National Pathology Quality Registry Drives Improvement in the Lab

By Ali Brown and Steve Kroft - November 16, 2022


Most laboratories lack a robust, actionable method for sharing best practices in a timely fashion. The American Society for Clinical Pathology (ASCP) aims to provide that with its National Pathology Quality Registry (NPQR), a quality platform created by pathologists and laboratory professionals to help drive meaningful improvement in the lab, with the ultimate goal of enhancing patient care.

Instead of just providing benchmarks, the NPQR ties in ASCP’s vast expertise and educational content to give pathologists and laboratories the tools they need to drive change. If pathologists and laboratory professionals aren’t familiar with performance improvement methodologies, the NPQR allows them to get a better handle on quality improvement science and how to implement projects in their own labs. The NPQR also helps providers meet the requirements of the Centers for Medicare and Medicaid Services Merit-Based Incentive Payment System (MIPS), a quality payment program created by the Medicare Access and CHIP Reauthorization Act of 2015. MIPS rewards or penalizes providers based on their performance, so ASCP developed the NPQR to help pathologists come out on top.

Some medical specialty registries are developed with the primary purpose of government reporting. While the NPQR provides a user-friendly process for this as well, it also offers opportunities for tangible quality improvement and meaningful impact on patient care delivery. Ultimately, ASCP is driven by its mission to improve patient care, which was supported broadly by the pathology and laboratory community initially surveyed to gauge interest in such a performance improvement platform. The input from this community was clear. While they understood the importance of government reporting, they were frustrated by the lack of applicable measures that could be used to drive meaningful improvement in the laboratory. Therefore, ASCP developed the NPQR to provide an easy-to-use government reporting option, but more importantly, to also serve as an analytics tool that brings real-time laboratory data, coupled with supporting material, to drive improvement.

In the laboratory, we have long understood the amount of data we produce each day is vast. The NPQR aggregates these data from both clinical and anatomic pathology lab information systems to create meaningful dashboards that can drill down to patient- and provider-level data. From these dashboards, users can create reports that can be shared with frontline staff, departments, practice managers, and hospital administrators to enhance the role of the lab in improving patient care.

ASCP recognizes the heterogeneity in pathology practices. We kept in mind your feedback about how previous measures suited only a small number of pathologists, developing the NPQR with the goal of having measures applicable for most labs. In order to reach this goal, we designed the registry to measure topics broad enough to suit both anatomic and clinical pathology. The NPQR has an inclusive data collection system developed around the following four topics (with more to come in future versions).

  1. Monitoring appropriate utilization of laboratory testing: Everyone in the laboratory struggles with effective test utilization. The NPQR’s appropriate use measures use vetted testing guidelines to help pathologists guide clinicians in appropriate test ordering. Since ASCP is the pathology organization representing the laboratory in the ABIM Foundation’s Choosing Wisely initiative, we have created this portion of the registry in part to operationalize our Choosing Wisely recommendations.
  2. Improving preanalytical processes: This portion of the registry helps us track all possible areas for improvement of preanalytical issues prior to specimen testing. With this tool, you will be able to benchmark your laboratory against other labs and share best practices. Historically, there have been challenges in sharing the vast knowledge and data collected on preanalytical error between institutions. The NPQR will help break down barriers in order to share best practices and highlight the importance of the laboratory in patient care.
  3. Optimizing turnaround time and critical value reporting: These measures monitor turnaround time from specimen collection to the reporting of testing results. The NPQR gathers these data directly from your laboratory information system to minimize manual data entry. Your lab can use these extracted datapoints to establish benchmarks for comparison with the turnaround times of similar laboratories. While this is something all labs do, it lacks standardization. Tracking these data will drive continuous improvement by establishing a standardized approach to reporting turnaround time and critical values.
  4. Assessing analytical and diagnostic accuracy: Diagnostic accuracy measures assess discrepancies in diagnostic reporting and help guide development of processes for diagnostic review within practices. We all understand the importance of proper diagnosis, but often fail to develop robust guidelines for what constitutes major and minor discrepancies. There is considerable variation among and even within practices on this issue, which has historically stifled development of standardized practice before it has even begun. Our goal is to use the NPQR to assess diagnostic review practices broadly to find a starting point for the development of best practices, and to use the expertise of our participants to assess the current state of such practices to drive improvement in a specialty-led initiative rather than with a punitive focus.

Across all registry topics, the NPQR will provide easy-to-use, drill-down-capable dashboards that are updated at regular intervals to show recent, actionable data. We will provide educational tools to show participants how to make improvements and structure an effective quality management program in their institutions. It all comes down to patient safety and improving the whole patient care experience through the laboratory.

What does the future of the NPQR look like? We are currently working with our early adopters to optimize processing and reporting of the large amounts of data we receive, so we are able to deliver effective, meaningful reports. In the future, we’ll have even more measures in more subject areas, and will be able to look to the early adopters to make future versions even more user-friendly.

We encourage laboratories to join our NPQR team. Our profession values quality diagnostic results. Pathologists, working with laboratory professionals, created this registry to suit the needs of the laboratory. Through the NPQR, ASCP aims to highlight the critical work of the laboratory in providing the best possible care to its patients.