August 13, 2024, OneLab Test Open Forum

DISCLAIMER: This text is being provided in a rough draft format. It is not a verbatim transcript. Communication Access Realtime Translation (CART) is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings.

>> Julie Son: Take you for joining us.  We will get started.  A couple of notes about the webinar, if you are having technical issues throughout the webinar feel free to email our inbox for support.  As you can see, we are leaving the chat open for your engagement throughout the webinar.  Use the chat to connect with each other, reacting to what you are hearing, sharing experiences and asking questions also.  We ask that you engage with respect and professionalism.  Anything inappropriate will result in removal from the webinar.  We are offering captioning for the session so if you'd like to use the feature, please use the link in the chat and be sure to keep the captions window open as well.  With that, I would take you into the agenda.  But today, we will start discussing some relevant OneLab resources to the testing community.  Then we will go into the introduction.  As well as a presentation on tests and then the session will end with a discussion of upcoming test events.  I will now turn it over to Meredith.  

>> Meredith Reagan: Thank you.  As said, I will go over resources with you before we get into the discussion.  OneLab reach offers infographics on specimen collection and so these aim to improve specimen collection for Sars testing will be in the chat.  Along with the link to a fact sheet titled how professional and genetic testing what you need to know, and the resource contains basic information about molecular genetic testing and results.  All of the links will be in a chat.  I am Meredith Reagan; I lead the partnerships and promotions team at the training and workforce development branch.  Any of the emails, web, any of the promotions you see around OneLab my team leads that.  We are the communication office for OneLab.  

>> Julie Son: Thank you, my name is Julie, I am a senior consultant with Guidehouse.  I support the one lab initiative.  I currently support the strategic planning efforts for both of our communities of practice.  I support the engagement activity for the OneLab community practices.  I'm happy to be here today.  With that, I would turn it over a little bit of a look back into OneLab test.  Before we dive into our discussion, we want to take a look back at what led us to launch OneLab test and recap some of the highlights.  As many of us know, COVID-19 reshaped our understanding of point-of-care testing.  Part of OneLab initiatives vision is to support the testing community with timely relevant resources.  We saw that there was a high demand for point-of-care testing along with our OneLab vision we wanted to build capacity for testers to respond to the demand in a timely manner.  This resulted in OneLab test launching in March 2023.  We held a kickoff event in June after the launch.  During the event we had a variety of panelists including two speakers who are able to provide us with experiences during the COVID-19 search and the lessons they learned.  We followed up with webinars that highlighted training and resources to help support our understanding of the testing communities need.  Our previous event in collaboration with OneLab network focused on managing burnout resulted in a great discussion.  We wanted to build upon that event in today's discussion.  We hope during our discussion portion we learn more about the lessons learned during the past few years, especially during covid.  What are your current states looking like and challenges that you are facing.  And how we can continue to tailor our events and resources to your needs.  Before we dive further into the discussion, we wanted to speak on some past events.  I want to take a moment to highlight our updated events page layout.  So, we will bring up the screen with our slides we will have a link to the site in the chat.  If you scroll to the past events, you will notice a streamlined layout where the recordings and slides are posted.  If you missed any of our events, please feel free to explore the pages.  One of our recent events in terms of topics was on PPE and how to properly Don and Doc it.  When you are able to explore the events page is one of our most popular events.  I encourage you to explore it.  As you can see on the screen, this is our event page layout.  If there are any past events that you have missed, please feel free to explore the recordings and audios as well as the slides.  I will turn it over now and transition to the discussion portion for today.  Before we get started, I wanted to keep some of the open form rules of engagement in mind.  Be respectful of other people's time and space.  Please remain u on mute until it is your turn to speak.  Use your raise hand function if you have a question or comment.  The team will work to engage everyone in the order hands were raised.  Come and go as you please.  We'll be live until 1pm.  And you can email one lab with questions or technical issues.  You may also use the chat for questions or comments.  We are happy to have you come and go as you please.  As I mentioned earlier, if you have any questions or issues feel free to email the inbox.  With that, I will transition this to Meredith.  

