Interprofessional Team Diagnostics Consultation Improves Health Professions’ Practice Outcomes and Clinical Research

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Elizabeth Kenimer Leibach Professor Emerita


Background: Communication gaps in health services delivery significantly compromise quality in clinical decision making. Information generated by diagnostics professionals’ accounts for much of the objective data in the clinical record and therefore is foundational in clinical decision support. This work describes the Diagnostics Consultation Model©, a diagnostics communications portal, which supports communications among interprofessional teams, providers, and institutions.

Aims: Study aims were to develop and validate a workflow prediction index (the complexity index) to assign resolution of consultation requests to diagnostics practitioners with requisite competencies based on an algorithm comprised of characteristics available at the point of consultation initiation. The complexity index functions as the entry into a workflow process directing consultation requests, first, to diagnostics practitioners for investigation and then into communication processes for tracking medical history, patient/consumer clinical information, resolution logic, conclusions, and next step recommendations among all healthcare providers.

Methods: Data to develop the complexity index (N = 325 consultation cases) were collected during daily activities in the clinical diagnostics laboratory and describe consultation characteristics important in clinical decision making and available at the point of consultation initiation. The complexity index was developed and validated by comparison of regression analyses using consultation characteristics, i.e., clinical outcomes, available at the point of consultation initiation (development) and after consultation completion (validation).

Results: Diagnostics Consultation Model© methodology links communication processes among all providers in all care settings, i.e., community, institutional, and referral, involved in the care paths of individual patient/consumers. This methodology also provides the capability to follow individuals’ medical histories longitudinally and, through regular consultations and practice-based clinical research, to address issues of medical effectiveness, cost efficiency, access, equity, timeliness, safety, and compliance.

Implementation of Diagnostics Consultation Model© methods and curriculum in health professions’ daily practice has the potential to change health services delivery by the redistribution of care through interprofessional teams coordinated by standardized communication processes. Employed as a systems approach to individualized patient/consumer care, the Diagnostics Consultation Model© could provide the communications technology and methodology structure for value-based healthcare continuously optimized to address the needs of individuals, populations, and health systems throughout the continuum of care.

Keywords: IPT Team Diagnostics Consultation Improves Health Professions’ Practice Outcomes and Clinical Research, Interprofessional Team Diagnostics Consultation, Health Professions’, Health Professions’ Practice, Health Professions’ Practice Outcomes, Health Professions’ Practice Outcomes and Clinical Research, Clinical Research

Article Details

How to Cite
LEIBACH, Elizabeth Kenimer; EMERITA, Professor. Interprofessional Team Diagnostics Consultation Improves Health Professions’ Practice Outcomes and Clinical Research. Medical Research Archives, [S.l.], v. 10, n. 10, oct. 2022. ISSN 2375-1924. Available at: <>. Date accessed: 19 june 2024. doi:
Research Articles


