CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
The bigger challenges relate to the pace of emerging science—particularly precision medicine, which has its own lexicon. Raouf Nakhleh, MD, who chairs the Council on Scientific Affairs, says that the need for the best available evidence accessible to nonpathologists without an interpreter exploded when personalized medicine began to find its footing. That may have been the single best reason to create the Center, Dr. Nakhleh says, because when a lot is happening at once, the real problem is figuring out what is most relevant.
The Center is designed to distill what needs to happen first and provide a place to talk that through. To that end, we have had the benefit of a thoughtful document developed in 2011 by the then Institute of Medicine of the National Academies titled “Clinical Practice Guidelines We Can Trust,” which looks at approaches to managing conflict of interest, establishing transparency, and forming a balanced, qualified multidisciplinary team. More recently, the Center has added another resource, known as GRADE (Grading of Recommendations Assessment, Development and Evaluation), an internationally recognized tool to weigh the strength of evidence and create guidelines that are transparent, clear, and consistent. GRADE will foster communication across disciplines and enable us to show our value to all facets of medical care. An editorial in Laboratory Medicine explains how it works (Schmidt RL, et al. 2019;50[1]:5–7).
One early concern was that our initial projects were focused on anatomic and breast pathology. Elizabeth Wagar, MD, who succeeded Dr. Hammond, brought more guideline projects into the realm of clinical pathology, encouraging a deeper dive into other biomarkers and immunotherapies. That was a big step, but as Dr. Wagar likes to say, the CAP has chosen to look outward for new ways to help our patients and to grow awareness of how pathology contributes to patient care. Patrick Fitzgibbons, MD, who now chairs the Center, also sees our potential through a wide-angle lens. He has noticed, for example, that our guidelines are being applied to develop metrics for the CAP Pathologists Quality Registry. What goes around comes around.
After guidelines are complete, they are shared across the CAP. The Council on Accreditation, for example, reviews final guidelines to identify items for referral to responsible councils and the Checklists Committee. Because the CAP has deeming authority to represent the Centers for Medicare and Medicaid Services, we are tasked with making sure that our accredited laboratories comply with CLIA requirements. It takes time to write the checklist requirements that implement a new guideline, and that cannot begin until the guideline is approved. So it is important to understand that release of a practice guideline does not trigger its use in laboratory inspection. Laboratory inspectors work with the checklists.
I’d like to recognize our wonderful staff led by Lisa Fatheree at the CAP. Center teams review and revise; we may receive thousands of comments on a given guideline and every single one is carefully weighed. It never ends. Fortunately, our staff is energetic, diligent, and bright, with wide expertise. The Center could not function without them.
As the science presses forward, Center guidelines will grow along with it, giving our colleagues new tools to inform and refine patient care and opening new avenues of inquiry for translational research. And we will provide a space within which to continue the pursuit.
Dr. Williams welcomes communication from CAP members. Write to him at president@cap.org.