>> Meredith Reagan: Thank you, we can start with our discussion questions and topics for lessons learned.  We are interested in hearing from you about what type of waived testing you perform and so where do you currently perform waive testing today?  

I am seeing in the chat some physician office, primary care and specialty care.  We would love to hear from others on the settings in which you all perform the testing.  Also, would anyone like to share struggles roadblocks or issues that your facility has faced in the last year and how have you or your team overcome the roadblocks.  I'm seeing in the chat provider office and the lab more primary care thank you for chiming in.  The more we can come out would be the better.  Ambulatory surgery is great.  We welcome other thoughts.  

>> Are these private offices?  Or is it more based within the hospital or health network?  

>> Julie Son: I am also getting microbiology log.  

>> Meredith Reagan: Amatory surgery.  Would anyone like to talk about struggles and challenges from the past year?  Alicia noted in the chat we welcome input and you're welcome to come off of mute and talk.  

>> Julie Son: Health department in the lab as well.  We are getting maintaining competency with nursing staff with shortages.  I'm assuming during covid especially and having to get staff ready and make sure that we have enough people given the high demand.  In terms of staff shortages, how do you respond to the staff shortages?  Were there any pros and cons in terms of lessons learned?  I'm seeing hands being raised.  Kevin, please feel free to come off of mute.  

>> Hello this is not Kevin, for my particular hospital system one struggle we faced we are not attached to our hospital system.  We have our own clear way testing going on at each individual ambulatory, primary care, specialty care or ambulatory surgery center.  One of the hardest things is to figure out how to maintain competencies and make sure that everyone is trained.  Everyone is testing and most of the places are a maze.  They do not come from a scientific background or have done point-of-care testing.  That has been a big issue.  Trying to make sure we are standardized.  Every physician office has preferences and right now since testing is not specific about who can be a lab director it is kind of like I'm a doctor here and I like to use the -- analyzer and you go down the street to different primary care and they like to use something else.  It makes it hard for everyone to come together and provide training because at that point everyone does something different.  

>> Julie Son: It is hard to standardize everyone has their own preferences.  

>> Whenever you have testing there's a lot of options.  Whatever distributor you have to kind of shop online.  

>> Julie Son: Okay, how did your facility respond to that?  

>> Right now, when you go to LinkedIn there are newer positions open for clinical operations and lab specialists.  My background is in molecular diagnostics.  I was on boarded to this hospital system to provide guidance and also provide training for those MAs.  That is where I am at, and I want to see things everyone else is doing and collaborate.  Right now, I am at the point where I am thinking how do I make it happen?  A lot of it is financial.  Trying to get all of our physicians on board with getting in analyzer is hard because you have to get a buy in, and everyone prefers visual rates because it is easier.  Maybe not easier, it might be harder, but it is cheaper.  You do not have to maintain specific instruments.  That is one thing I faced in trying to overcome a roadblock.  Right now, we want to make sure we eventually start putting thoughts and heads that we would like to have more of an analyzer and produce results instead of having visual reads.  

>> Julie Son: And trying to get a level of standardization even though there are different preferences and equipment.  Giving you resources towards standardization is what I'm hearing.  

>> Yes, that and having an intro for MAs.  A lot of good information for lab training for the CDC training but not MAs.  Whenever they come in there are a lot of them who have not done point-of-care testing, and they do not know that they need to read this or that.  Or know how to store and handle things correctly.  A lot of little things they are not aware of because it is not in their scope of practice.  

