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Part III: QC - Quality or Compliance? PDF Print E-mail
Written by James O. Westgard, Ph.D.   

Final5 CLIA Rule. Part III:
QC - Quality or Compliance?

CLIA recommends you meet the needs of your patients, but only requires that you meet minimum requirements of the regulations. Dr. Westgard examines these minimum requirements for compliance, and compares them to the needs of your patients. (preview)

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Part II: Perplexity about Complexity and Personnel PDF Print E-mail
Written by Dr. Sharon S. Ehrmeyer, PhD   

Final5 CLIA. Part II:
Perplexity about Personnel and Complexity

We're pleased to have this article by Dr. Sharon Ehrmeyer, PhD, well known for her grasp of CLIA and regulatory affairs. Dr. Ehrmeyer offers us her view of the new CLIA rules. In particular, she clarifies how these new rules will impact personnel requirements and qualifications in the laboratory. (preview)

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Part I: Key Changes PDF Print E-mail
Written by James O. Westgard   


Final5 CLIA Rule.
Part I. Key Changes

The "last" regulations for CLIA were published on January 24th, 2003. Big changes were made in terminology, organization, and regulation. The "minimum compliance" for QC has been changed. Responsibilities for much of quality control have shifted from diagnostic manufacturer to sit squarely on the shoulders of the healthcare laboratory. What does all this mean to you? Dr. Westgard and colleagues provide you with a quick snapshot of all the changes.

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1999 Stockholm Consensus Statement PDF Print E-mail

CONSENSUS AGREEMENT

The Organising Committee are pleased to report that this recent Conference was most successful. Over 100 participants from 27 countries actively contributed to the discussions on the 22 formal presentations. Our primary aim in organising the Conference was to provide a vehicle for reaching consensus on the setting of global quality specifications in laboratory medicine. This objective was achieved and lively constructive debate after the presentations were complete led to agreement on the principles laid down in the draft Consensus Statement posted here. IFCC, IUPAC and WHO kindly sponsored the Conference but it must be noted that the Consensus Statement reflects the views of the presenters and registrants who participated in the Conference and does not necessarily represent those of the sponsoring bodies.

Comments on the draft Consensus Statement are welcome from all participants. These should be sent by
e-mail [ This e-mail address is being protected from spambots. You need JavaScript enabled to view it ] or FAX [+353 1 455 9073] before the end of May. The Editorial Group [Callum Fraser, Anders Kallner, Desmond Kenny and Per Hyltoft Petersen] will then evaluate the comments received and prepare a final version that we are sure will be very widely published in a variety of formats.

"CONSENSUS STATEMENT [DRAFT]

The main outcome of the Conference was agreement that the following hierarchy of models should be applied to set analytical quality specifications.

I. Evaluation of the effect of analytical performance on clinical outcomes in specific clinical settings

II. Evaluation of the effect of analytical performance on clinical decisions in general:

A. data based on components of biological variation
B. data based on analysis of clinicians' opinions

III. Published professional recommendations

A. from national and international expert bodies
B. from expert local groups or individuals

IV. Performance goals set by

A. regulatory bodies
B. organisers of External Quality Assessment (EQA) schemes

V. Goals based on the current state of the art

A. as demonstrated by data from EQA or Proficiency Testing schemes
B. as found in current publications on methodology.

Where available, and when appropriate for the intended purpose, models higher in the hierarchy are to be preferred to those at lower levels.

The concept of such a hierarchy is described in a recent Editorial in Clinical Chemistry in which the relative merits of the above models are discussed [Clin Chem 1999;45:321- 3].

This hierarchy has also been proposed by the ISO/TC 212/WG 3 subgroup on "Analytical Performance Goals Based on Medical Needs" as the basis for the ongoing revision of ISO/CD 15196.

The following matters were also discussed and agreed:

  • The above hierarchy includes currently available models; however, new useful concepts will undoubtedly evolve.
  • Implementation of any of the models should use well-defined and described procedures.
  • To facilitate the future debate on the setting of analytical quality specifications, there is a need for agreement on concepts, definitions and terms.
  • There is a need for continuous improvement in the exchange of information on quality issues:
    • between clinical laboratory professionals and the diagnostics industry and
    • between clinical laboratory professionals and the users of the laboratory service."

Short versions of the papers presented by all of the speakers at the Conference, together with an Introduction and the final version of the Consensus Statement will be published in a Special Issue of the Scandinavian Journal of Clinical and Laboratory Investigation (September). One copy will be sent to each participant later this year.

Reprints will only be available as the complete set of articles. Reprints can be ordered from the secretariat of the conference (Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it ). The price for the first copy will be USD 55; additional copies prepaid before July 31 will cost USD 35. Payment includes airmail. Payment should be made to Postgirot Bank, Swiftcode PGSISESS, account number 599143-5.

 
RCPA (Australasian) Quality Requirements PDF Print E-mail

The RCPA (Royal College of Pathologists of Australasia) have developed a thorough set of specifications for allowable error. For those not bound by the CLIA regulations, these can serve as a valuable resource. Many analytes that are non-regulated by CLIA can be found here, too.

 

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