Different clinical labs use different names for the same medical laboratory test, causing confusion among doctors who order and interpret tests and adding risk to patient care
Is there a common name for every unique medical laboratory test? Patients and consumers generally assume that to be so. But clinical pathologists, medical technologists, and other lab scientists know that different labs use different names for the same medical lab test and methodology.
The lack of uniformity in how medical laboratory tests are named by different labs is a problem—not just for physicians and patients, but also when lab test results are shared across the electronic health record (EHR) systems of hospitals and doctors’ offices. The multiplicity of names for the same medical laboratory test can confuse physicians when they are ordering lab test or interpreting the results of those tests. All of this adds risk to patient care.
Now, a new national coalition of pathologists, clinicians, professional organizations, accreditation agencies, large reference labs, and terminology groups called TRUU-Lab (Test Renaming for Understanding and Utilization in the Laboratory), is working “to create a consensus guideline for giving laboratory tests more rational and consistent names.”
TRUU-Lab aims to create a set of guidelines for the development of clear and consistent medical laboratory test names, as well as the launching of easy-to-understand names in online lab test menus.
“It is a bit shocking that it is 2019 and there is no standardization in the US on how to name the lab tests,” Ila Singh, MD, PhD, founder of TRUU-Lab, told Dark Daily. “Sometimes we name the medical laboratory tests based on the analyte—or the patient for which it was first discovered—or we call it after the physician who discovered it. And vendors give names to lab tests that meet their goals. So, it’s kind of a free-for-all,” she admitted.
Singh is Chief of Laboratory Medicine in the Department of Pathology at Texas Children’s Hospital and a tenured Professor of Pathology and Immunology at Baylor College of Medicine in Houston. She will be speaking at the upcoming Executive War College in New Orleans on TRUU-Lab’s national initiative to “create a consensus guideline for giving laboratory test more rational and consistent names.”
Lack of Standard Clinical Lab Test Names Confuses Ordering Physicians
Some medical laboratory scientists and pathology leaders say the lack of standardization in naming medical lab tests not only confuses ordering clinicians, it confuses patients and insurers as well. It also leads to inappropriate test utilization, high costs, and safety and quality issues.
TRUU-Lab and coalition member the American Society for Clinical Pathology (ASCP) Choosing Wisely conducted a survey to ascertain some of the top perplexing medical lab test names.
“Vitamin D is a big one,” Singh said. “There are two main tests, but you can find up to a dozen names for the same test.”
One such blood test is 25-hydroxy vitamin D (Calcifediol) and another is 1,25-dihydrozy vitamin D (Calcitriol). Both tests involve vitamin D, however the latter test is ordered “when kidney disease or abnormalities of the enzyme that converts 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D is suspected,” according to Lab Tests Online, a guide to lab tests coordinated by the American Association for Clinical Chemistry (AACC), a TRUU-Lab coalition member.
“If physicians cannot distinguish between the two different vitamin D names, they decide to just order both tests and deal with the issue later when the results come back. And if results are fine, they know they don’t have to deal with it at all. So, there is a lot of excessive test ordering and wrong ordering,” Singh explained.
She added that a study conducted at Texas Children’s Hospital found that ordering clinicians chose the wrong vitamin D test 30% of the time.
Other popular tests have different names for the same test and the redundancies can lead to inefficiencies in test ordering, the TRUU-Lab website notes. It gives the example of hemoglobin A1c, which is also known as glycosylated hemoglobin or HgbA1C.
Problems also arise when doctors cannot find the right lab tests to order. Take, for instance, viral tests that are named for the virus. Sounds simple enough. The test for the human immunodeficiency virus (HIV) is called the HIV test. However, viral test ordering can get tricky. For example, the test for measles is named after the rubella virus (Rubella, Latin for “little red,” was first used to describe measles in 1866). “People forget it is called rubella. Then, it is hard for physicians to find the name of the test. They end up ordering tests that lead to delays (in diagnosis and care),” Singh said.
“There are lots of problems,” Singh noted, adding that people think a Free Prostate-Specific Antigen test is a lab test that is “free-of-charge,” which would be funny if it weren’t so concerning.
Clinical Laboratory Leaders Can Help!
Though Singh acknowledges past attempts to rename medical laboratory tests in the US, as well as the work by lab industries in Canada and Australia, where standard guidelines for lab test names do exist, she stresses that more work is needed. “The problem is they have not made ease of understanding the standardization (among clinicians) a priority,” Singh said.
TRUU-Lab has three goals:
- Reach consensus on guidelines for naming lab tests;
- Develop easy-to-use names for tests; and,
- Implement and adopt use of lab test names as widely as possible.
Attendees of the 24th annual Executive War College, April 30 to May 1, will have an opportunity to learn about TRUU-Lab’s efforts during Singh’s breakout session, “New! National Effort to Standardize Names of Lab Tests to Avoid Confusion, Help Physicians, Patients, Payers: Progress Update and How Your Lab Can Help.”
Singh’s presentation will inform clinical lab leaders that:
- Understanding the lack of lab test name guidelines is a huge problem affecting utilization management at hospitals;
- TRUU-Lab is a way to address the problem nationally; and,
- Opportunities exist for pathologists and lab leaders to get involved.
“I want this to be the kind of project people want to get aligned with,” Singh said.
Register for EWC online by clicking here, or by calling 707-829-8495. (Or copy and paste this URL into your browser: https://www.executivewarcollege.com)
—Donna Marie Pocius