How do you implement a digitization project in your lab? Learn from the success of two organizations.
Produced in partnership with Kapios
In clinical laboratory inspections, instrument maintenance and service visit documentation rank among common deficiencies cited by The Joint Commission, the College of American Pathologists (CAP), COLA, and the Centers for Medicare and Medicaid Services (CMS). While a majority of the time lab techs are diligent about the required maintenance and responsibilities of laboratory equipment, instruments, and analytical systems, the checkoffs are often left to finish later.
No one will dispute that accuracy in clinical lab test result reporting and precision of the total testing process stand paramount in providing quality laboratory services. Those who know the lab environment well would also probably acknowledge that an essential piece of a lab’s defensibility in a challenge is showing proper documentation of laboratory instrument maintenance logs and other required records.
Unfortunately, the reality is such that laboratory managers must run through miles of paper trails looking for evidence of regulatory compliant records of instrument maintenance and other checks.
The goal of this white paper is to demonstrate how some clinical lab directors and technical supervisors sought to relieve the unnecessary labor and hazards in one of the most common analog-world bottlenecks—and were successful. This white paper also identifies three commonly overlooked existing resources for taking the first steps to streamline instrument checks and documentation in the lab today.
Table of Contents
Part 1: Framing a Path to Digitization as Part of the Clinical Laboratory Quality Control Plan
Whether or not large-scale digital transformation of the clinical laboratory is on the immediate horizon or further in the distance, how does the conversion to digitization of lab equipment management processes materialize?
Part 2: Small-scale Digitization Projects: Where, How, and Why Other Labs Made Changes
Some hospital and health system laboratories have transitioned to paperless systems for projects and jobs such as quality assurance (QA) monitors, online quality control (QC) reviews, remote temperature monitoring, and cloud-based document management. Lima Memorial Health System in Lima, Ohio, is one such hospital laboratory operation.
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Outspoken Wecht wants readers to understand ‘the multifaceted challenges of the interface of law and medicine’
Pathologists will recognize the name of nationally-acclaimed forensic pathologist Cyril Wecht, MD, JD, who for more than a half-century has been at the center of many of the country’s highest-profile civil and criminal cases. Thus, Dark Daily readers will be intrigued to learn the so-called “godfather of forensic pathology” has published a memoir that takes readers behind the scenes of many of his most controversial forensic pathology cases.
In his recently published memoir (above), forensic pathologist Cyril Wecht, MD, JD, offers readers an inside look at some of his most controversial cases, as well as a defense of his own brushes with the legal system. Anatomic and clinical pathologists may be especially intrigued by Wecht’s description of how “he was acquitted on charges of personally profiting from his office as Allegheny County Coroner” during a federal public corruption charge that was dismissed in 2008, the book’s description states. (Photo copyright: Exposit Books.)
A ‘No-Holds-Barred’ Account
According to TribLIVE, the book—written by Wecht and award-winning writer/filmmaker Jeff Sewald—is a “no-holds-barred account” of Wecht’s personal and professional life. Among the more interesting tidbits are details regarding Wecht’s 1972 discovery that JFK autopsy materials and specimens had gone missing.
“They had been in the government’s possession, so nobody could have touched them, but now the metal container which has held John Kennedy’s brain in formalin was no longer on the list of contents. In addition, various photographs and microscopic tissue slides were also no longer listed. The President’s brain was missing!” wrote Wecht, who argued Lee Harvey Oswald did not act alone in killing JFK and may not have fired the shots that killed him.
In 2006, Wecht faced an 84-count federal public corruption trial, which resulted in him resigning as Alleghany, Pa. medical examiner, the Pittsburgh Post-Gazette reported. In his memoir, Wecht wrote extensively about his public corruption trial. TribLIVE noted Wecht “expresses particular disgust” over the accusation that he supplied Pittsburgh’s Carlow University with cadavers in exchange for use of their laboratory space for his own practice. His trial ended in a hung jury.
