Diagnostic danger in the lab: Time to reform how we process orders

I don’t know about you, but I was stunned by the findings from a recent report published by Coverys, a national liability insurer, which I feel should put the entire lab industry on notice that it plays a crucial role in keeping patients safe. According to the report, which examined over 10,000 claims in an effort to understand the chief drivers of medical malpractice suits, 52 percent of the claims were riddled with lab testing-related errors.¹ Either the wrong test was ordered, or the test was incorrectly administered, or the results misinterpreted.

These findings aren’t just a random outlier, either. In another concerning report, the ECRI Institute listed diagnostic errors as its number one patient safety concern for 2018.²

As a physician, I know that many of these errors can originate on the provider side. It’s not always all that simple to choose the right test based on the right diagnosis. And if that task is delegated to someone else, even more can get lost in translation before the order is actually submitted to the lab.

But in my additional experience as the founder of a lab interoperability company, I also see the diagnostic safety issue as one that labs are in an influential position to solve. Any lab that does so will become the established, trusted facility in their healthcare community.

With that, here are three reforms in particular labs can institute—helping to create what I call “the Perfect Order” process.

Reform #1: Real-time electronic order capture. This single change can greatly reduce the confusion that comes with handwritten or EMR-printed requisitions. Different options capture orders electronically, in real time, from each physician’s practice with little if any human intervention. These include EMR interfaces to the LIS; web-based ordering/resulting portals; or even paper-to-digital conversion services.

An additional word on portals—these aren’t only for client physicians to order and view results. Patients, too, can directly access their results from these portals, eliminating multiple steps for labs and providers. However, as a physician, I have to recommend that this doesn’t include the crucial step of explaining the results to the patient. While that isn’t typically the lab’s province, the lab would do well to emphasize to client physicians that portals should enhance, not supplant patient-provider communication.

Lastly, consider using an electronic means—such as 2D or 3D barcoding—to label lab specimens. This can also greatly reduce the potential of error simply by making the information on the label clearly legible and removing the need for human data entry.

Reform #2: Patient identity matching. According the RAND Corporation, we could save upwards of $77 billion by assigning a unique patient ID to each patient.³ More importantly, we could also save lives. As noted in a letter sent by several sitting U.S. senators to the Government Accountability Office, patient matching is an essential strategy to reduce risk of harm to patients. The senators cited a survey by The Council of Health Information Management Executives, in which 20 percent of surveyed physicians said they’d directly encountered mismatched information that resulted in illness or injury to a patient.⁴

In some communities, the risk of mismatching data is even higher, including ethnic communities with a high prevalence of the same name.

Here again labs can step up and solve a persistent problem. Today’s state-of-the-art technology allows labs and imaging centers to implement a unique patient ID as part of their ordering and results integration efforts. In addition to reducing risk, having a unique patient ID in place can help labs participate in more population health initiatives, in local ACOs and obtaining payer contracts with payers who desperately need clean and reliable clinical data.

Reform #3. Better reimbursement compliance. Labs can no longer stand on the sidelines when it comes to billing for orders. Risk of audit is increasing, even as reimbursement is declining. A system for allowing real-time order editing before an order enters the laboratory is key. It should allow the lab to receive all orders electronically and fully validated for medical necessity; patient identity; insurance eligibility; and pre-authorization when required.

A final observation about implementing patient safety reforms. They need not come at the expense of profitability. These reforms should actually pay for themselves by reducing claims denials and giving facilities a competitive edge. No doubt other labs will follow suit. As such, it’s time to decide if your own lab will be one of the followers—or the one leading the charge for patient safety reform.

<sup>1. https://coverys.com/PDFs/Coverys_Diagnostic_Accuracy_Report.aspx↵
2. https://www.ecri.org/press/Pages/Diagnostic-Errors-Patient-Safety-Concerns.aspx↵
3. https://www.rand.org/pubs/monographs/MG753.html↵
4. https://www.warren.senate.gov/files/documents/2017_10_03_GAO_Patient_Matching_Letter.pdf↵</sup>

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Oleg Bess, MD, is a founder and CEO of 4medica, the clinical data exchange company. With a quarter century of healthcare experience, Dr. Bess has spent the last 13 years honing his development and leadership expertise in informatics while maintaining his 20-year-old OB/GYN practice in Los Angeles. A board certified OB/GYN physician, he is a nationally recognized gynecological and laparoscopic surgeon, as well as a committed philanthropist.