decision making among primary care physicians and laboratory professionals when selecting the most appropriate laboratory test. Content is derived from a scenario based skit between a clinical pathologist (Mike Laposata, M.D., Ph.D) and internal medicine hospitalist (Jim Meisel, M.D., FACP) that offers insight on the importance of clearly communicating with laboratory professionals to ensure that the most accurate laboratory test is selected in order to obtain an accurate clinical diagnosis for quality patient care.
- Describe at least one diagnostic error related to coagulation testing
- Identify at least two clinical laboratory challenges experienced by clinicians
- List two ways to improve team based care among laboratory professionals and clinicians
- Complete the activity by listening to podcast, available here http://www2c.cdc.gov/podcasts/player.asp?f=8642660 or below
Communicating and Collaborating for the Right Lab Test and Diagnosis
- To receive continuing education, you must complete an evaluation and pass a post-test with a minimum score of 80%: http://www2a.cdc.gov/TCEOnline/registration/detailpage.asp?res_id=5958
CLIHC peer-reviewed publications raise awareness about gaps and potential solutions for clinicians’ optimal use of clinical laboratory services for improvement in patient care.
Clinical Decision Support
- Savel TG, Lee BA, Ledbetter G, Brown S, LaValley D, Taylor J, Thompson P. PTT Advisor: A CDC-supported initiative to develop a mobile clinical laboratory decision support application for the iOS platform. J Public Health Informatics. 2013;5(2).Cdc-pdfExternal
- Shirts BH, Jackson BR, Baird GS, Brown JM, Clements B, Grisson R, Hauser RG, Taylor JR, Terrazas E, and Brimhall B. J Pathology Informatics 2015; 6(1): 9.External
- Oxana Tcherniantchouk, Michael Laposata, and Marisa B. Marques. The isolated prolonged PTT. American Journal of Hematology. 2012; 88 (1): 82-85.External
Laboratory Test Selection/Ordering and Result Interpretation
- Hickner J, Thompson P, Wilkinson T, Epner P, Sheehan M, Pollock A, Lee J, Duke C, Jackson B, Taylor J. Primary care physicians’ challenges in ordering clinical laboratory tests and interpreting results. J Am Board Fam Med. 2014;27:268-274.External
- Marques M, Hickner J, Thompson P, Taylor J. Primary care physicians and the laboratory: Now and in the Future. Am J Clin Pathol, 2014;142: 739-740External.
- Passiment E, Meisel J, Fontanesi J, Fritsma G, Aleryani S, Marques M. Decoding laboratory test names: a major challenge to appropriate patient care. J Gen Intern Med. 2013;28(3):453-458.External
- Taylor JR, Thompson PJ, Genzen JR, Hickner J, Marques M. Opportunities to Enhance Laboratory Professionals’ Role on the Diagnostic Team. Lab Medicine. 2016: 0: 1-7.External
- Smith B R, Kamoun, M, and Hickner J. Medical Student Education in Laboratory Medicine in United States Medical Schools: A 2014 Status Report. Academic Medicine. 2015.External
Five Newsletter Reports referenced CLIHC work:
- Clinical Laboratory News, 2012 – feature story about CLIHCExternal
- Dark Report, 2012 – highlighted the physician’s surveyCdc-pdf
- Society to Improve Diagnosis in Medicine, 2013 – highlighted “Decoding laboratory test names” articleExternal
- Journal of General Internal Medicine article cited on the Agency for Healthcare Research and Quality (AHRQ), 2013-cited “Decoding laboratory test names” Patient Safety Network(PSNet)External
- Clinical Laboratory News, 2014-highlighted the physician’s surveyExternal
CLIHC presentations given at conferences/meetings:
- Diagnostic Error and the Need for Better Diagnostic Testing” CDC- Medscape Expert CommentaryExternal
- Optimizing the Use of Laboratory Testing Services to Improve Patient DiagnosisExternal
- Optimizing Laboratory Test Utilization for Better Patient Care, NLTN Webinar, Julie R. Taylor, April 16, 2014.External
- American Society of Clinical Pathology (ASCP)Cdc-pdf
- American Association of Clinical Chemistry (AACC)Cdc-pdf
- Clinical Laboratory Improvement Advisory Committee (CLIAC)Cdc-pdf