Lab Test Methodology and Widespread EMR Use

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IN BIRMINGHAM, ENGLAND, LAST WEEK to participate at the Frontiers in Laboratory Medicine (FiLM) conference, Editor Robert Michel picked up an interesting theme that connects to current laboratory events here in the United States.

“General practice (GP) clinics in England are establishing electronic medical record (EMR) systems as a preliminary step toward the goal of a national patient health record (PHR),” explained Michel. “Consequently, pathologists and clinical biochemists who run the nation’s laboratories are beginning to foresee how one longstanding practice in laboratory medicine has the potential to create confusion among physicians and patients.

“In each city across the country, individual laboratories have always selected their test methodology, then used specimens collected from local residents to validate the test and develop reporting ranges,” he continued. “Now, some lab professionals realize that, when a national patient health record becomes a reality, the individual patient’s record will contain lab test data produced by several different labs. Because of different methodologies and different reporting ranges for the same test, they can foresee how physicians and patients, as they consult the individual’s electronic medical record, will find the presentation of these cumulative lab test results to be confusing and not easy to understand. This realization by forward thinkers in the laboratory profession is causing some to predict that greater standardization of test methodology and reporting guidelines across all laboratory sites will need to occur as a consequence of a single national system of electronic medical records.”

Michel’s observation about this development in the United Kingdom has a parallel here in the United States. Wider adoption of a universal patient health record that is transportable across different providers, hospitals, and health insurers will raise the same issue in this country. The explosion of interest in Vitamin 25(OH) D testing may provide our health system with a first example of the problem generated by the use of different test methodologies. Today, different labs are using different methodologies to test for Vitamin 25(OH) D. They use locally-collected specimens to establish reporting ranges. This means that clinicians and patients, looking at Vitamin D results from different labs, cannot automatically assume that one lab’s result means the same as another lab’s result. Evidence exists that this situation has caused confusion among some physicians and patients during the past two years—a time when interest in Vitamin D testing grew dramatically.

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