Clinical Operations
Clinical operations involve a patient-centered approach to determining what to order and when to order it. This entails striking a delicate balance- ensuring sufficient testing for patient and community concerns without overburdening the healthcare system with unnecessary charges. It also involves staying informed about guidelines updates from federal, state and professional organizations.
What Is Required
What to Order
Define panels based on individualized patient care as well as community needs. Panels will need to be specific to the different risk levels in pain management and to the clinical needs of the patients in substance use disorder treatment.
When to Order
Testing frequency is based off the risk level or time of sobriety of the patients. These testing policies should be well documented and follow all the latest guidelines. When possible, the testing should also be randomized.
Document Requirements
Proper documentation is critical for both patient care and billing justification and should cover at least three main areas; a comprehensive written testing policy, individualized order justification for the patient and documentation of the laboratory results and how they were used.
Clinical Testing Policy Based On Patient And Community Needs
Substance Use Disorder (SUD) and Chronic Opioid Treatment (COT)
Substance use disorder and chronic opioid treatment have different patient treatment requirements. What to order is usually based on a combination of patient needs and history as well as local and national community trends. We have tools that can help fine tune and justify what to order.
Community Trends- National
With our Patient Population Analysis (PPA) database, our distinctive service, you can make critical decisions about what to test for using up-to-date real-world data. Evaluate what might be missing and/or get rid of unnecessary testing to maximize efficiency.
Community Trends- Local
Our Q2R Toxicology Production software allows us to monitor all of the raw clinical data from the mass spec instrumentation. We can then create and adjust the different order panels based on the statistical analysis of real time raw patient data. This is used to help our customers walk that fine line between ordering enough clinical data to treat patients without over burdening the healthcare system with unnecessary tests.
Emerging New Analytes of Interest
As we are continually implementing new labs all over the country as well as monitoring all the emerging data, we are exposed quickly to any new emerging analytes of interest. These newest analytes, if appropriate, can be added to your lab.
Long term success in toxicology laboratory starts with a patient centric testing policy in the clinic. We understand that navigating the regulatory landscape can be challenging, which is why we are here to support you. Our team of experts is well-versed in payer policies and testing requirements. It is critical that the ordering clinician understands the needs and requirements to order a sample before that sample is ever sent to a lab.
When To Order
Whether you are setting up a Physician’s Office Lab (POL) or a reference lab, order justification is critical. The guidelines are becoming more coherent and clearer, and thus are more critical to follow. The newest guidelines mandate that order frequency is determined based on patient risk level or time of sobriety. The testing policy of when to test a patient should be clearly documented and followed. These orders need to be randomized when possible and justified in the patient record.
Documentation
Documenting why and how patients are treated is critical not only for good patient care but to also justify the ordering of expensive but necessary tests. The latest guidelines lay out specifically what needs to be documented.
Testing policies should be documented and cover not only what and when to order, but also justify when to use a presumptive screen or a definitive confirmation test based on the advantages and limitations of those methodologies.
Patient charts need to be individualized and justify the need for testing for that patient at that time. These justifications have been defined and should not become burdensome to the providers.
Results from the ordered tests must be charted and read. The interpretation of the results also need to be documented.
The documentation requirements are needed regardless of where a sample is processed and by who. However, it is our belief that while these requirements need to be followed, they should not be overly burdensome on the clinical staff. Policies, procedures, education and tools should all be geared towards providing the documentation that is needed in the most efficient manner.