>> Julie Son: One of the things I wanted to mention, an upcoming event is highlighting one of our featured resources for you and I would recommend exploiting the website for that.  It is our featured training course on ready set test.  That resource would be able to highlight and addressing the concern of those that do not have scientific backgrounds.  This is a good place to start.  It highlights skills that you are mentioning.  That will be an upcoming event.  We will walk through that.  I encourage you and anyone else that you recommend in terms of colleagues to join the event.  We will give more information toward the end.  Thank you so much for providing your insights.  I see another hand raised, all right, I guess not.  I have Ahmad, would you like to come off mute?  I think I allowed everyone to come off of mute so those with hands raised please feel free to come off of mute, but I want to take a moment to recognize more in a chat as well.  Going back to maintaining competency with nursing staff shortages.  I'm also noting set laboratory setting concerned because of covid.  The administrator’s response to that as well as a push for additional standardization so maybe resources in providing resources in developing standardized operating procedures.  

>> Meredith Reagan: As you know the reason that we stood up this community of practice is to create a platform for all of us to interact.  We would love to hear from you about what do you think your facility or site could gain from connecting with other OneLab test members?  How do you envision connections supporting your work?  We would love to hear feedback.  

>> I think it would be a great idea because we could have a way to discuss how we do things here and how they do things there.  Eventually especially my position I like to see what other systems are doing and other clinics are doing and how they are able to standardize and how they are able to that just what processes they have in place that works.  Every clinic is different.  The -- what area you are in exchange.  In Texas, it is hard for us to maintain storage and handling sometimes during hurricane season because we have extreme weather events.  When these things happen everyone turns to me as the only person right now supporting them asking what we do with our QC liquids, what do we do with our point of care tests?  They were probably up N95 because there was no air conditioning in the building.  That is something that is area specific and it would be nice to know for people in my area for example.  

>> Julie Son: So, more resources.  Are you thinking in terms of a job aid or checklist?  

>> Exactly.  And also, for being prepared.  A lot of our clinics are not prepared.  Do they just put all of their boxes inside of a cart and take them to the main hospital because they have generators.  They will not lose power.  Do they need to take it as a loss because these are going to get outside of that stage we will have temperature excursions.  What choices do they have and what are other places doing?  One thing I noticed is a lot of the testing provides one form of QC inside of the kit.  The COVID-19 antigen card has one set of swabs for QC.  Once you QC it you cannot do it again.  That is one thing that I noticed QC checks getting those done can be difficult.  

>> Julie Son: To follow up on your question, do you have policies on a risk assessment approach?  

>> Our facility is new.  We are trying to match whatever the hospital does right now, but the hospital has a lot of accreditations, and their things are very much geared towards that.  Our systems are not accredited.  It makes it harder to get some of the things done because there is no motivation.  It has been our team going out there and providing an audit and doing checklists every year going to see if we are doing this or that right.  A lot of times it is not.  There is a true motivation to get it done because it is not like we will get something done --  

>> Julie Son: Your expertise and knowledge you know it would be beneficial to have the processes in place.  

>> Yes, for safety and all sorts of other reasons as well.  

>> Julie Son: Yes, definitely.  Thank you for that.  Going back to the check, I would love to hear what others are doing to address the testing reluctant since pediatric patients.  In case there's anyone here that works with pediatric pagers what are some of the best practices and lessons learned?  

>> I can.

>> a lot of the testing when you read the intended for use section a lot of time it tells you the age should be six or below and sometimes it will tell you these tests are only meant for this age range.  If you are out on the range, the CDC says the for any adults if you want to test for adults, you cannot do antigen because the viral load is lower in RSV, and it is easier to capture it if you are doing antigen.  It would be referred out if you're not doing a high complexity certification.  We struggle with this.  You do not want to do any testing unless it is for sure okay with the manufacturer.  

>> Julie Son: Thank you for that.  Is anyone else wanting to chime in before we move forward?  In the chat, people are adding in on the compliance conversation.  We can purchase individual swabs for additional QC needs.  Additionally thinking through resources to support the annual rounding for compliance.  If you do not have the manufacturer instructions the test becomes complex.  Making sure there is additional guidance on manufacturer instructions, especially in how to navigate and prepare staff on reading through the instructions and might be an area for us to explore.  