“The body-snatching issue was seized upon by the media and was the subject of some of the most horrible cartoons ever,” Wecht wrote. “What made them especially horrible was the fact that I believe anti-Semitism was at their core. They made me look wicked and shadowy, like a ‘Shylock’ who was willing to stoop as low as selling human corpses for a handful of shekels. It was sickening.”
Wecht became known nationally through media appearances and his many decades of work as a medical-legal consultant in civil and criminal cases. At the 2000 Forensic Science and the Law Conference, television host and political commentator Geraldo Rivera, JD, stated, “I’ve known Cyril Wecht for most of my 30-year broadcasting career, and my respect for him has only grown over the decades. His skills as an attorney, as a pathologist, as a medical examiner are legendary.
“Dr. Wecht has guided my audiences through our coverage of crimes ranging from the Kennedy assassination to the O.J. Simpson trial to the JonBenet Ramsey murder mystery,” Rivera added. “And whether or not my audiences knew it, they were getting an education in forensic science—and a lesson in how medical science is applied to this country’s criminal laws.”
An ‘Expert’ and an ‘Irritant’
Though also certified in anatomic pathology and clinical pathology, Wecht has spent his career as a forensic pathologist focused on determining the cause of death. He has performed approximately 17,000 autopsies and has supervised, reviewed, or been consulted on approximately 30,000 additional postmortem examinations, the Cyrilwecht.com website states.
Cyril Wecht, MD, JD (above), told the Pittsburgh Jewish Chronicle that he wrote this memoir so readers could understand the “… complexity and the multifaceted challenges of the interface of law and medicine, specifically in the realm of pathology, and how important it is for justice to be served, with the input from forensic science, and how the system can be subverted, perverted, suppressed, and manipulated.” (Photo copyright: Pittsburg Business Times.)
Pathologists who followed Wecht’s career may know of his reputation “as both an expert and an irritant,” noted the Pittsburg Post-Gazette. For his part, Wecht stated, “If I had been a bit more diplomatic and patient, and a little less antagonistic and controversial, I might have achieved more,” the newspaper reported.
Anyone interested in forensic pathology will likely enjoy reading the behind-the-scenes stories from Wecht’s more than six decades of work. But Wecht’s memoir should be particularly intriguing and informative for clinical and anatomic pathologists, as well as all medical laboratory scientists.
Though clinical laboratory RT-PCR tests remain the ‘gold standard’ when diagnosing COVID-19, at-home antigen tests offer convenience and quick test results. But are they accurate?
Clinical laboratory and pathologists generally acknowledge that RT-Polymerase Chain Reaction (RT-PCR) tests remain the preferred method for detecting COVID-19 disease. However, according to Popular Science, rapid at-home antigen tests that accurately identify people carrying larger loads of the virus are becoming important tools in the fight against spread of the coronavirus.
DxTerity SARS-CoV-2: This saliva-based collection kit is available on Amazon and at Walmart for $110. Specimens must be sent via FedEx on the same day as collection. Results are available within 24 to 72 hours of the sample being received by the PCR testing lab.
Lucira Check It COVID-19 Test Kit: Billed as offering “PCR quality molecular accuracy,” this nasal swab test costs $55 and provides results in 30 minutes or less.
Abbott BinaxNOW Antigen Self-Test. Results within 15 minutes and available for $23.99 at major pharmacies. Each box includes two nasal swab tests, with the second test taken within 36 hours of the first.
Pixel COVID-19 At-Home Collection Kit: This nasal-swab-based mail-in collection kit is available online for $119. Results delivered within 24 to 48 hours of the sample being received by Labcorp.
Many of the newest at-home tests not only have users collect their own swab or saliva samples, but some also provide results in less than an hour, which can be sent to the user’s smartphone. Conversely, home-based collection kits that are returned to clinical laboratories for testing can take 48 hours or longer for shipping and processing.
