Ask the Expert with Barry Craig | September 2013

Before I respond to this month's questions, a suggestion. Now is the best time of the year to stock up on your seasonal flu kits. Manufacturers are making deals now that they will not make any other time. You can cut your cost sometimes by 30% by ordering in bulk before the season hits. So stock up, and swab away! (Kids love having a large Q-tip shoved up their nose).

Q: Help! In my lab, I stand in the same spot for hours at a time and my feet are KILLING me at the end of the day. I know this is not really a lab question, but my feet hurt! Any suggestions besides the standard foam mat?
A: I would talk your physicians into purchasing one of the gel kitchen mats. These are expensive, but it is heaven on your feet. Make sure the one you get is non-porous. You can find them online for about 100 dollars. Your feet and sanity are worth it. If they will not get you one, tell them your sore feet are walking out!

Q: How do I look up a test to determine what CLIA classification it is?
A: You can go to the FDA website and use their look up feature. You can look at a test and see what the instrument it is approved for or look up an instrument and see which tests have approval for that device. And at what classification level.

Remember, if you want to use a reagent or test and it is not in the FDA dadtabase listed for your instrument, it has no approval or pairing for your machine and is considered High Complexity testing if you use it on your instrument.

Example: You have "Bob's Brand A reagents" you would like to use on your instrument, the "Labalyzer." When you look up the "Labalyzer," it has "Susie's Brand B reagents" listed as Moderate Complexity on that instrument but Bob's reagents are not listed. You can still use the reagents, but you would have to follow all the CLIA guidelines for High Complexity, including validations, personnel, etc.

Q: I know most doctors must get an EMR system to continue to get paid for government billing. We just purchased one and now I have to enter all of my tests results by hand! This is awful, we are going backward instead of forward.
A: Don't panic yet. Put a bandage on your sore fingers, and listen up. Most automated analyzers can be interfaced with the host EMR to download the results directly into the patient's EMR file. There is a charge to build this interface, but it is well worth it.

If no interface is available, get a cheap scanner and scan all lab documentation (even your manual tests) directly to the patient's EMR file. By scanning, you are retaining the original printout from the instrument which makes inspectors happy.

Q: I feel completely disorganized in my lab. I misplace items constantly and when we get really busy, the lab flies apart. Do you have any organizational advice?
A: Yes, I do. You can thank my wonderful wife for this. My wife has worked in the automotive manufacturing business for years now. Do you know why Toyota and Honda build such great cars?

Quality and Speed.

Quality - They both pay close attention to detail, tolerances, errors, etc.

Ah, but Speed is what allows them to make more cars in less time for less money (no waste). These automakers do not waste steps, space, or time.

Your lab needs to have every inch of it labeled. Every shelf, every inch of counter space, and every tool or device used should be labeled. If each drawer has a specific purpose and a specific item that is stored there, your brain will automatically remember it, but label it anyway.

Items should be arranged so that you do not have to take steps to reach the supplies you need to perform a task. Example: If you have a pass thru cabinet where urines are placed for analysis, locate your urine dipsticks, paper for blotting, result forms, timer, and hopefully a sink for discarding all around that pass thru window.

Separate your space into workstations with each task having its own area and storage. Grouping tests together can help also. Example: Put all of your kit tests together on one counter. Designate a space for each. Put the instructional card for the test directly behind it. Make sure all supplies are located with the test. Label everything!

When you are done, you should almost be able to perform your tasks blindfolded without moving a single step.

Barry Craig


Expert on physician office laboratories and diagnostic equipment

Barry works almost exclusively with POLs and understands the needs and challenges they face. With more than 20 years of lab consulting experience, his company works with office lab start-ups, inspection follow-ups, and help with the CLIA, COLA and JCAHO regulatory issues offices face daily. He offers a unique insight and customer focused approach to the lab and its solutions. In his current role as President of Laboratory Consulting, LLC, Barry is leading the way for physician's offices to develop their in-house labs as a place to obtain fast, accurate results and maintain a healthy profit using the latest technology available.

Being in touch with the POL community nationwide his company has a unique insight into the problems and questions that arise from the operation of a POL.