>> Meredith Reagan: Another goal for the OneLab community of practice is that we are feedback driven and we when we develop job aids or resources or learning courses etc., we do it with you in mind.  We would love to hear from you about what are the specific areas in need of supplementary training materials.  What were the most helpful general resources and OneLab specific resources that you encounter or use this year?  What educational needs are you anticipating your staff encountering?  We would love people to come off mute and share or drop your thoughts in the chat.  

>> Julie Son: Building off of our previous discussion it looks like we could use more resources on standardization and equipment and risk assessment.  Are there any other focus areas that would help in terms of training or additional resources that might be helpful for overall responding to point-of-care testing needs.  

>> Okay.

>> Alisha: A lot of the things that we have already for our labs can be customized for point of care.  You can always use things that are relevant to your area.  The quality and resources can still be customized to any location.  Do not feel that you can only use what we have for test, which is a lot of it related to covid, a lot of the things that we have for our lab sits on network side can be customized.  It is good to take a look at those resources that we have.  We also have an onboarding document that you can use when you're onboarding new people.  Inside the document, you can drop any training.  You can drop the manufacturers manuals into one document and that way you have one place where you can train someone.  If it is in a different location that can be customized for another location etc. I want to stress that we have a lot of things that you are asking for sitting on another platform.  You can use those.  All of our manuals and job aids are customized.  You can take that word document and customize it to the area that you are working in.  

>> Julie Son: Thank you.  We put in the chat the link to the site.  You will be able to explore the OneLab page.  We have also linked the laboratory onboarding template as well.  That is all in the chat.  Any technical training opportunities for those resourced – as countries to attend and perfect person especially for infectious disease genomic sequencing.  As a question will have to follow up on and look into more.  I do not want to mis- speak.  We can follow up through email on that.  

>> Alisha: All of our things that we do because of regulations we only do for the United States, however you are free to use our resources.  As far as certification we do not use certification.  You have to find through the resources.  Maybe other colleagues on this call might be able to provide you with a better way to find the things that you need.  Unfortunately, everything that we do is in the US labs.  Take the opportunity to network with colleagues on this webinar and reach out to them and see if they can help you with an answer.  

>> Julie Son: Thank you.  Back to our question in terms of resources, looking ahead for upcoming flu, RSV, covid season, thinking through as we are preparing for the season are there resources for point-of-care testing that might fill in training gaps for you?  

>> I would like to see resources geared towards those who are on the administrative side.  Right now it is hard for any of the staff that they have underneath them for example we have an administrator in charge of the financial side, and so I would like to see more information geared towards them because they are not coming from the clinical side and do not understand the importance of having someone always checking for expiration dates on the kits or someone always having to do a skills check every year.  They think that that is pulling them away from the clinic and taking away potential time where they can be seeing a patient.  I would like to see resources geared towards them.  We could get a buy-in from them and all of the necessary things about will fall into place because they will understand the importance of it.  There is a lot of administration and people in charge of financial budgets who are saying they do not want to buy a QC swab if you need extra, I know that that is true but the issue is when they see the end of the day it is a financial burden more than anything and I feel like if they knew how important these things are and how important it would be more patient safety and satisfaction example they will probably think it is a good idea to approve the other purchases because and it may amplify the budget a little bit if they knew how important things are.  And what goes into it right now is like you do your testing and that is it.  They do not know what all goes into it.  They do not know that we are trying to do risk management and the little things that we do to make sure the system works.  

>> Julie Son: In terms of your interaction with administration, has there been something that has worked for you that you think we can build upon?  What are things that allowed to be successful in terms of the conversation forgetting a buy-in?  