The FDA’s emergency use authorization announcement (EUA) for Ellume’s $38.99 COVID-19 At Home Test (above) states the test “is a rapid, lateral flow antigen test, a type of test that runs a liquid sample along a surface with reactive molecules. The test detects fragments of proteins of the SARS-CoV-2 virus from a nasal swab sample from any individual two years of age or older.” Ellume’s self-collection test was the first such test to receive an FDA EUA for use without a physician’s order. (Photo copyright: Ellume).
Among the issues cited were the potential for inadequate samples and improper handling to cause inaccurate results, as well as uncertainty whether at-home antigen tests will pick up on COVID-19 variants.
At-home tests also are less likely to be covered by insurance, MedPage Today reported.
During the CAP virtual media briefing, pathologist Kalisha Hill, MD (above), Chief Medical Officer and Chair, Department of Pathology and Medical Director, Laboratory Services, at AMITA Health St. Mary’s Kankakee (Ill.), said, “The gold standard is still a laboratory-performed real-time PCR test and that is the most sensitive and most accurate that we do that is very specific for COVID-19.” Hill called at-home tests a “good screening tool,” but she noted, “You’re testing that moment, that day, and as soon as you leave your home or come in contact with someone else, you could potentially be COVID positive. It’s also important to recognize that when you’re collecting a sample yourself, you may not be able to obtain enough sample for an accurate result … It’s very important how it is collected and also the sensitivity and specificity of the test,” she added. (Photo copyright: AMITA Health/LinkedIn.)
How Do the Tests’ Accuracy Compare?
The Quest Direct and LabCorp Pixel tests—both of which are sent to company labs for PCR testing—scored highest on the two main statistical measures of performance sensitivity (positive percent agreement) and specificity (negative percent agreement). According to Popular Science, each of these tests’ sensitivities and specificities are close to 100%.
According to the websites of the other tests reviewed by Popular Science:
DxTerity test, which uses a saliva sample—97.2% sensitivity and a 92.5% specificity.
BinaxNOW test—84.6% sensitivity and 98.5% specificity.
Cue COVID-19 test—98.7% sensitivity and 97.6% specificity.
Lucira Check Its test—98% accuracy.
Ellume test—95% sensitivity and 97% specificity.
Rapid Antigen Tests Accurate and Easy to Use, says Popular Science
Popular Science found the tests generally easy to use and concluded they are a beneficial—if imperfect—tool in the fight against COVID-19.
“If you’re unvaccinated and symptomatic, they’re a great way to confirm a COVID-19 infection without risking a trip out of the house,” Popular Science stated in its article. “If you’re unvaccinated and have no symptoms, and just want to know whether you can safely attend a family dinner or soccer game, an at-home test remains an imperfect way of self-screening. Remember: If the test comes back negative, there’s still the chance the result is false, and you could accidentally expose others by being within six feet of them without a mask on.”
As the popularity of at-home COVID-19 tests increases, clinical laboratories that perform RT-PCR tests may want to keep a watchful eye on the demand for at-home rapid antigen testing, especially now that some tests are available without prescription.
New USPSTF guidelines suggest reducing the volume of Vitamin D deficiency testing in the general population, which could reduce revenue for clinical laboratories
From 2005 to 2011, the volume of clinical laboratory tests for Vitamin D soared nationally as more doctors tested more patients for Vitamin D deficiency. This became a major source of revenue growth for many clinical laboratories performing those tests. But at least a portion of lab revenue associated with Vitamin D testing may be in jeopardy.
In a recommendation statement published in JAMA Network, titled, “Screening for Vitamin D Deficiency in Adults,” the United States Preventive Services Task Force (USPSTF)—following up on its 2014 recommendations—stated “that the current evidence is insufficient to assess the balance of benefits and harms of screening for Vitamin D deficiency in asymptomatic adults.”
The USPSTF’s new recommendations concerning Vitamin D testing came after the federal task force performed an extensive review of the benefits and potential harm of screening for Vitamin D deficiencies in non-pregnant adults who displayed no symptoms of a deficiency. Symptoms of a Vitamin D deficiency include fatigue and tiredness, bone and back pain, depression, impaired would healing, bone loss, hair loss, and muscle pain.
