What’s in a Name? Comparative Analysis of Laboratory Test Naming Guidelines as Applied to Common Confusing Test Names

Introduction/Objective

Laboratory test names frequently do not enable easy understandability or promote correct test utilization, which leads to difficulty for providers in finding the correct test and results in unnecessary cost and medical errors. Laboratory test names are also largely unstandardized and are not named by a consistent set of conventions. To address these issues, the TRUU-Lab (Test Renaming for Understanding & Utilization) initiative aims to generate a consensus test naming guideline for better human understandability of laboratory test names. These studies address the first aim of the TRUU-Lab initiative: to identify root causes and challenges in understanding and using laboratory test names.

Methods

We conducted survey studies to capture the most problematic laboratory test names, then performed analysis of these names to identify aspects of these names that led to confusion among providers. A subset of these test names were used to evaluate five existing laboratory test naming guidelines (LOINC, ONC TigerTeam, Pan- Canadian iEHR Viewer Name, Standards for Pathology Informatics (Australia), and ARUP Laboratories internal style guides) for their ability to produce understandable test names.

Results

274 survey responses yielded ~100 unique laboratory tests cited as confusing, and highlighted substantial diversity both in the names of these tests between institutions and in respondent opinion on the best alternative names. The top 10 most commonly-cited tests yielded ≥ 3 unique names, and the top 2 tests (Vitamin D and anti- factor Xa) yielded ≥ 10 unique names. Post-survey analysis identified eight characteristics associated with poor understandability of a test name, including ambiguity, abbreviations, homophones, multiple indications for a single test, proprietary names, synonyms, truncation, and “panels” where components are obfuscated. Existing guidelines produced highly variable names given the same prompt, and varied in their ability to avoid pitfalls associated with poor understandability.

Conclusion

These studies highlight aspects of existing laboratory test names that lead to confusion among ordering providers, and identify the inability of existing laboratory test naming practices to adequately address these issues. Efforts are ongoing within TRUU-Lab to use these results to inform novel laboratory test naming guidelines to promote universal human understandability.

TRUU-Lab: Methods for Optimizing Test Names for Understanding and Utilization

Introduction/Objective

Poor understandability of laboratory test names increases the risk for inappropriate test utilization and medical errors. Yet, human understandability has not been a major consideration in existing laboratory test names or naming guidelines. TRUU-Lab (Test Renaming for Understanding and Utilization for Laboratory Test Names) is a national initiative that now has more than 45 members representing more than 20 academic and industry organizations, the CDC, and the FDA. The goals of the initiative include: 1) Identify root causes and challenges in understanding and using laboratory test names; 2) Share resources related to potential solutions; 3) Develop consensus guidelines for laboratory test naming; 4) Establish consensus names for existing laboratory tests; and 5) Promote the adoption and implementation of consensus laboratory test names.

Methods

We previously addressed the first two goals of this initiative by identifying problematic test names and features of test names that contribute to misutilization. We also identified the advantages and limitations of current test naming guidelines and previous standardization efforts. This current study addresses goals 3 and 4. We developed an iterative process of guideline development. This process includes collecting feedback on consensus names to improve guidelines, which then informs the improvement of the consensus names.

Results

By analyzing test name characteristics, we found that the requirements for understandability vary with respect to the clinical scenario and provider background. We have used these results to design a 30-min long survey to test candidate names. The survey will be distributed through the Brand Institute, which offers expertise in pharmaceutical name and brand identity development. This pilot survey will be sent to primary care providers to assesses intuitive name preferences given a short and specific prompt. The second phase will take place in a simulated electronic medical record environment to present clinical scenarios where physicians will select an appropriate test.

Conclusion

We expect that results from survey studies will directly inform the development of TRUU-Lab naming guidelines, in turn permitting development of better-optimized laboratory test names. This process represents a new strategy for the intentional design of laboratory test names that are understandable and promote correct provider utilization.