3 Unit #1 Introduction to Laboratory Medicine A. Definition of Clinical Laboratory Science – A profession concerned with providing information based on the performance of analytical tests on human body substances to detect evidence of or prevent disease or impairment and to promote and monitor good health.B. Scope of Practice (American Society for Clinical Laboratory Science - ASCLS) – Assuring reliable test results which contribute to the prevention, diagnosis, prognosis, and treatment of physiological and pathological conditions.
4 Unit #1 Introduction to Laboratory Medicine C. Overview of Clinical Laboratory Science ProfessionRead information on the role of the MLT/MLS in the clinical laboratory from the American Society for Clinical Pathology:(See Unit #1 Assignment for further information on this website)
5 Unit #1 Introduction to Laboratory Medicine D. History of Clinical Laboratory ScienceEvidence of blood fluid testing as early as 1500 B.C.First clinical lab opened at Johns Hopkins Hospital in 1896 (Baltimore)American Society for Clinical Pathology (ASCP) formed in 1922 (originally named “American Society of Clinical Pathologists”)ASCP Board of Registry formed in 1928 to certify clinical laboratory personnel
6 Unit #1 Introduction to Laboratory Medicine D. History of Clinical Laboratory Science (cont’d)American Society for Clinical Laboratory Sciences (ASCLS) formed in 1933 (formerly named “American Society for Clinical Laboratory Technicians”, “American Society for Medical Technologists”, “American Society for Medical Technology”)First autoanalyzer introduced in 1957
7 Unit #1 Introduction to Laboratory Medicine D. History of Clinical Laboratory Science (cont’d)Medicare and Medicaid established in 1960sNational Credentialing Agency for Laboratory Personnel (NCA) formed in 1976 by ASCLSClinical Laboratory Improvement Act in 1988NCA assumed by ASCP on October 23, 2009
8 Unit #1 Introduction to Laboratory Medicine E. Organization of a typical clinical laboratoryLocated in hospitals, clinics, doctors’ group practices, single doctor offices, health departments, reference laboratories
9 Unit #1 Introduction to Laboratory Medicine DepartmentsChemistry – body fluid components
10 Unit #1 Introduction to Laboratory Medicine Microbiology – pathogenic microorganisms
11 Unit #1 Introduction to Laboratory Medicine Hematology – whole blood analysis and coagulation
12 Unit #1 Introduction to Laboratory Medicine Urinalysis
13 Unit #1 Introduction to Laboratory Medicine Blood Bank (Immunohematology) – transfusion related testing
14 Unit #1 Introduction to Laboratory Medicine Serology (Immunology) – antibody studies
15 Unit #1 Introduction to Laboratory Medicine Specimen Collecting and Processing – includes phlebotomy
16 Unit #1 Introduction to Laboratory Medicine F. Requesting a Laboratory TestOnly a physician can order a lab test
17 Unit #1 Introduction to Laboratory Medicine Categories of Test RequestsRoutineASAP (as soon as possible)STAT (from Latin word “statim”, meaning “with haste”)Pre-Op (pre-operative)NPO (from Latin words “non per os”, meaning “nothing by mouth)pp (or pc) (post-prandial or “after eating”)pp literally means post-breakfastpc literally means post-meal
18 Unit #1 Introduction to Laboratory Medicine G. Educational Requirements for Clinical Laboratory PersonnelPhlebotomistHigh school graduate or equivalentCertification (passing a national proficiency exam) preferredAustin Community College offers Phlebotomy training – visit or call for informationMedical Laboratory Technician (MLT-ASCP)Associate’s degree or 1 year certificateCertification requiredAustin Community College offers MLT Program – visit or call for information
19 Unit #1 Introduction to Laboratory Medicine Medical Laboratory Technologist (MLS-ASCP)Bachelor's degreeIncludes a formal training programMLS/CLS training may be:3 years general college plus one year hospital internship - U.T. Austin offers this type of degree; for informationAssociate’s degree in MLT plus two years additional years of professional training – U.T.M.B. Galveston offers this type of degree; for informationCompletion of bachelor’s degree and one year hospital internship –Austin State Hospital offers this type of internship; for information4 years college, which includes professional training and hospital internship – Texas State University offers this type of degree; for information
20 Unit #1 Introduction to Laboratory Medicine Specialists – Requires MLS and several years of documented experience, plus certification through ASCP (examples: SBB = Specialist in Blood Bank, SH = Specialist in Hematology, SM = Specialist in Microbiology, etc.)Pathologist – M.D. (4 years college and 4 years medical school) years of residency training in pathologyMay be certified in:Anatomical Pathology (AP) and/orClinical Pathology (CP)
21 Unit #1 Introduction to Laboratory Medicine H. Clinical Laboratory Improvement Act of 1988 (CLIA ’88)Actually implemented on Sept. 1, 1992Divides all clinical labs into “waived”, “moderately complex”, and “highly complex” categories
22 Unit #1 Introduction to Laboratory Medicine Waived laboratoriesPerform tests that are so simple and accurate as to render the likelihood of errors of results negligibleHave no certification or education requirements for testing personnelDo not require proficiency testing (external comparison of laboratory quality control)Waived tests include tests listed on under “Categorization of Tests” on left side of web page
23 Unit #1 Introduction to Laboratory Medicine Moderately ComplexMainly manual procedures with limited steps and preparation and automated analyses that do not require operator intervention during the analytical processRequires proficiency testing. If lab fails, it can be prevented from doing the analyte failed.Testing personnel must have a minimum of high school graduation plus completion of 50 weeks of military training or other appropriate documented training
24 Unit #1 Introduction to Laboratory Medicine Highly ComplexDesignation for labs that perform ALL laboratory testing, including highly specializedRequires extensive proficiency testingTesting personnel must have at least an associate’s degree in a laboratory science