After completing its research, the USPSTF concluded “the overall evidence on the benefits of screening for Vitamin D deficiency is lacking. Therefore, the balance of benefits and harms of screening for Vitamin D deficiency in asymptomatic adults cannot be determined.”
Are USPSTF Conclusions Contrary to Current Deficiency Testing Practices?
“Among asymptomatic, community-dwelling populations with low Vitamin D levels, the evidence suggests that treatment with Vitamin D has no effect on mortality or the incidence of fractures, falls, depression, diabetes, cardiovascular disease, cancer, or adverse events,” the JAMA Network article states.
Other studies have linked low Vitamin D levels with some health conditions and risks, however, the USPSTF review found no studies that directly evaluated any perks associated with Vitamin D screening in otherwise healthy individuals.
Everyday Health listed 10 illnesses linked to low Vitamin D deficiency. They include:
“We see a lot of associations between Vitamin D deficiency and poor health outcomes,” Mary Byrn, PhD, RN, an associate professor at Loyola University in Chicago who studies Vitamin D, told Everyday Health. “Although these are relationships and we are unable to conclude cause and effect, taking Vitamin D supplements or exposing yourself to the sun in a safe manner to increase Vitamin D naturally are easy ways to improve your health and try to reduce your risk of multiple diseases,” she said. (Photo copyright: Midwest Nursing Research Society.)
Can Vitamin D Supplementation Be Harmful?
The USPSTF study also stated that Vitamin D supplementation appears to be safe and that toxicity from too much Vitamin D would be rare. One of the USPSTF’s key concerns of screening for Vitamin D in asymptomatic individuals was the potential for misclassification and inaccurate diagnoses.
The study also revealed that more research is needed to determine what serum levels are optimal when diagnosing a Vitamin D deficiency, and whether those levels vary by subgroups, such as race, ethnicity, or gender.
The JAMA Network article states that “the evidence is inconclusive about the effect of treatment on physical functioning and infection.”
The amount of Vitamin D individuals need each day depends upon their age. The National Institutes of Health (NIH) recommends that adults between the ages of 19 and 70 get 15 micrograms or 600 International Units (IU) of Vitamin D daily.
According to an NIH fact sheet, people can receive Vitamin D through sun exposure, supplements, and some food, such as fatty fish, mushrooms, beef liver, cheese, and egg yolks, plus foods that are fortified with Vitamin D, such as some milk products and breakfast cereals.
Vitamin D and COVID-19
It has been widely reported that approximately 42% of Americans are Vitamin D deficient. And Vitamin D deficiency has been linked to an increased risk of contracting the SARS-CoV-2 coronavirus and how well patients recover after COVID-19 treatment.
A study published in the Journal of Clinical Endocrinology and Metabolism that examined 216 COVID-19 hospitalized patients in Spain found that over 80% of those individuals were deficient in Vitamin D. The study also found that COVID-19 patients who had lower Vitamin D levels also had a higher number of inflammatory markers that have been associated with poorer COVID-19 outcomes. The results of this study were in March.
For several decades, experts have recommended avoiding sun exposure and using sunscreen to avoid skin cancers. This may have caused people to get less Vitamin D from sun exposure. It may also have contributed to an increase in the number of Vitamin D deficiencies and increased COVID-19 infections.
Pathologists and clinical laboratory managers should keep in mind that the USPSTF recommended less testing for Vitamin D deficiencies in asymptomatic individuals. This proposal may affect test volume in clinical laboratories, as Vitamin D testing has been a common and lucrative assay for many years.
The precipitous drop in COVID-19 testing leaves clinical lab leaders wondering, “What comes next?” So it’s time to pivot—again.
When the pandemic hit in March 2020, clinical labs faced a sudden halt in routine testing, and many were able to shift quickly to COVID-19 test offerings. Fast forward one year: with the COVID-19 vaccine rollout, SARS-CoV-2 testing in clinical laboratories has rapidly declined. In the United States, COVID-19 testing dropped from two million per day in January 2021 to only about one million by March.