>> It is usually where you say if you could QC swab's we will not have to throw away other kits if we do not know whether or not they were exposed to a temperature excursion, or we can say there is data showing that visual reads are probably not the standard.  The standard is for us to have an analyzer.  Maybe an integration word uploads test results into the patient chart instead of just printing out the receipt and posting it to the patient’s chart and hopefully everyone gets it right etc. It is little things where you can tie into a financial standpoint and look at the data that supports having this or that.  Having integration, having analyzers to do the work for you would be something that would be nice to get data showing them and be able to see this is the CDC saying this.  They would like to see someone who has knowledge come forward.  

>> Julie Son: Effective quality control and management.  

>> Alisha: We have a resource already.  It can be found in the test or not to test.  We have something.  Again, everything that we have is customized.  You can customize it to your location.  

>> That is the issue.  Whenever we give them open information about what labs are doing, we do not have the same resources as labs, we are primary care.  We do not have a -- in charge of experience we have MAs, doctors, etc. they feel like it is separate from any suggestions that come from labs they say that we have different settings etc.  I do not know if that is the general conception because it is hard to familiar sought mill your eyes yourself.  That is my experience.  I do not know about anyone else.  

>> Alisha: Okay.

>> Meredith Reagan: One of the things that we are looking at is to take some of those available resources that are more targeted towards lapses and adjust those to fit the point-of-care testing environments.  Everything that you are talking about is helpful because as we are going through this are able to say a job aid or training will give us an opportunity to focus on things that we could give more guidance on point-of-care testing and from there be able to give you guidance on how to make that fit with what you are working with specifically.  All of this is helpful.  We can take the next step of getting the things to you that are pointed towards the point-of-care testing.  

>> Julie Son: A lot of what I am seeing in a chat is responding and building off of what you are saying.  Whether it is sharing requirements and the price of potential mistakes, etc.  Some suggestions on the equipment being used at the moment.  I am seeing a lot of that in the chat as well as the link to what was mentioned to test or not to test booklet.  Understanding algorithms for the MA is something that we will -- we will build upon that.  

[SPEAKER AWAY FROM MICROPHONE]  

>> can you hear me?  

>> Alisha: We have a little bit of background.  

>> I want to make sure that you understand the definition of wave testing.  It is simple testing that is easy to do, it has the least amount of error or potential for error and when you start talking about equipment there are some tests that come with equipment.  You can have a glucose reader but sometimes they are not where you can have them put the result into the system you have to still type it into the system because the more complex your instrumentation is, the more you have to do to a specimen then you get past -- and you go into another category.  For instance, moderates, compliance, accreditation etc.  Then you have to have staffing that has more education and more certification.  That is why most of the testing are simple.  It is a swab, or a test strip and you apply the glucose, for example you apply the blood to the strip and wait five or 10 minutes to read it.  Most instrumentation not all but most requires you to spend the specimen down put it in a centrifuge and spin it.  If that's the case, you will fall into moderate, so you are going to go to a whole different level.  I hope that that answers some of your questions.  

>> Julie Son: I see a lot of thumbs up so thank you.  Thank you, Teresa.  I think we are wrapping up with more building upon of potential education needs for staff.  We saw that earlier.  We have had this discussion about having materials geared towards those but not with no scientific background because they may not be in the administration roles may not understand the importance of care testing.  Those are good starting points for us.  Is there is anything that you think that we are missing feel free to jump into the conversation.  

For me in terms of another follow-up question, are there resources and needs for your facility with other special vulnerable populations that you may deal with, and it your facility deals with them are there additional lessons learned with working with the populations regarding point-of-care testing?  I am getting diabetics, and HIV.  Do you currently have resources available?  A lot of homeless population.  Do you have resources available at your facility that helps educate further on the point-of-care testing needs for the populations?  

Elaborate further, were there any lessons learned at your facility for working with them that you can share?  What worked well?  You have a diabetic clinic that specializes in certain populations that is good to know.  Especially for a team of what populations do you serve as point-of-care testers.  With that, be mindful, were there any additional questions?  

