Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to page options Skip directly to site content

Evidence-based Laboratory Medicine


Clinical Laboratory Integration into Healthcare Collaborative

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.

Impact on Patient Care
CLIHCTM’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.

CLIHC™’s Projects
The 2012 CLIHCTM 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.

CLIHC™’s projects concentrate on several approaches to support healthcare providers with appropriate laboratory test usage:

  • Development of smartphone/smartpad applications to guide clinicians step-by-step in appropriate coagulation testing

  • PTT Advisor app launched in the iTunes store in 2012 guides clinicians in appropriate follow-up testing for patients presenting with a normal prothrombin test (PT) and abnormal partial thromboplastin time (PTT)

  • Development of clinical decision support (CDS) mechanisms to help clinicians select the appropriate laboratory test(s) and result interpretation(s) for patient diagnoses. These may include mechanisms such as algorithms, electronic test ordering guidance embedded in the computer physician order entry (CPOE) system or the electronic health record (EHR), and laboratory call centers.
  • Survey of US medical schools’ laboratory medicine curriculum

Training, Publications, and Presentations

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.


  • 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

To receive continuing education:

Eight peer-reviewed publications from CLIHC™ raised awareness about gaps and potential aids for clinicians’ optimal utilization of clinical laboratory services.

Five Newsletter Reports referenced CLIHC™ work

CLIHC™ presentations given at conferences/meetings:


 Top of Page