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  Matching labs for inspection now faster,
  more objective

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April 2007
Originally published in CAP TODAY

Ed Finkel

The world of online dating isn’t the only place where a good match is golden.

In a peer-based accreditation program, the right pairing of inspected and inspecting labs is all-important. That’s why the CAP has rolled out a new automated inspector assignment system—one that’s more efficient, objective, and systematic in determining which labs should inspect which labs.

The new system quantitatively matches labs as closely as possible by size, complexity, subspecialty areas, and location. The system also checks to make sure labs are not assigned to inspect another lab during their own six-month inspection window for unannounced inspections.

“In general, it’s a positive move. It needs some refinement, and they are refining it,” Inspection Process Committee chair C. Robert Baisden, MD, says of the automated system. It will help the accreditation program’s state commissioners make assignments more objectively. It will also speed things up, making it possible for inspections to be assigned well in advance—and for inspection planning and preparation to be efficient.

Adrienne Malta, manager of inspector services for the CAP, says the aim is a “system that’s helpful for everybody.”

“We received feedback that lab directors want to be assigned to similar, nearby labs… We are trying to be sensitive to the feedback we’re getting. We’re adjusting as we can, but it’s critical to ensure that conflicts of interest are minimized.”

Desiree Carlson, MD, is the accreditation program’s Northeast regional commissioner, covering the six New England states, Quebec, and Canada’s Maritime Provinces, as well as division commissioner handling assignments for eastern Massachusetts and Maine. She has used the system and appreciates being able, on a single screen, to compare potential inspector labs with the lab to be inspected.

“When you go to assign a laboratory in this system, it shows you what the overall match quality is,” she says. “They [CAP staff] came out to my site and had me look at some sample matches they had made.” It was generally felt that an inspection team that doesn’t do, for example, point-of-care testing in its own lab should not be matched with one that does.

Thus, the system compares labs by subdisciplines and puts the areas that don’t match at the top of the list, marked with red asterisks, says Dr. Carlson, chief of pathology at Brockton (Mass.) Hospital. That prompts commissioners to ask themselves: “Do you believe that, because of their experience, this inspector could handle those things they might not do in their own lab? Or would it be better to eliminate them as a potential inspector? Or should you assign them but make a comment to the College that they might need help with certain areas?

“It makes it easier for the assigning commissioner to see very clearly what the activity menu of the inspectee and inspector are,” she adds. “The computer system has a better memory than human beings.”

The computer also is more objective, says Brad Karon, MD, pathologist at the Mayo Clinic and the program’s Minnesota state commissioner, who hopes that the objectivity will prompt fewer of those assigned to beg off.

“I hope it saves the CAP time with labs accepting an assignment and then changing their minds and saying they can’t do it,” Dr. Karon says. “The labs may accept that the computer system can find compatible inspections as well as the commissioners. Or they may not. Hopefully, they’ll accept that we need to be more objective in our assignment and not pick and choose as much.”

The system will match labs no more than 200 miles away from one another. “In general, people feel they shouldn’t have to travel more than two hours by automobile,” Dr. Baisden says.

There are good reasons not to shrink the radius too much. “As we reduce the distance, it lowers the number of potential inspectors,” Malta explains. “We don’t want to give up the quality of the match. It’s all balancing. We have to decide, Are our customers happy with the matches we’re making?”

Dr. Carlson cites another reason not to reduce the distance by too much. “We’re trying not to have them be too close,” she says. “They might be competitors.”

Where laboratories that will do the inspecting once received phone calls from their state commissioners to make assignments, they will now receive a letter with a packet of information that includes an acceptance form, Malta says. The packet contains detailed information including demographics about the lab to be inspected, the current status of potential inspection team members with respect to whether they have received the required training from the CAP, and a conflict-of-interest statement.

The “inspector acceptance of assignment and disclosure statement” that’s inside the packet lists five appropriate reasons for rejecting an assignment: existing business or professional relationship, existing close personal relationship, inability to perform the inspection in the required time frame, a direct competitive relationship, or “other” with space given to specify.

The training-related spreadsheet shows name, affiliated laboratory and address, training status, trained date, subspecialties qualified to inspect, and previous inspection experience for all team members. “That’s meant to be a tool to put together their inspection team,” Malta says.

The switch to an automated system is an unqualified positive for the accreditation program commissioners, Malta says. For one thing, the dozen or so commissioners with whom she’s talked like the user-friendly, Web-based interface the system offers. It displays a side-by-side comparison of laboratory matches it makes, so commissioners can easily cross-check the demographics, test volume, number of beds, and checklists and subspecialties, providing the best match possible, Malta says. They do not have to toggle between screens and take notes on what they see.

Moreover, the system’s scan for conflicts of interest eliminates situations in which a laboratory is assigned to inspect its own inspector. “We don’t want this to become adversarial,” Malta says. “Our new automated assignment process minimizes possible conflicts of interest.”

Previously, keeping track of those conflicts and others would have required an array of spreadsheets and notes, Dr. Carlson says. “I have to make sure B is not inspecting A,” she says. “The computer makes sure that their own lab’s inspection will not occur during that six-month window. I used to do this on spreadsheets and send the spreadsheets out, and ask people where they were willing to go.

“It was incredibly labor-intensive. It would take me a couple days to write letters to people. Things would come up at the last minute. Now I log on to the CAP Web site, it pops up, and if I don’t like something the computer sees as a potential match, I can reject it.” New possibilities are provided the next day. “It’s really easy, it’s more fair, and it cuts down on all the paperwork.... You can find out upfront whether [lab personnel] have blackout dates and what their hours of operation are. There’s a lot more information available on the computer for making these choices,” she says.

The system prompts commissioners to draw labs from out of state in regions like New England, where the states are all in close proximity.

“If the computerized system can’t find a good match in Maine, it might start looking in Vermont or New Hampshire or Massachusetts,” Dr. Carlson says. “The system keeps track so we’re not pulling too much from one region, to another, and not giving back. It’s an advantage especially in small states like Rhode Island. It would tend to get inbred if you didn’t start pulling from farther away.”

Dr. Karon began to use the system only recently, but it was clear from the start that “it saves a lot of time for the commissioners,” he says.

He figures that “a year’s worth of assignments, for the average commissioner, could take 20 to 30 minutes or less,” whereas under the old system “it could take days to make a year’s worth of assignments.

“You’d start with a first assignment, you’d take a list of the people who could do it, you’d leave a message, they wouldn’t be there. Then they’d call back and say they wanted to go fishing in May.”


Ed Finkel is a writer in Evanston, Ill.