How to run a laboratory: Determining point-of-care testing options

One of the most important aspects of implementing a new laboratory is determining which tests to offer. Start by using your practice data and demographics to select the first set of tests to implement.

For primary care practices with a well-established patient base, you'll have a clear grasp of the types of illnesses that present most commonly. You could also base your testing decisions on which tests you have sent out most frequently in the recent past. However, you might end up with a broad range of tests, including esoteric, rarely ordered tests.

Instead, to capture the most commonly needed tests, consider using the 80/20 rule. According to the 80/20 rule, a small number of common conditions will account for most of the tests you'll order.1

Here's a theoretical example: If your practice sees 1,000 patients per month and 70% of the patient visits require a lab result to initiate or modify a treatment plan, then this means that 700 treatment plans per month use lab data. If you stack-rank the tests that influence 80% of your treatment plans, about 500-550 treatment plans per month would benefit from physician office lab testing. These are the tests you'll want to offer first.

The list of tests below covers many of the patient conditions that present in a typical primary care practice.

General screening

Tests used for general screening:

Glucose
Urinalysis
Lipids
CMP
BMP
Hemoglobin

**Testing options for general screening*:**

Test	CLIA waived	Product examples
Glucose	Yes	HemoCue Glucose 201
Urinalysis	Yes	Siemens, Roche, private label from most distributors
Lipids (cholesterol, HDL, triglycerides)	Yes	Abbott Rapid Dx Cholestech
CMP	Yes	Abbott Piccolo Xpress
BMP	Yes	Abbott I-Stat, Abbott Piccolo Xpress
CBC	No* Yes	3- and 5-part analyzers from Beckman Coulter, Abbott, Sysmex & Horiba Sysmex XW^TM -100 3-part analyzers
Hemoglobin	Yes	HemoCue Hb 801

*Sysmex offers the XW^TM-100 CLIA-waived CBC automated hematology analyzer. Contact your McKesson Medical-Surgical account manager for more information.

Risk-based screening

Tests used for risk-based screening (based on individual, gender, age, prior history or other risk element):

Glucose
Pediatric lead testing
Fecal occult blood for patients over 50
Lipid screening for patients with a family or personal history of heart disease
Medicare preventive services (CMS)²
HIV/HCV/HPV
- CDC recommends HIV screening for adults aged 13-64 years³
- CDC recommends HCV screening for baby boomers⁴
- CDC recommends HPV screening in combination with Pap tests⁵
PT/INR for patients on anticoagulant therapy
Complete blood count for anemia ad infection

Testing options for risk-based screening**:

Test	CLIA waived	Product examples
Glucose	Yes	HemoCue Glucose 201
Lead testing	Yes	Magellan Lead Care products
iFOBT	Yes	Beckman Coulter, Hemosure, private label from most distributors
Lipids (cholesterol, HDL, triglycerides)	Yes	Abbott Rapid Dx Cholestech
HIV	Yes	Abbott Rapid Dx ClearView Complete
HCV (hepatitis C)	Yes	Orasure OraQuick
HPV	No	–
PT/INR	Yes	Roche CoaguCheck XS
CBC	No* Yes	3- and 5- part analyzers from Beckman Coulter, Abbott, Sysmex & Horiba Sysmex XW^TM-100 3-part analyzer

*Sysmex offers the XW^TM-100 CLIA-waived CBC automated hematology analyzer. Contact your McKesson Medical-Surgical account manager for more information.

Follow-up screening

Tests used to follow up a positive screening result or medication follow-up:

PT/INR for anticoagulant therapy
Lipids/glucose/ALT and AST for elevated lipids and statin therapy
Diabetic follow-up
- A1C
- Creatinine
- Urinalysis
- Glucose

Testing options for follow-up screening**:

Test	CLIA waived	Product examples
PT/INR	Yes	Roche CoaguChek XS
Lipids (cholesterol, HDL, triglycerides)	Yes	Abbott Rapid Dx Cholestech
ALT/AST	Yes	Abbott Piccolo Xpress
A1C	Yes	Siemens DCA Vantage, Abbott Afinion 2
Creatinine	Yes	Abbott I-Stat, Abbott Piccolo Xpress
Urinalysis	Yes	Siemens, Roche, private label from most distributors
Glucose	Yes	Hemoue Glucose 201

Acute onset symptom disorder testing

Tests used to manage acute onset symptom disorders (respiratory, fever, pain/discomfort):

CBC for anemia, appendicitis, infection, others
Amylase for GI pain and appendicitis
Influenza for respiratory symptoms
Group A strep for respiratory symptoms
RSV for respiratory symptoms
GI pain/gastric blood
Urinalysis for dehydration, UTI, others
Glucose for ketone breath, disorientation, loss of consciousness

Testing options for acute onset symptoms:

Test	CLIA waived	Product examples
CBC	No* Yes	3- and 5-part analyzers from Beckman Coulter, Abbott, Sysmex & Horiba Sysmex XW^TM-100 3-part analyzer
Amylase	Yes	Abbott Piccolo Xpress
Influenza***	Yes	Abbott Rapid Dx, BD, Quidel, Roche, Sekisui, Cepheid
Group A strep***	Yes	Abbott Rapid Dx, BD, Quidel, Roche, Sekisui, Cepheid
RSV***	Yes	Abbott Rapid Dx, BD, Quidel, Roche, Sekisui, Cepheid
Gastric blood	Yes	Beckman Coulter Gastrocult
Urinalysis	Yes	Siemens, Roche, private label from most distributors
Glucose	Yes	HemoCue Glucose 201
Hemoglobin	Yes	HemoCue Hb 801

*Sysmex offers the XW^TM-100 CLIA-waived CBC automated hematology analyzer. Contact your McKesson Medical-Surgical account manager for more information.

Physician office laboratory testing supports initiatives in improved patient outcomes and better patient satisfaction, a broader range of practice services, enhanced revenue opportunities and MACRA compliance. While first steps to initiate testing may seem daunting, the future is bright in many ways for practices that choose in-office testing and the patients that count on them for their healthcare needs.

For more tips and guidance, continue reading McKesson's six-part series, The primary care physician's guide to expanding your practice with point-of-care testing.

**Both the list of tests and product examples described herein are a representative subset of options and are not a comprehensive list of all testing options.

***Most listed manufacturers offer more than one testing method or technology option

1: https://www.forbes.com/sites/kevinkruse/2016/03/07/80-20-rule/?sh=6e6036f53814
2: https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive- services/MPS-QuickReferenceChart-1.html
3: https://www.cdc.gov/hiv/testing/
4: https://www.cdc.gov/hepatitis/hcv/guidelinesc.htm
5: https://www.cdc.gov/vaccines/pubs/surv-manual/chpt05-hpv.pdf

Be advised that information contained herein is intended to serve as a useful reference for informational purposes only and is not complete clinical information. This information is intended for use only by competent healthcare professionals exercising judgment in providing care. McKesson cannot be held responsible for the continued currency of or for any errors or omissions in the information.