1. Kosack CS, Page AL, Klatser PR. A guide to aid the selection of diagnostic tests. Bull World Health Organ. Sep 1 2017; 95(9):639-645. doi: 10.2471/BLT.16.187468
2. Bandeiras C. Advancing technology for a healthier humanity. IEEE Potentials. March 6. 2020;
doi: 10.1109/MPOT.2019.2959850
3. Fitzgerald J, Higgins D, Mazo Vargas C, et al. Future of biomarker evaluation in the realm of artificial intelligence algorithms: application in improved therapeutic stratification of patients with breast and prostate cancer. J Clin Pathol, Jul 2021; 74(7):429-434; 74(7):429-434; doi: 10.1136/jclinpath-2020-207351
4. Iacobucci G. Covid-19: Tests must be more rigorously regulated to protect public, say statisticians. BMJ, 373, Article n1483. Jun 9 2021; 373:n1483.
doi: 10.1136/bmj.n1483
5. Isbell TS. Direct-to-Consumer Tests on the Market Today: Identifying Valuable Tests from Those with Limited Utility. Clin Lab Med. Mar 2020; 40(1):13-23. doi: 10.1016/j.cll.2019.11.008
6. Carayon P, Schoofs Hundt A, Karsh BT, et al. Work system design for patient safety: the SEIPS model. Qual Saf Health Care. Dec 2006; 15 Suppl 1:i50-8.
doi: 10.1136/qshc.2005.015842
7. Carayon P, Wooldridge A, Hose BZ, Salwei M, Benneyan J. Challenges and opportunities for improving patient safety through human factors and systems engineering. Health Aff (Millwood). Nov 2018; 37(11):1862-1869. doi:10.1377/hlthaff.2018.0723
8. Graziadio S. How to ease the pain of taking a diagnostic point of care test to the market: a framework for evidence development. Micromachines, 11(3), 291. 2020; doi: 10.3390/mi11030291
9. Zuckerman DM. Emergency Use Authorizations (EUAs) versus FDA approval: implications for COVID-19 and public health. AJPH. 2008.111(6): 1065-1069.2021. doi:
10. Church DL, Naugler C. Essential role of laboratory physicians in transformation of laboratory practice and management to a value-based patient-centric model. Crit Rev Clin Lab Sci. Aug 2020; 57(5) : 323-344. doi:
11. Kratz A, Laposata M. Enhanced clinical consulting—moving toward the core competencies of laboratory professionals. Clinica Chemica Acta 2002; 319: 117-125; doi:
12. Leibach EK. Another Step in Diagnostics Consultation Model© Actualization: Examining the Impact of Consultation Workflow Processes on Providers' Clinical Decision Making. 2022; doi:
13. Baker SL, Waller KV. Consumer satisfaction to laboratory test interpretation by the ASCLS Response Team. Clin Lab Sci 21(3), 162-166. 2008;
14. Leibach EK. The Doctorate in Clinical Laboratory Science: the keystone practitioner for the profession. Clin Lab Sci 20(1), 4-6 .2008; doi:
15. Leibach EK. The Doctorate in Clinical Laboratory Science: enhanced quality for healthcare. Clin Lab Sci 21(1), 5-6. 2008; doi: 2/publication/221789775_Healthcare_costs_are_increasing_dramatically/links/5d42caf4299bf1995b5beddc/Healthcare-costs-are-increasing-dramatically.pdf
16. Leibach EK. Grounded theory in medical laboratory science expert practice development Clin Lab Sci, 24(4), Suppl:37-44. 2011; doi:
17. National Academies of Sciences, Engineering, and Medicine. Improving Diagnosis in Health Care. 2015;
18. Donabedian A. Quality assessment and assurance: unity of purpose, diversity of means. Inquiry. 1988; doi:
19. Armstrong KA, JP Metlay. Clinical decision making: using a diagnostic test. Annals of Internal Medicine. 2020;
20. Hallworth MJ. The 70% Claim: What is the evidence base? Ann Clin Biochem 48, 487-488. 2011;
doi: 10.1258/acb.2011.011177
21. Zhi M, Ding EL, Theisen-Toupal J, Whelan J, Arnaout R. The landscape of inappropriate laboratory testing: a 15-year meta-analysis. PLoS One. 2013; 8(11):e78962. doi: 10.1371/journal.pone.0078962
22. Blazin LJ, Sitthi-Amorn J, Hoffman JM, Burlison JD. Improving patient handoffs and transitions through adaptation and implementation of I-PASS across multiple handoff settings. Pediatr Qual Saf, 4, e323. 2020; doi:
23. Bissell M. Introduction: What’s in a laboratory outcome? In Bissell, M. G. (Ed.). Laboratory-related measures of patient outcomes: An introduction. AACC Press; 2000.
