ASCP News - April 2021

COVID-19 Tests to Question Before Using

ASCP has identified two targeted, evidence-based recommendations for COVID-19 testing, developed by the ASCP Effective Test Utilization Committee in collaboration with the ASCP Commission on Science, Technology and Policy.

“ASCP hopes to disseminate these recommendations to the broader medical community to ensure that we get the right test to the right patient at the right time,” said Lee H. Hilborne, MD, MPH, FASCP, DLM(ASCP)^CM, a past ASCP President and chair of the ASCP Effective Test Utilization Committee.

Examples of inappropriate and over-utilized tests are still pervasive throughout both anatomic and clinical pathology and laboratory medicine. As stewards for laboratory medicine, ASCP is mindful of the need to use the best tests available while conserving scarce testing resources.

Among its recommendations, ASCP advises against using serology testing to evaluate patients with upper or lower respiratory tract symptoms of acute COVID-19 infections, and to instead use nucleic acid amplification or antigen testing. “When considering which test is optimal for a patient, the healthcare provider should consider the test performance characteristics (ie, sensitivity and specificity) and the pre-test probability of infection, in conjunction with the risk to the patient and others of obtaining a false negative or false positive test result,” the recommendation states.

The other recommendation for clinicians, when treating symptomatic patients with a negative antigen test, is to confirm with a more sensitive test (ie, PCR) if clinically indicated. ASCP’s recommendation notes that antigen tests are less sensitive than nucleic acid amplification tests. Hence, if a patient appears to have COVID-19, but the antigen test is negative, then a follow-up COVID PCR test is strongly recommended.

National COVID-19 Testing Strategy

ASCP applauds President Joe Biden’s National Strategy for the COVID-19 Response to address the pandemic. The plan includes signature policies and proposals that ASCP has championed over the past year. The President has also called for the creation of a National Pandemic Testing Board, for which ASCP has strongly advocated.

The National Pandemic Testing Board is charged with identifying strategies to expand testing, coordinating federal government efforts to increase testing, reducing disparities in access to testing, and providing guidance on how to enhance the clarity, consistency, and transparency of federal government communication with the public about the goals and purposes of testing.

The President’s Executive Order calls for the development of a sustainable workforce initiative, known as the U.S. Public Health Workforce Program. It requires the Secretary of the Department of Health and Human Services to provide “technical support to state, local, tribal, and territorial public health agencies with respect to testing and contact-tracing efforts” and “to assist such authorities in the training of public health workers.”

Inside the Lab

Inside the Lab is ASCP’s podcast focusing on current topics showcasing the everyday laboratory professional and pathologist. The podcast’s goal is to generate thought-provoking discussions about topics relevant to the field of pathology and laboratory medicine. Episodes center on topics such as COVID-19, mentorship, burnout, retention of community practitioners, serology, patient care and more. Each Inside the Lab episode is eligible for CME/CMLE credit.

ABPath Announces Changes to CC Program

The American Board of Pathology (ABPath) has announced two changes to the Continuing Certification (CC) Program that are approved by the American Board of Medical Specialties. Beginning in 2021, the ABPath will no longer require:

• Self-Assessment Modules (SAMs) for Part II Lifelong Learning of the CC program
• A Patient Safety Course. While this is no longer required, participation in Patient Safety Continuing Medical Education (CME) is encouraged.

The SAMs requirement was developed by ABPath to ensure at least 20 of the required 70 CME credits had a self-assessment activity. Since ACCME accreditation requires that the CME provider analyze changes in learners (competence, performance, or patient outcomes) achieved as a result of the overall program’s activities/educational interventions, having a SAMs requirement is no longer necessary.

ABPath’s CertLink longitudinal assessment has been approved by ABMS as a permanent change to our CC program in 2021. This provides diplomates with self-assessment of medical knowledge as well. Diplomates are still required to complete and report a minimum of 70 AMA PRA Category 1 CME credits for each two-year CC reporting period. ASCP offers a robust CME credit-bearing portfolio.

Quality Registry Approved to Participate in MIPS for 4th Year

ASCP’s National Pathology Quality Registry (NPQR) has been granted Qualified Clinical Data Registry (QCDR) status for the fourth consecutive year by the Centers for Medicare and Medicaid Services (CMS). With QCDR status, NPQR offers pathologists a way to meet requirements under CMS’s Merit-based Incentive Payment System (MIPS).

The NPQR is an institution-based registry that allows pathologists and entire laboratory teams, as well as quality managers and IT managers, to participate in quality improvement initiatives. With renewed QCDR approval, pathologists can submit for CMS quality reporting.

“We continue to concentrate on the laboratory’s impact on our patients and how the NPQR can highlight our specialty’s patient-focus. Our registry is designed to give pathologists the tools they need to drive meaningful improvement in their practices.” said Ali Brown, MD, FASCP, Chief Officer of Medical Quality for ASCP.

New Resources for Genomics Education

The Training Residents in Genomics (TRIG) Working Group has recently launched updated genomics resources for pathology residents. In addition, a brand new genomics curriculum to use with medical students has been developed by the Undergraduate Training in Genomics (UTRIG) Working Group.

In 2014, TRIG released an extensively vetted handbook and toolkit to allow residency programs to implement local team-based learning workshops. This curriculum has been used worldwide and, in 2019, was updated to include new cases, online genomics tools and patient testing reports. In 2016, TRIG released online modules. Newly-updated Genomic Pathology Online Modules, based on the Y-19 update to the handbook and toolkit, are now available.

Newly-released materials also enable the integration of a flexible, field-tested introductory genomics curriculum into medical school coursework. Similar to the TRIG resident curriculum, an Instructor Handbook and Toolkit are available to help medical and other health professional schools locally implement this training, which includes four to six hours of active, team-based learning instruction.

Cancer Coalition Awards $500,000 in Capacity Building Grants

A group of global oncology organizations have joined forces to establish the Coalition for Implementation Research in Global Oncology (CIRGO) to improve the coordination of cancer care systems in low- and middle-income countries, particularly in Africa.

As a first step, CIRGO is awarding $500,000 in capacity building grants to eight projects in Africa. Each project will receive a $60,000 grant to develop country-specific initiatives that focus on early detection of breast cancer, cancer data quality, improving rural access to cancer testing and diagnostic services and strengthening cancer registries. Funding has been provided by the Bristol Myers Squibb Company.

CIRGO’s goal is to coordinate efforts to implement a cancer care infrastructure in resource-limited countries, and to connect potential funding sources with oncology service providers to expand cancer (treatment) services in under-resourced countries and develop systems that can be replicated.

“We need implementation science research. We have to look across the spectrum of cancer care capacity building and select certain projects to pilot in different countries, evaluate how they work and, if we can, replicate them in other countries,” said Ute Dugan, MD, a co-founder of CIRGO and Senior Vice President for Clinical Research at the Park Institute for Cancer Immunotherapy, in San Francisco.

“The only way to implement these solutions is to bring together the funders and oncology organizations to work on specific projects that have been vetted,” added Dan Milner, MD, MSc(Epi), FASCP, also a co-founder of CIRGO and ASCP Chief Medical Officer. “That way, they can identify and implement best practices to fight cancer.”