The clinical laboratory is positioned the play a pivotal role in the transformation of medicine towards patient-centeredness and care coordination for each individual. As the industry places emphasis on moving from volume to value reimbursement, it becomes incumbent upon the laboratory to work with clinicians to provide the tools for enabling appropriate ordering of laboratory test that will ensure quality care for every patient while reducing redundancy.

Much has been written about unnecessary laboratory tests being ordered.  Estimates of unnecessary laboratory tests run as high as 30 percent. But, what peaks my interest even more is that there are very few studies that indicate a rate of necessary tests not being ordered but clearly there are instances where this occurs. It is not possible for any one individual to have fingertip information on the utility and interpretation of each and every clinical laboratory test available; therefore, laboratories have an obligation to provide decision support tools for test ordering.

To do this effectively, laboratorians need to work with clinicians directly to develop appropriate protocols for not only ordering tests but also in providing interpretation of the results, particularly when multiple integrated tests have been ordered.

So who has the responsibility to provide those decision support tools?  I would contend it is the “reference laboratory” working in conjunction with knowledgeable clinicians.  Reference laboratory needs to be broadly defined to include hospital, health system, ACO, and regional reference and national reference laboratories.  These laboratories have LIS systems possessing the ability to facilitate knowledgeable ordering and test interpretation that can include evidence based guidelines for diagnosis and disease management.

Granted, these guidelines may not be appropriate for every patient. At their Laboratory Utilization Conference in 2013, Mayo Medical Laboratories discussed that with proper coordination of laboratory and specialty clinicians in the development and implementation of evidence based guidelines, 80 percent compliance can be achieved. Although it is not ideal, it is a significant place to start to build this collaboration between laboratorians and clinicians to effectively transform the delivery model.

In upcoming blog posts, I will share some of the tools that are being used today that clinicians should be demanding from their laboratories to assist them in ordering and interpreting laboratory results.