24. Bonini P, Plebani M, Ceriotti F, Rubbioli F. Errors in laboratory medicine. Clin Chem 48, 691-698. 2002; doi:
25. Burns CD, Brown JP, Corwin HL, Gross I, Ozawa SJ, Shander A. Special report From the Society for the Advancement of Blood Management: the Choosing Wisely Campaign. Anesth Analg. Nov 2019; 129(5):1381-1386. doi:
26. Cheloff AZ, Huang GC. More than Meets the Eye: Diagnostic procedures as hazards in clinical decision-making. American College of Medical Quality, XXX(XXX), 00-00. 2021; doi:
27. Christenson RH, Snyder S, Shaw CS, et al. Laboratory Medicine Best Practices: systematic evidence review and evaluation methods for quality improvement. Clin Chem 57(6):816-825. PMID: 21515742.2011; doi:
28. Glaser J. It’s time for a new kind of electronic health record. Harvard Business Review, June 12.2020; doi:
29. Porter ME. A strategy for health care reform — toward a value-based system. N Engl J Med, 361, 109-12. 2009; doi: 10.1056/NEJMp0904131
30. Desmedt M UD, Grosemans J, Hellings J, Bergs J. Clinical handover and handoff in healthcare: a systematic review of systematic reviews. International Journal
for Quality in Health Care 00(00), 1–24. 2020; doi: 10.1093/intqhc/mzaa170
31. National Academies of Sciences, Engineering, and Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. 2001;
32. Bate P, Robert G. Experience-based design: from redesigning the system around the patient to co-designing services with the patient. Qual Saf Health Care 2006; 15:307–310.2006; doi: 10.1136/qshc.2005.016527
33. Abraham J, Meng A, Tripathy S, Avidan MS, Kannampallil T. Systematic review and meta-analysis of interventions for operating room to intensive care unit handoffs. BMJ Qual Saf, 30, 513–524. 2021; doi: 10.1136/bmjqs-2020-012474
34. Applebaum B, Robbins S. Language access and health equity: changes under the affordable care act. J Health Care Poor Underserved. 2016; 27(2):416-26. doi: 10.1353/hpu.2016.0064
35. Classen DC, Holmgren A, Co Z, et al. National trends in the safety performance of electronic health record systems from 2009 to 2018. JAMA Network Open, 3(5), e205547. 2020; doi: 10.1001/jamanetworkopen.2020.5547
36. Krasowski MD, Chudzik D, Dolezal A, et al. Promoting improved utilization of laboratory testing through changes in an electronic medical record: experience at an academic medical center. BMC Medical Informatics and Decision Making, 15, 11. 2015; doi: 10.1186/s12911-015-0137-7
37. Brown L, Saini V, Carter C. Standardizing multidisciplinary rounds. Creation of an efficient and effective process to care for the critically ill. JONA, 50(1), 5-8. 2020; doi: 10.1097/NNA.0000000000000830
38. Cao V, Tan L, Horn F, Bland D, Giri P, Maken K, Cho N, Scott L, Dinh VA, Hildago D, Nguyen HB. Patient-centered structured interdisciplinary bedside rounds in the medical ICU. Critical Care Medicine. 2018; doi:
39. Palojoki S, Vuokko R, Vakkuri A, Saranto K. Electronic health record system-related patient safety incidents – how to classify them? In A. Värri et al. (Eds.), Integrated Citizen Centered Digital Health and Social Care. IOS Press. 2020; doi: 10.3233/SHTI200714
40. Arsoniadis EG. Electronic health record-integrated handoff notes: content, implementation, and analysis. Doctoral dissertation, The University of Minnesota; 2020.
41. Adler-Milstein J, Zhao W, Willard-Grace R, Knox M, Grumbach K. Electronic health records and burnout: time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians. JAMIA, 27(4), 531-538. 2020; doi:
42. Williams MS. Misdiagnosis: burnout, moral injury, and implications for the electronic health record. JAMIA, 28(5), 1047-1050. 2021;
43. Casey MH, Turner B, Williams M. Improving efficiency using electronic medical record rounding report and sign-out report. J Pediatr Health Care, 34, 535-541. 2020;
44. Caudell-Feagen M, Thompson M. Standard technology presents opportunities for medical record data extraction. Pew Charitable Trust. 2021; doi:
45. Shanbhag A, Bender J. Application Programming interfaces in health IT. Health IT Buzz. 2020, June 11; doi:
