😢 Quest - specimen source/type question for all

Nancy,
The HIV/STD group at Virginia has received 1411 ELRs from the Quest QLS sites (majority from Quest Horsham) since 8/1/18 of which all contain "430304001^Specimen from unspecified body site (specimen)^SCT^USPEC^Source,Unspecified^HL70487^2.5.1^V UNKNOWN" in SPM-4. We noticed in the Chlamydia and Gonorrhea messages that the local code description located in OBX-3.5 contains a specimen type such as: Urogenital, Throat and Rectal. VDH has reached out to Quest to ensure that the value in OBX-3.5 contains the true specimen information associated with the resulted test, but have yet to receive a response. 

As for the Syphilis and HIV results, the specimen type seems to be located in OBX-3.2 in the format of: SERPL, PLAS, SER, and BLD. VDH is also looking to receive confirmation regarding these findings.

Virginia is part of the pilot for Quest Chantilly and OBX-3.5 and appears to also contain specimen information. Chantilly was able to confirm that OBX-3.5 contains the true specimen information for Chlamydia and Gonorrhea. 

Thanks,
Greg

A quick count from Connecticut for results received into our surveillance system from ELR since August 1 reveals

Non-STD:
3453 unspecified (most are for Lyme tests)
607 blank (Hep C)
total 4063

STD:
15,519 unspecified
104 blank
total 15,638

When MO was onboarding, we were given an FAQ from APHL. The most current FAQ I have is from 10/06/17 so the information may have changed, but in it, it said that for SPM4:
 
Quest Diagnostics does not currently require either the ordering provider or the laboratory technical staff to include specimen source for each individual test*. The collection/inclusion of that information for testing that has a single allowable specimen type; i.e. serum for hepatitis testing, would be a monumental shift for the laboratory industry. For tests that can be performed from various sources, the specimen source can usually be found in the Quest test name which is in the OBR-4 field and can also be designated by a specific source LOINC code located in field OBX-3.

*Please Note*: Sample source for testing performed in Microbiology is usually noted and provided in the SPM-4 field. When the Quest Diagnostics lab does not have information about specimen source, SPM-4 is reported as "unspecified specimen". 

The resolution in the FAQ said that PHA software will need to take this into account. 

In the last 30 days, MO has received 5,113 unspecified specimens out of 7,894 received from Quest Lenexa.

Mapping Specimen Type in the lab template part of the Hepatitis message has been quite a hurdle for WI. We too find that not all labs follow the allowable vocabulary for Specimen Type.

Thanks all. We prefer SNOMED codes for specimen source -- they are cleaner and more specific. I will be curious to see what folks think of accuracy of using OBX 3 components for specimen source.

Now that the standard has effectively been lowered...  PA was left out of the QLS project until late in the game mainly because we have had ELR connections with three of the four largest Quest labs and six other lower-volume labs since 2008 and because we would be difficult to work with as we would not accept poor-quality data.

My initial impressions were that CDC, APHL and Quest were railroading this project and the minimum standards were going to be the rule.  The more I have learned the less I like it.  It is a brazen “you get what you get you will like it” attitude from all three organizations is frustrating.  APHL gets to check boxes and CDC to boast about nationalizing a project.  Yay!

The data we get from our current Quest ELR labs (2.3.1) is generally good with low volume of errors or missing data.  But data quality is not as good as it should be, Specimen Source details and local codes being issues.  Now we will have double the labs and no improvements on data quality, if not worse in some cases?

Quest’s refusal to use standard codes, to follow-up with their providers to collect missing or generalized Specimen details and “functions as designed” excuse, in my opinion, means this project never should have happened.  The failure of APHL and CDC to require compliance to standards and pushing more down on the states to just “deal with it” has enabled labs to continue poor behavior and can only encourage others.  States which have gone along with this lowering of the standard just to get ELR share blame as well.

Almost every call and meeting has time devoted to complaints about lab data quality, yet it is accepted because something is better than nothing.  The lab response: “We get what we get” is essentially saying, “It costs too much time and money to chase details”.  So, volume is money.  Data quality is the state’s problem.  When does it stop?

My first suggestion is that APHL should own the process of converting Quest local codes to Standard Codes.  If APHL wants to be the transformation engine, then do it all, stop pushing it down on the states.

Secondly, serious, organized push-back on all reference labs.  If they are collecting specimens it should be their burden to collect ALL relevant data.  No exceptions.  If their ‘forms’ do not contain fields for the data, CHANGE the * form.

Third, state staff need to stand up and jointly enforce standards and stop making exceptions and allowing a work-around.  Off-line paper reporting.  Institute direct data-entry into data systems.  Make it painful for the labs.  Swing a big legal stick.  

Nothing will change until some lab over-lord realizes it is more profitable to do the right thing.