Now labs are having to adapt again, leading forward-looking lab managers and directors to ask:
What will be the new balance between testing for SARS-CoV-2 and routine diagnostics?
Should my clinical laboratory even continue testing for coronavirus?
Where is the best opportunity to generate revenue now?
How do I transition my lab effectively—and efficiently—to best serve patients and the healthcare industry as a whole?
This white paper, Repurposing Your Lab’s Leftover COVID-19 Samples: Building New Revenue and Better Patient Outcomes Through Collaboration with Life Science, answers these questions and more. It explores how the rapid decline in SARS-CoV-2 testing affects molecular laboratories and the life sciences industry as a whole and offers opportunities for drug developers and labs to work together in new and beneficial ways.
Biospecimens present a win-win proposition for both the clinical lab and life sciences industries
As researchers on the life-science side study coronavirus and other diseases, the value of accumulated biosamples is being reevaluated. UCSF Professor Scott VandenBerg, MD, PhD, draws the connection: “Biospecimens are important because they allow researchers to better understand the causes of diseases and evaluate potential therapies.” Labs have always retained biospecimens, but COVID-19 has spotlighted their value.
Drugmakers are expected to prioritize the development of therapeutics for new patient cohorts, such as long-haul COVID-19 patients while verifying the fidelity of biomarkers used to identify and treat comorbidities. Data generated from analysis of leftover COVID-19 samples that labs can provide could dramatically accelerate this process.
This white paper examines how molecular laboratories can generate new revenue while also contributing to the greater good of society. One primary way to achieve both is to harvest more value from samples through new relationships with life science companies and biobanks. In these new business arrangements, labs would also benefit because instead of paying to dispose of their leftover COVID-19 specimens as regulated medical waste, they could biobank them at little to no cost.
Table of Contents—Chapters at a glance
This 24-page white paper, Repurposing Your Lab’s Leftover COVID-19 Samples: Building New Revenue and Better Patient Outcomes Through Collaboration with Life Sciences, includes the following main chapters:
Chapter 1: COVID-19 Testing: What’s Next After the Rapid Ramp Up and Sudden Decline?
While many labs initially lost revenue when routine testing crashed with the pandemic shutdown, the seemingly unending demand for SARS-CoV-2 testing helped labs rally as they pivoted from traditional diagnostics to COVID-19 testing. Some labs reported exceptional year-over-year revenue growth. At least 48% of clinical labs adopted new testing methodologies or automation to meet the demands of COVID volumes, and many startup and pop-up labs were launched, pointing to a significant investment in COVID testing alone. This chapter examines where we are now and what might be ahead now that COVID-19 testing is winding down.
Chapter 2: Looking Beyond COVID-19 Testing to Find Residual Value and Revenue in Collected Specimens
To stay profitable and relevant, every clinical and molecular laboratory’s short-term and long-term strategic planning must consider the evolving nature of the pandemic. This chapter covers what labs should consider as they evaluate how to repurpose their COVID-related assets, including equipment, molecular testing platforms, and COVID-19 specimens themselves.
Chapter 3: Key Points of Molecular Laboratory Diversification into Biobanking
Biobanking can be a positive thing for labs—for example, to supplement revenue, advance research, and lead to other business development in the lab services space. But it also has its challenges. This chapter discusses both the potential benefits of biobanking and the hurdles labs can face, including regulations, logistical difficulties, consent, collecting and managing samples, and building relationships with industry and research partners.
Chapter 4: The Role of LIMS in Biobanking
Questions often surround the value of a sample, such as: How was the sample collected from the patient? How was it stored? Is the label still secure? When will the sample expire and no longer be considered valuable for research? For labs trying to organize their samples and have at-a-glance answers to questions about them, a proper laboratory information management system (LIMS) or laboratory information system (LIS) streamlines the process. This chapter covers what lab managers and directors should consider as they look to strengthen their quality systems to validate and verify their samples and tests.
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