College of American Pathologists
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  President’s Desk Column


cap today

Laboratory quality: good works get better

August 2003
Paul A. Raslavicus, MD

Our College is a unique organization. Other medical associations tend to have a professional staff run them while the members exist as passive bystanders. The CAP, on the other hand, involves its members fully, and, at the same time, depends on its members to make things tick. Your officers and governors, elected by you often in a truly contested fashion, bring to their job of running this organization the wisdom and knowledge of the diverse environments in which we all practice. And hundreds of you and your coworkers in the medical laboratory are engaged in and run our Laboratory Accreditation and Surveys programs. It is because you are involved and concerned about doing the right things that our specialty maintains its preeminence.

Others may try to provide accreditation services, but our program is the only one that is not a patchwork of the diverse offerings of different providers. Other accreditation programs will never match the seamless integrated product you have developed for the College. And while costs of participation vary with the complexity of the laboratory, our programs are competitively priced and have features (such as the presence of a pathologist on the inspection team) for which other providers charge a substantial fee.

In any given year, 10,000 people will serve on CAP inspection teams. Our inspectors—be they medical technologists, cytotechnologists, supervisors, quality assurance managers, laboratory and administrative directors, or pathologists—have the opportunity to both teach and learn from others. This knowledge exchange, unique to our program, invigorates all participants.

Our inspectors have expertise in all anatomic and clinical pathology disciplines and direct knowledge of the day-to-day challenges laboratory personnel face. They are provided with additional learning opportunities that provide CME and CEU credits. They can earn credits by attending inspector training workshops and audioconferences and by enrolling in Web-based learning programs. And this year, medical technologists who work in transfusion medicine, microbiology, and hematology will be able to earn CEUs by taking self-tests incorporated (at no additional charge) into their proficiency testing modules.

Unlike some, we believe all testing is important to patient care and should be monitored. We reject the notion that waived tests cannot endanger patient welfare and do not require proficiency testing. Just ask risk managers whether excluding such testing from the accreditation process makes fiscal sense. We are committed to providing proficiency testing for all tests (waived, basic, and leading edge), and we have the resources to do it. More than 60 medical technologists on the CAP staff have access to hundreds of highly qualified pathologists and full panels of subspecialists on CAP resource committees to answer the inevitable questions that arise.

We ensure that you can evaluate your laboratory’s performance well by offering large peer groups for nearly every analyte-method combination. Our menu of more than 400 unique products is much larger than that offered by any other proficiency testing provider and meets the needs of laboratories of every size. In 2004 alone, thanks to the efforts of our pathologist-run resource committees, we will provide 29 new Surveys and EXCEL modules, at least 15 of which are not available from any other source.

Some of you, I’m sure, are overwhelmed by the inspection process. Because of our training in scientific medicine, physicians tend to be thorough in examining the patient. Similarly, when it comes to evaluating the medical laboratory, we tend to examine that elephant from all sides rather than get just an overall view. We aim for the best diagnosis of quality in the laboratory. In achieving this, we have permitted the number of laboratory checklist questions to grow significantly. With the help of federal regulations and the bureaucracy of HIPAA, CLIA, compliance, and more, we have seen a marked increase in the required documentation. It could consume the paper output of an entire Maine lumber mill.

Your colleagues on the Commission on Laboratory Accreditation have recognized these burdens and are committed to smashing the bureaucracy. Many of you have worked, in focus groups, on inventing customer-friendly solutions. We all agree that in examining the elephant, we do not need to ask if the elephant has stripes. A few examples of changes that have been made:

  • Customized checklists tailored to each laboratory’s test menu are now in the field. If you don’t do mycobacteriology, you will not find those questions in your packet. If you don’t do electrophoresis, you will not be asked about it. No more “not-applicables.”
  • The chemistry, special chemistry, and toxicology checklists have been combined to eliminate redundant questions. One hundred ninety such questions have bit the dust.
  • New or modified questions have been highlighted to make it easier to spot changes.
  • The College now provides immediate online acknowledgment as soon as Surveys results and other lab improvement program documents are received.
  • We have redesigned our account statements to reduce ambiguity about the status of the account.

But those changes are just the beginning. As I wrote in my May column, educating professionals is best achieved with programs that provide timely feedback and opportunity for interaction. Hence, our Board has approved the immediate development of an information technology Internet-based initiative that will provide interconnectivity between our laboratories and the CAP. Whether you are a laboratory administrator or a charge medical technologist, real-time inquiry and visualization of proficiency testing status will be a reality. No, we will not introduce nonmanipulative files (such as PDF files) for print out. That does nothing more than transfer paper printing costs from the provider to you. Rather, we will feature dynamic, two-way electronic communication in a secure environment. In a robust way, we will provide tremendous flexibility for you to manipulate and use the knowledge advantage you gain by being a CAP-inspected laboratory.

If you are being inspected this year, by the next inspection cycle you will be able to authorize online access to specific lab improvement program documents for which your staff is responsible, provide online inter-institutional data to those responsible for hospital or laboratory systems, and manipulate data for varied applications. By 2005, Laboratory Accreditation and Surveys participants will have access to optional forms to submit much of their data electronically. Individual performance evaluations and participant summary reports will be available via secure online communication.

We have made important changes in our laboratory improvement programs in the past two years, and more milestones will be achieved in the future. The technology is wonderful, and it will make life easier for all of us. But the foundation of these programs will always be the willingness of all of you in the laboratory to invest time and energy on inspection teams, on resource committees, and in a host of related good works. You are the backbone of our success.