46. Stendahl K, Siddon A, Peaper DR, Hauser RG, Campbell S, Tormey C. The development and implementation of a novel electronic consult system by a laboratory medicine service. Experience from the first 2 years of use. Arch Pathol Lab Med, 145, 75-81.2021; doi:
47. Amaral ACKB, Vincent J-L, Rose L, et al. An international perspective on the frequency, perception of utility, and quality of interprofessional rounds practices in intensive care units. J Critical Care, 55, 28-34. 2020;
48. Booth AL, Katz MS, Misialek MJ, Allen TC, Joseph L. "Please help me see the dragon I am slaying": implementation of a novel patient-pathologist consultation program and survey of patient experience. Arch Pathol Lab Med, 143, 852-858. 2019; doi:10.5858/arpa.2018-0379-OA
49. Laposata M, Cohen M. It’s our turn. Implications for pathology from the Institute of Medicine’s report on diagnostic error. Arch Pathol Lab Med, 140. 2016;
doi: 10.5858/arpa.2015-0499-ED
50. Theparee T, Shanes E, Maurer D, et al. A new era in pathology consultation: the MyPathologist electronic consultation tool. Academic Pathology, 5, 1-7. 2018;
51. Crews BO, Drees JC, Greene DN. Data-driven quality assurance to prevent erroneous test results. Crit Rev Clin Lab Sci. Nov 2, 2019:1-15.
doi: 10.1080/10408363.2019.1678567
52. Porter ME. What is value in health care? N Engl J Med 363(26), 2477-2481.2010; doi: 10.1056/NEJMp1011024
53. Rashidi HH, Tran NK, Betts EV, Howell LP, Green R. Artificial intelligence and machine learning in pathology: The present landscape and supervised methods. Academic Pathology, 6, 2019; doi: 10.1177/2374289519873088
54. Tabachnick BG, Fidell LS. Using Multivariate Statistics (5th ed). Pearson Education, Inc.; 2007.
55. Killin L, Hezam A, Anderson KK, Welk B. Advanced medication reconciliation: A systematic review of the impact on medication errors and adverse drug events associated with transitions of care. TJC Journal on Quality and Patient Safety, 47, 438-451 2021;
56. Procop GW, Weather AL, Reddy AJ. Operational aspects of a clinical decision support program. Clin Lab Med, 39, 215–229. 2019;
57. Ellis RP, Hsu H, Song C, et al. Diagnostic category prevalence in 3 classification systems across the transition to the International Classification of Diseases, Tenth Revision, Clinical Modification. JAMA Network Open, 3(4), e202280. 2020; doi:
58. The Joint Commission. National Patient Safety Goals® effective January 2021 for the hospital program. 2021; doi:
59. The Joint Commission. National Patient Safety Goals® effective January 2021 for the laboratory program. 2021; doi:
60. D’Avena A, Agrawal S, Kizer KW, Fleisher LA, Foster N, Berwick DM. Normalizing high-value care: findings of the National Quality Task Force. NEJM Catalyst, May 1, 2020; doi: 10.1056/CAT.20.0063
61. Cattell D, Eiijkenaar F, Schut FT. Value-based provider payment: towards a theoretically preferred design. Health Economics, Policy, and Law, 15(1), 94-112. 2020;
doi: 10.1017/S1744133118000397
62. Porter ME. Value-based health care delivery. Annals Surgery, 248(4), 503-509. 2008;
63. Porter ME, Lee TH. The strategy that will fix health care. Harv Bus Rev 91, 24. 2013; doi:
64. Porter ME, Lee TH, Murray ACA. The value-based geography model of care NEJM Catalyst 12. 2020; doi:
65. Blokland P, Reniers G. Safety Science, a systems thinking perspective: from events to mental models and sustainable safety. Sustainability, 12(12), 5164. 2020;
66. Sapatnekar S, Demkowicz R, Chute DJ. Implementation of a quality and patient safety curriculum for pathology residency training. Academic Pathology, 8. 2021; doi:
67. Westgard JO. Six Sigma Quality Design and Control (2nd ed.) Madison, WI: Westgard Quality Corporation; 2006.
68. Westgard S. Prioritizing risk analysis quality control plans based on sigma-metrics. Clinics in Lab Med, 33(1), 41-53. 2013;
69. Plebani M, Laposata M, Lippi G. Driving the route of laboratory medicine: a manifesto for the future. Intern Emerg Med. Apr 2019; 14(3):337-340. doi: 10.1007/s11739-019-02053-z
