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Clinical Laboratory Integration into Healthcare Collaborative (CLIHC)

About 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.

Free Mobile Applications from CLIHC

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 here.

Partial Thromboplastin Time (PTT App)

CDC’s PTT Advisor 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.

2012 CLIHC National Survey

The 2012 CLIHC national survey 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.

Training, Publications, and Presentations

Training

CLIHC training offering continuing education:

Title

Communicating and Collaborating for the Right lab Test and Diagnosis

Description

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.

Objectives

Publications

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
Laboratory Test Selection/Ordering and Result Interpretation
Collaboration
Education
Newsletters

Five Newsletter Reports referenced CLIHC work:

Presentations

CLIHC presentations given at conferences/meetings:

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