1. CAP Test Ordering Program
Adding to Pathologist Value
Anthony J. Guidi, MD, FCAP
CAP Quality Practices Committee
Prepared for the Massachusetts Society of Pathologists
May 30, 2018

2. Survey #1 of CAP Members - Test Utilization Market Study
Agreement with Statement: “My practice and/or institution is interested in improving laboratory test utilization.”

3. Survey #2 of CAP Accredited Lab Directors
Agreement with Statement:
“Need to address test ordering patterns at my institution.”

4. CAP Member Feedback (2015 Survey)
63% of lab medical directors surveyed felt test ordering patterns needed to be addressed
84% of respondents felt the pathologist is critical to address the issue of test ordering
There is a positive correlation between the range of tests offered and the level of concern about the utility of ordered tests
Most popular strategies: educate clinicians (94%) and provide testing guidelines (89%)
The quote at the bottom of the page was a free-form comment from one of the CAP member respondents to the survey.
“The most urgent issue in pathology today”
© College of American Pathologists

5. Test Ordering Program Background Information
Designed & developed by QPC members to assist pathologists with their test utilization efforts
Decision to advance concept as a free benefit service to CAP member community
Provides testing strategies in a rational and evidence-based manner
Focuses on both underutilization and overutilization
MOC Part IV ABP Approved - Self Claim Activity
This is NOT CAP providing guidelines, per se

6. Test Ordering modules include…
High-level synopsis with relevance
Background information
Module objectives
Multiple interventions appropriate to the problem:
Changes to computerized provider order entry systems (alerts, soft stops, hard stops)
Duplicate test order checks (same day, never repeating constitutional genetic tests)
Establish diagnostic algorithms (celiac disease)

7. Test Ordering modules include…
Impact Analysis: How making changes will impact patient care, laboratory operations, etc.
Tables to collect data before & after interventions (test volumes, decreased send out costs)
MOC style questions with answers and explanations
References and useful links
“Clinician” handout with test ordering suggestions & rationale for recommendations
Sample diagnostic testing algorithms, as appropriate

8. Test Ordering Module Pathway to Approval
Because of the impact of test ordering on pathologists and laboratories, a rigorous process is used to approve topics and review modules through appropriate committees and councils before publication.

9. Modules Provide Information, Solutions and Diagnostic Support to Stakeholders
Pathologists
Laboratory managers
Internists, primary care physicians, specialists, genetic counselors, etc.
Hospital/Laboratory information system managers
Hospital administrators, C-Suite
…and ultimately, patients.
Pathologist leadership in appropriate laboratory test ordering reflects pathologist value.

10. Modules launched during in late 2017
4 web-based modules available: BNP, Cardiac Markers, Red Cell Folate, HCV
Two different downloads for CAP members:
Full text pathologist document
Clinician handout provided with background, order suggestions and references
Additional Web features planned for Version 2
Case examples
Member feedback

11. Accessing the Test Ordering Program
Log in to
Visit the Test Ordering Page
(Home > Member Resources > Test Ordering
Program)

12. Web Page

13. The Modules (on the Web Page)

14. Example Module: BNP

15. Full Module for Pathologists
The full module looks very similar, but it includes far more sections. In the case of BNP, the clinician handout is 1 complete page and part of a second page to cite sources. The full module is 5 pages and includes several a list of interventions, a section on conducting impact analysis, and educational reinforcement questions.

16. Clinician Handout
The full module looks very similar, but it includes far more sections. In the case of BNP, the clinician handout is 1 complete page and part of a second page to cite sources. The full module is 5 pages and includes several a list of interventions, a section on conducting impact analysis, and educational reinforcement questions.

17. Example Module: Celiac testing

18. Example Module: Tick Borne Testing

19. Discussion
What interventions are you using currently for testing ordering?
What interventions for test orders would you adopt for your laboratory?
How would/do you notify clinicians regarding test ordering interventions at your laboratory?
Would you show the change in test orders to your facility administrators?
What test orders or diagnoses provide the most challenges to your laboratory?
What modules would you like to see developed by the CAP Quality Practices Committee?