70. Plebani M, Laposata M, Lippi G. A manifesto for the future of laboratory medicine professionals. Clinica Chimica Acta. Feb 2019; 489:49-52. doi: 10.1016/j.cca.2018.11.021
71. Dickerson JA, Fletcher AH, Procop G, et al. Transforming laboratory utilization review into laboratory stewardship: guidelines by the PLUGS National Committee for Laboratory Stewardship. J Appl Lab Med. Sep 1, 2017; 2(2):259-268. doi: 10.1373/jalm.2017.023606
72. Hill JE, Stephani AM, Sapple P, Clegg AJ. The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: a systematic review. Implement Sci. Apr 19, 2020; 15(1):23. doi: 10.1186/s13012-020-0975-2
73. Leibach EK. The doctorate in Clinical Laboratory Science, a view of the strategy for continuity, growth, and realization of potential. Clinical Laboratory Science, 20(3), 189 -192 2007; doi:
74. Leibach EK. Autonomy and privacy in clinical laboratory science policy and practice. Clin Lab Sci 27(4), 222-230. 2014; doi:
75. Leibach EK, Russell BL. A typology of evidence based practice research heuristics for clinical laboratory science curricula. Clin Lab Sci 23(3) Suppl3, 46-50. 2010; doi:
76. Ballard DJ, Fleming NS, Allison JT, Convery PB, Luquire R. Achieving STEEEP Health Care. Boca Raton, LA: CRC Press Taylor and Francis Group; 2014.
77. Kudler NR, Pantanowitz L. Overview of laboratory data tools available in a single electronic medical record. J Pathol Inform. May 26, 2010; doi: 10.4103/2153-3539.63824
78. Strizick L, Kim CS. Improving outcomes for medically complex patients undergoing hip fracture surgery: It will take a village. THC Journal on Quality and Patient Safety, 47, 205-206. 2021; doi:
79. Sivashanker BG, Khorasani R, Lacson R, et al. Electronic Health Record Transition and Impact on Screening Test Follow-Up. THC Journal on Quality and Patient Safety, 47:422-430. 2021; doi:
80. Carayon P, Wetterneck TB, Rivera-Rodriguez AJ, et al. Human factors systems approach to healthcare quality and patient safety. Appl Ergon. Jan 2014; 45(1):14-25.
doi: 10.1016/j.apergo.2013.04.023
81. Del Mas F, Garcia-Perez A, Sousa MJ, Lopes da Costa R, Cobianchi L. Knowledge translation in the healthcare sector. A structured literature review. The Electronic Journal of Knowledge Management, 18(3), pp 198-211 2020; doi: 10.34190/EJKM.18.03
82. Lewanczuk R, Chuck A, Todd K, Yiu V. Value in healthcare: designing an integrated value-based healthcare system. HealthcarePapers, 19(1), 59-65; 2020; doi: 10.12927/hcpap.2020.26154
83. Modica C. The value transformation framework: an approach to value-based care in Federally Qualified Health Centers. J Healthc Qual. Mar/Apr 2020; 42(2):106-112.
doi: 10.1097/JHQ.0000000000000239
84. Pelaccia T, Messman AM, Kline JA. Misdiagnosis and failure to diagnose in emergency care: Causes and empathy as a solution. Patient Educ Couns. Aug 2020; 103(8):1650-1656.
doi: 10.1016/j.pec.2020.02.039
85. Rabi DM, Kunneman M, Montori VM. When guidelines recommend shared decision-making. JAMA. Apr 14 2020; 323(14):1345-1346.
doi: 10.1001/jama.2020.1525
86. Schrijvers G. van Hoorn A, Huiskes N. The care pathway: concepts and theories: an introduction. Int J Integr Care v12 (Special Edition Integrated Care Pathways); Jan-Dec 2012 PMC3602959. 2012;
doi: 10.5334/ijic.812
87. Maness HT Behar-Horenstein LS, Clare-Salzler M, Charmala S. Informatics training for pathology practice and research in the digital era. Academic Pathology, 7 2020; doi:
88. Plebani M, Sciacovelli L, Aita A. Quality indicators for the total testing process. Clin Lab Med. Mar 2017; 37(1):187-205. doi: 10.1016/j.cll.2016.09.015
89. Plebani M, Aita A, Padoan A, Sciacovelli L. Decision support and patient safety. Clin Lab Med. Jun 2019; 39(2):231-244. doi: 10.1016/j.cll.2019.01.003
90. Siemieniuch CE, Sinclair M. Extending systems ergonomics thinking to accommodate the sociotechnical issues of systems of systems. Applied Ergonomics, 45, 85-98. 2014; doi:
91. Leibach EK. Evidence based practice in CLS education. Clin Lab Sci, 23(3), Suppl: 2, 3-2. 2010;
doi: 10.29074/ascls.23.3_Supplement.2