CEO SUMMARY: There’s a treasure trove of information and insights about how physicians use clinical laboratory tests contained in survey data recently collected by a team from the Centers for Disease Control and Prevention. Designed to identify challenges in how physicians utilize laboratory tests, the survey findings offer a road map about how innovative clinical labs could deliver added value to physicians, particularly in providing consultative services and better access to laboratory expertise.
RATHER THAN CONSULT with laboratory professionals, referring physicians almost always seek other sources of information when uncertain about clinical laboratory test results. This is one significant finding of a survey conducted by the Centers for Disease Control and Prevention (CDC).
The survey has other useful insights for lab administrators and pathologists interested in learning how to deliver more value to physicians. Among other findings, the survey reveals that physicians have many frustrations when they seek to get certain types of information and support from clinical laboratories.
The survey was conducted by the CDC’s Division of Laboratory Science and Standards (DLSS), Clinical Laboratory Integration into Healthcare Collaborative (CLIHC). Data from focus groups of primary care physicians served as the basis for questions in the survey. Responses were gathered from 1,700 primary care and internal medicine physicians. Results are being analyzed and will be published in a peer-reviewed journal.
THE DARK REPORT asked the CDC about the results and received replies by email from Julie Taylor, Ph.D., Project Lead for CLIHC. Her responses are the basis of this article.
One goal of the survey was “to explore the challenges in laboratory test selection and result interpretation [by primary care physicians] with potential strategies to address those challenges,” wrote the CDC. Among other notable insights, the survey determined that physicians tend to go to other sources of information before reaching out to their laboratory testing provider.
Docs Consult other Sources
“When clinicians experience uncertainty about test ordering and result interpretation, they reported that they consult many resources before asking a laboratory professional,” noted the CDC in its written answer to THE DARK REPORT. “The results showed they frequently review published references (electronic and/or paper) and guidelines, refer the patient to a specialist, or see how the patient’s presentation evolves. Consultation with a laboratory professional was the least frequent approach.”
This finding is certainly a challenge for clinical laboratories. Physicians reported that they consistently went to other sources before they would then contact a clinical laboratory professional. However, this situation is also an opportunity, because it shows that once physicians receive a patient’s lab test results, they actively look for additional information to develop their diagnosis and come up with an appropriate treatment plan for the patient.
The CDC’s survey identified other challenges that physicians have in their relationship with their laboratory test providers. “The most problematic challenges reported with test ordering were related to the cost of laboratory tests (to the patient), lack of comparative information, and insurance limitations,” noted the CDC.
Lack of Uniformity
It will be no surprise to clinical pathologists that the clinical laboratory industry’s general lack of uniformity is a problem for physicians. Survey results showed that “other challenges were test panels from different laboratories comprised of different tests, confusion over different test names for the same test, tests that were not available, and conflicting recommendations from different guideline-development organizations.
“Physicians reported they usually review the patient’s history and follow-up with the patient when they are uncertain about test result interpretation,” continued the CDC. “They expect the laboratory to deliver data. Not receiving results quickly and a lack of previous results were reported as the most problematic issues in result interpretation while difficulty communicating with the laboratory professional was less problematic.”
Less complimentary to the laboratory medicine profession are survey responses by physicians that confirm their reluctance to engage clinical pathologists and laboratory scientists for one-on-one consults and conversations about patients and laboratory test results. Survey responses indicate that physicians don’t see their lab test provider as an easy source to tap for clinical expertise.
Assistance not Forthcoming
The CDC wrote that, when referring physicians communicate with laboratory professionals, they do so, “primarily to determine the status of missing results or to obtain preliminary result information. Clinicians infrequently reported communication with laboratory professionals for assistance with follow-up testing or to obtain a medical opinion of test results.”
There were some positive aspects about how physicians utilized clinical lab testing resources. “Most survey respondents reported reflex testing, result trending, and interpretive comments were readily available and were useful means for test result interpretation,” said the CDC. “Computerized physician order entry (CPOE) with electronic suggestions was least available but moderately useful.”
Respondents found these additional lab testing resources to be useful: 1) access to test performance characteristics; 2) a dedicated laboratory phone line for questions; and, 3) clinical testing algorithms. “Lab usage may improve as clinicians have better access to decision support tools,” commented the CDC.
Lab Test Interpretation
In the all-important area of interpreting lab test data and developing an action plan, the CDC said that, of referring physicians surveyed, “They primarily utilize electronic/paper references and guidelines, among other methods, when they are uncertain about test ordering. They go back to the basics of care and review information about the patient when they are uncertain about test result interpretation.”
Clinical laboratories did not get high marks in how they supported clinicians with consultative services. “The clinicians responding in our survey did not readily contact the laboratory professional when unsure about test ordering or test result interpretation,” wrote the CDC.
Reinforcing this point, it was noted that “one primary care physician in the focus group said, ‘You don’t talk to a radiologist or pharmacist in a hospital, you talk to a colleague. [But when] you talk to a lab, it’s a black box…’ When they do communicate with laboratory professionals, the [survey] results show it is primarily to determine the status of missing results or to obtain preliminary result information. Clinicians infrequently reported communication with laboratory professionals for assistance with follow-up testing or to obtain medical opinion of test results.”
Daily Clinical Relationship
This early peek at the survey results—prior to the planned publication of a full assessment of the survey and focus groups in a peer-reviewed publication—confirms that there are important gaps in the daily clinical relationship that clinical laboratories have with primary care physicians. Understanding these gaps is a necessary first step before they can be fixed.
This is consistent with the goals of the CDC’s survey, which was not designed to ask physicians about how they use laboratory testing in their practices, “but rather to obtain information about what challenges physicians face in test ordering and result interpretation and the resources physicians frequently use to address those challenges.”
Innovative clinical pathologists and lab executives who want to position their laboratory organizations at the leading edge of clinical excellence will find much that is useful in the information generated from this CDC survey. Probably the single most useful insight is that—after physicians receive the lab test results for a patient— they spend time accessing other sources, not laboratory professionals, for clinical knowledge. It means that the first call they make with questions is not to their clinical pathologist or laboratory scientist. Labs should view this survey finding as an opportunity to change the status quo.
Opportunities for Labs
As healthcare evolves toward new models of integrated clinical care, the insights generated by this CDC survey of the challenges physicians encounter with lab testing can be a useful road map for the lab testing profession. The survey results show opportunities for clinical laboratory professionals to work more closely and productively with referring physicians. More will be reported on this survey when the full presentation is published.
CDC Survey Sought Insight on PCP Practices
IT WAS LAST YEAR when the Centers for Disease Control and Prevention announced that it wanted to investigate how the rapid evolution of laboratory medicine was affecting primary care physician practices. To do so, it reported in the Federal Register the intent to conduct the “Quantitative Survey of Physician Practices in Laboratory Test Ordering and Interpretation.”
“This proposed survey follows a series of qualitative focus groups with primary care physicians that identified common concerns and problems with laboratory test ordering and test interpretation,” the CDC said in its Federal Register announcement. “This survey will quantify the prevalence and impact of the issues identified within the focus groups. Understanding the relative importance of physician issues in the effective and efficient use of laboratory medicine in diagnosis will guide future efforts of the CDC to improve primary care practice and improve health outcomes of the American public.”