Ila Singh is no stranger to the often-confusing web of laboratory test names used in children’s hospitals. She once spent more than six months working to clarify the naming convention for a single vitamin D test. A mostly eradicated childhood disease led her to seek change on a larger scale.
“Most laboratories in the country today still have the measles test listed as rubeola, the old name for measles,” said Singh, MD, PhD, chief of laboratory medicine and chief of pathology informatics at Texas Children’s Hospital in Houston. “It's a rare enough disease that people may have never come across rubeola before. That’s one of the earliest tests that propelled me to find a better way.”
Studies show that as many as 30% of the roughly 13 billion tests performed in the United States every year are either unnecessary or incorrect. In addition to the impact on patient outcomes, testing mistakes pose a financial burden: a National Academy of Medicine study shows unnecessary lab tests cost a typical hospital nearly $2 million each year. Confusion around test-naming protocols is a prime source of these errors.
To address the need for uniformity in lab test naming, Singh founded the Test Renaming for Understanding and Utilization (TRUU-lab) initiative in 2019. TRUU-Lab enlists professionals from nearly every phase of the testing process to inform improvements, with the ultimate goal of standardizing test names in all electronic medical record and laboratory information systems.
Contributors include health care providers and clinicians, professional societies, electronic medical record (EMR) and laboratory information system (LIS) representatives, instrumentation and pharmacogenomic vendors, and liaisons from federal agencies, including the Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), and Food and Drug Administration (FDA).
Identifying the challenges
Soon after its inception, TRUU-Lab surveyed clinicians to determine and classify the most common causes of errors around lab test ordering. Some of the more common naming issues included:
- Ambiguous nomenclature.
- Confusing abbreviations.
- Similar-sounding test names.
- Same test names but more than one indication for use.
- Brand names vs. generic.
- Synonyms.
- Information system limitations, including the inability to fully detail panel components or test algorithms.
Additionally, with funding from the CDC, TRUU-Lab has surveyed more than 1,200 clinicians responsible for test orders. These surveys aim to unbiasedly identify the components of a lab test name that make it clear and accurate.
The TRUU-Lab team meets monthly to create surveys, discuss survey results, identify guidelines for naming tests, and determine how best to proceed with their findings. The next step in the process will be to select new names and create mock EMR platforms to evaluate how providers fare in choosing the new “optimal” lab test names compared to current names.
Three actions hospitals can take now
Singh said it will take some time to get new, standardized lab test names into live production. The surveys have yielded tens of thousands of data points that must be analyzed and categorized. And while the surveys are CDC-funded, the TRUU-Lab members are volunteers.
But she said children’s hospitals can take steps within their existing systems to mitigate confusion around lab test names and reduce the risk of medical errors and unnecessary patient testing:
- Be precise. Use full, exact names for tests to ensure accuracy and avoid confusion caused by multiple tests with similar-sounding names.
- Avoid abbreviations. Only use abbreviations that have become widely accepted in everyday language, such as PCR or HIV.
- Provide indication for use. To avoid confusion and erroneous orders, include in the name what the test is intended to assess.
- Prioritize clarity. Disregard old EMR system conventions like 40-character limits and all-caps. Lowercase letters improve readability and bold and italic fonts help highlight tests more likely to be appropriate for patients.
“We need to use every trick in the book to guide people into ordering the right test,” Singh said.
Putting it all together
Applying these principles to the long-standing confusion between the two forms of vitamin D tests, Singh advocates starting with a precise name like “Vitamin D, 25 hydroxy,” then adding an indication for use, such as “for deficiency screening.” Additionally, use a bold font to distinguish this more commonly used test from the easily misordered “Vitamin D, 1,25 dihydroxy” test.
The final name would look like this: Vitamin D, 25 hydroxy, for deficiency screening.
One key factor to consider when updating any lab test name is how they may be received by patients and their families. With lab test results visible through a patient portal—often before the patient’s doctor has had an opportunity to consult the family—it’s imperative that test names are clear and unambiguous, Singh said.
“I think the anxiety a parent feels around a child’s lab test is much more magnified than in the adult world,” Singh said. “So, clear communication in test naming is even more important because the clinician may not have time to explain each test to a parent before their child goes for a blood draw.”