>> Meredith Reagan: I think that we have a few additional questions that we can ask.  Looking ahead, would this be a good opportunity to talk about are there any needs you anticipate looking ahead or how can OneLab support you or your staff with your career trajectory.  That could be a topic that we can touch on before we wrap up.  

>> Julie Son: A way to get data of point-of-care deficiencies in the CDC, the last survey was in 2004.  That is something we can look into in terms of publishing more data reports or links to data reports that I know the CDC works on in terms of providing.  We can follow up on that.  They may already exist, but complexity of test is needed.  Can you elaborate a little more on that in terms of thinking through a potential job aid or resource of highlighting the complexity of test.  As more moderate complexity point-of-care tests are coming on board, okay.  Looking ahead to more advancements in point-of-care testing and point-of-care testing type is what I am seeing.  Some of these manufacturers are tricky because a certain panel may be complex but another -- another might be waived, okay. .  What is considered a waive test and having the list available?  

>> Meredith Reagan: You're making good points.  We know point of care testing is not limited to waive testing.  If you are doing more than just waive testing if you are doing moderate, I would love to get a sense of is mostly waive testing being done in your facility or is it a mix or is it more of a moderate complexity testing?  That would be good for us to understand as well.  The two I'm getting.

>> Julie Son: Or anyone that has a mix and more moderate and complex?  Mix in the hospital lapse, all waives and clinics tiered strictly clear waive.  A little bit of a mix in terms of our audience.  That is helpful and will help us take a more informative look at what we have available and tailor it to these unique needs.  Are there any questions that we want to wrap with Meredith?  

>> Meredith Reagan: I do not think so, I think we are in a good place.  We welcome any additional thoughts or feedback.  If something comes to mind after this call, you're welcome to get in touch with us.  I see one more question in the chat.  

>> Julie Son: How is everyone performing there -- so, with clear protocols with that?  I'm noticing some equipment does not have the product or manufacturer inserts.  Send outs.  Okay.  Send outs to respond to the question and also, we encourage within the chat if you feel comfortable with sharing your contact information with one another please connect a follow-up on conversations or share best practices and lessons learned.  Feel free to send contact information to one another.  We are hoping this is what will come out of the discussion.  We want you to be able to connect with one another and share tips and resources that may help others.  What that think that we can move on to our next slide.  Feel free to continue the conversations in the chat.  We can wrap up the slides.  

>> Meredith Reagan: Thank you everyone for participating and exchanging tips in the chat.  I want to get us wrapped up, so if you have joined the call today and you're not a OneLab member we would love to invite you to scan the QR code and join.  It is free.  It is the platform to which you can receive communications about future calls, test related job aids, courses, etc.  We would love to continue the conversation, and you will get updates related to OneLab test and stay aware.  We want to talk about our next event.  Later this month, we will be having the first of a two-part series on our ready set test resources.  Patient testing is important to get the right results is the first session.  You can register with the link here.  We will add the link to the chat as well.  In this session, there is information about best practices for professionals and volunteers who perform testing in nontraditional settings outside of the traditional labs.  Please register and pass along the link to your colleagues.  We welcome participation from you and from the people that you know and work with.  Like we do with all of our events, we will get this up on OneLab reach.  We aim to do that within two weeks.  You can share that link if there is anyone who you know who might be interested in was not able to be here today.  I want to encourage all of you we are feedback driven and we welcome your thoughts on this session.  Or anything else that may come to mind as far as resources, topics of interest, what you need, what you are finding helpful, we welcome all of that.  We encourage you to share your feedback via email.  We use your input to determine topics for future events, to understand what we can do to help you and to support your work, will put the email address in the chat and again, thank you for being here.  Thank you for all of the great feedback.  We look forward to having you join our next session later this month and we look forward to hearing your thoughts and feedback.  Thank you again for a great call today.  

>> Julie Son: Thank you, have a great day.