25 Unit #1 Introduction to Laboratory Medicine Governmental Agencies that regulate the roles of clinical laboratories (all are within the Department of Health and Human Services – HHS – which is charged with safeguarding the health of the public and providing those health services seemed essential to the maintenance of good health)
26 Unit #1 Introduction to Laboratory Medicine CDC (Centers for Disease Control and Prevention)Monitors disease outbreaks, implements disease prevention strategies, and maintains national health statisticsProvides immunization services, workplace safety, and environmental disease prevention guidanceMonitors international disease transmissionAdministers the Agency for Toxic Substances and Disease Registry
27 Unit #1 Introduction to Laboratory Medicine CMS (Centers for Medicare and Medicaid Services)Administers Medicare, a federal healthcare coverage plan for the elderly, those with severe kidney damage who require dialysis, and people with certain disabilitiesWorks with states to administer Medicaid, healthcare coverage for individuals living at or below poverty levelsControls Medicare and Medicaid payment for medical procedures, including laboratory servicesRegulates enforcement for CLIAEnforces the Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II)
28 Unit #1 Introduction to Laboratory Medicine FDA (Food and Drug Administration)Monitors safety and effectiveness of food, drinks, cosmetics, drugs, and medical devicesDetermines whether a laboratory test is classified as waived, moderately complex, or highly complex
29 Unit #1 Introduction to Laboratory Medicine ProfessionalismDefinitionsAccreditation – voluntary process in which a non-governmental agency grants recognition to institutions or programs that meet or exceed established standards of quality. Example: MLAB Program at ACC is accredited by NAACLS; ACC and other schools are accredited by SACS; some clinical labs accredited by CAP.
30 Unit #1 Introduction to Laboratory Medicine Registration – a general term referring to the voluntary requirement that all persons who engage in a given occupation register with the designated government agency. It does NOT require minimum education or experience requirements. Examples: Medical technology in the state of Texas
31 Unit #1 Introduction to Laboratory Medicine Certification – a process by which an individual or institution is evaluated and recognized as meeting certain predetermined standards. Usually non-government and voluntary. Examples: ASCP exam for medical technologyLicensure – often referred to as a “practice act”. Not voluntary. The granting of permission by an authority (usually a state) to an individual or organization in some practice or activity. Examples: State licensure for physicians, nurses (NOTE: Texas does NOT require licensure for clinical laboratory professions!)
32 Unit #1 Introduction to Laboratory Medicine Continuing Education – professionalism includes continuing your education after graduation/certification. Technology and medical research move at lightning speed, and it is VITAL for all health professionals to keep up with changes and developments in their fields. ASCP REQUIRES continuing education in order to maintain certification. ASCP offers a free Maintenance Certification Program for members to keep track of continuing education
33 Unit #1 Introduction to Laboratory Medicine Certification and Accrediting Agencies and Professional OrganizationsCertification AgenciesAmerican Society of Clinical Pathologists (ASCP) – Board of Registry (BOR) established in 1928American Medical Technologist (AMT) – 1939American Association of Bioanalysts (AAB) Board of Registry 1999 (Formerly called International Society for Clinical Laboratory Technology ISCLT – 1962)
34 Unit #1 Introduction to Laboratory Medicine Accreditation AgenciesNational Accreditation Agency for Clinical Laboratory Sciences (NAACLS) – 1973Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Accredits hospitals and other similar health organizations.College of American Pathologists (CAP) Accredits laboratories.Commission on Office Laboratory Accreditation (COLA) Accredits physician office labs (POLs)
35 Unit #1 Introduction to Laboratory Medicine Professional OrganizationsAmerican Society for Clinical Laboratory Science (ASCLS)American Association of Blood Banks (AABB)American Association of Clinical Chemists (AACC)Clinical Laboratory Management Association (CLMA)Clinical and Laboratory Standards Institute (CLSI) – sets standards for clinical laboratory testing and identifies best practices; formerly NCCLS
36 Unit #1 Introduction to Laboratory Medicine ConfidentialityAs a member of the health care team, it is expected that we will always respect the privacy of our patients.This includes not talking about our patients, their diagnosis or prognosis, or their test results to anybody except those that have ”a right to know”, such as other health care professionals working with this patient or the parents of a minor child.
37 Unit #1 Introduction to Laboratory Medicine Confidentiality also means that you protect the patient’s right to privacy in such areas as:Keeping the patient covered to the extent possible when the patient cannot do this herself.Not calling out to patients in doctors’ office about the nature of their visit to the doctor or their treatment when other patients are in earshot.
38 Unit #1 Introduction to Laboratory Medicine The Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) was passed by Congress to address patient privacy in the sharing of electronic databases, but was expanded to include patient privacy in ALL aspects of patient care and interaction.
39 Unit #1 Introduction to Laboratory Medicine ALL Austin Community College health sciences students are REQUIRED to complete the HIPAA Student/Employee Training Module. Go toClick on the HIPAA Student/Employee Training Module link and start the module.You will be asked to designate the Health Sciences program in which you are enrolled. Click on Medical Laboratory Technology