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For TRUU-Lab Initiative, test naming a work in progress

February 2022—Ask TRUU-Lab founder Ila Singh, MD, PhD, what’s in a name and she will provide an answer that differs greatly from that of Shakespeare’s Juliet Capulet. According to Dr. Singh, the answer can be too much information, not enough information, or ambiguous terminology—when referring to lab test names, that is.

Through the TRUU-Lab Initiative, Dr. Singh, who is chief of laboratory medicine and chief of pathology informatics at Texas Children’s Hospital, Houston, has joined forces with like-minded medical professionals and others to create easy-to-understand, standardized lab test names, with the goal of reducing errors in test ordering. Among the initiative’s more than three dozen members are representatives of hospital pathology departments, reference labs, electronic medical record companies, industry associations, U.S. federal agencies, and international organizations. “What’s great is that people from agencies like CMS, FDA, CDC, and others join our meetings,” Dr. Singh says.

TRUU-Lab (Test Renaming for Understanding and Utilization in the Laboratory) is developing more precise names for commonly confused tests, which it plans to use to develop consensus guidelines for naming most laboratory tests within the next few years. In contrast to the Regenstrief Institute, which created and maintains machine-readable LOINC codes to identify tests, Dr. Singh is focusing on names “that humans would understand.” To that end, TRUU-Lab is not only developing guidelines but formulating plans to analyze proposed test names in a simulated test-ordering environment, with assistance from the initiative’s EMR vendor members.

“What I would like [EMR vendors] to do—and they have agreed to it—is build mock EMRs,” Dr. Singh says. Vendors would populate the mock EMRs with some of the test names reached through a consensus of TRUU-Lab members to determine if clinicians make fewer mistakes ordering lab tests when using the new names, she explains.

TRUU-Lab member Nick Trentadue, project director for Beaker Laboratory, Epic’s laboratory information system, told CAP TODAY that “there is no reason we couldn’t, for those who have access to Epic, prop up an environment to take a look at what the test names would look like.” Epic clients already have access to a foundation system environment, he adds.

Due to proprietary intellectual property concerns, each vendor would need to build a mock EMR for its own customers, says Trentadue. (Cerner and Sunquest are also among the TRUU-Lab members.) Testing the names on various systems is important, adds Dr. Singh, because the names can often appear differently based on the EMR used.

“Every EMR has its own rules,” she explains. “Some allow 40 characters for a display name. Others, like Epic, have more lenient rules and you can build very long names, so we would have to try out [the names] with multiple vendors.”

It’s crucial that after the mock EMR phase, vendors add TRUU-Lab–recommended names to their base offerings, Dr. Singh says. “EMRs bring you a foundation build that comes with their base level. One way that we can make it easy [to adopt new test names] is by having these EMR vendors say here are all the preferred names in the foundation build.” So far, she notes, TRUU-Lab member vendors are supportive of the plan. “It would save the vendors and hospitals implementing or upgrading their systems both time and resources,” Dr. Singh emphasizes.

“Whether it’s an entire nomenclature or taking the 10 most commonly confused tests and starting from there,” Trentadue says, “we will take action. We have committed to build it out in our foundation system.” Epic will incorporate TRUU-Lab test names into the Epic EMR and Beaker Laboratory LIS since test name clarity is an issue that affects ordering clinicians and the laboratory team, he adds.

Once new names are built into foundation systems, health care institutions will not only be able to access them when they install new EMR systems but also when they upgrade their existing EMRs, Dr. Singh says. But, she notes, discussing test name accessibility is putting the cart before the horse.

For nearly two years, TRUU-Lab has been comprehensively surveying clinicians to assess how well they understand test names and determine what information they would like included in such names. The surveys are funded through a grant from the Centers for Disease Control and Prevention. The initiative is currently conducting a series of clinician surveys in partnership with Brand Institute, a branding company with extensive experience naming pharmaceuticals.

The surveys are necessary, Dr. Singh explains, as indicated by discussions she held with members of the laboratory medicine committee at Texas Children’s Hospital, because the information pathologists consider important in lab test names may not be relevant to clinicians. For example, some test names reflect the type or sensitivity of the assay, but clinicians may prefer test names that describe what the test should target. “We are giving them information that we would like to see but not what they need to see,” she says.

Brand Institute is sending the surveys to clinicians in its database. Respondents enter a portal and answer the questions. TRUU-Lab is seeking responses from clinicians in various specialty areas who order tests frequently, Dr. Singh says. As the survey captures results from a predetermined number of clinicians in one specialty area, it closes to respondents from that specialty.

Because the CDC grant is specifically earmarked for surveying ordering clinicians, TRUU-Lab is conducting separate but similar surveys of pathologists and other lab professionals who are members of the American Society for Clinical Pathology. Comparing the two types of surveys will help TRUU-Lab better understand different perspectives on lab names and, thereby, inform the guidelines, Dr. Singh says.