What’s in a Name? Comparative Analysis of Laboratory Test Naming Guidelines as Applied to Common Confusing Test Names
Authors: Garnett Emily , Wang Julia , Jackson Brian , Procop Gary , Bierl Charlene , Singh Ila 
Published: October 2020

Abstract
Laboratory test names frequently do not enable easy understandability or promote correct test utilization, which leads to difficulty for providers in finding the correct test and results in unnecessary cost and medical errors. As a further complication, laboratory test names are largely unstandardized and are not named based on a consistent set of conventions. To address these issues, the TRUU-Lab (Test Renaming for Understanding & Utilization) initiative aims to generate a consensus laboratory test naming guideline for better human understandability of laboratory test names. These studies address the first and second aims of the TRUU-Lab initiative: 1) to identify root causes and challenges in understanding and using laboratory test names, and 2) to share resources related to potential solutions. We initially conducted survey studies to capture the most commonly problematic laboratory test names, then performed analysis of these names to identify aspects of these names that led to confusion among providers. 274 survey responses yielded ~100 unique laboratory tests that respondents felt were confusing, and highlighted substantial diversity both in the names of these tests between institutions and in respondent opinion on the best alternative names, with the top 10 most commonly-cited tests having at least 3 unique names, and the top 2 tests (Vitamin D and anti-factor Xa) having at least 10 unique names. Post-survey analysis identified eight common characteristics associated with poor understandability of a test name, including ambiguity, abbreviations, homophones, multiple indications for a single test, non-descriptive proprietary names, synonyms, truncation due to software limitations, and €œpanels where test components are obfuscated. A subset of the survey-identified confusing test names were used to evaluate existing laboratory test naming guidelines for their ability to produce understandable test names. Five guidelines, including LOINC, ONC TigerTeam, Pan-Canadian iEHR Viewer Name, Standards for Pathology Informatics (Australia), and ARUP Laboratories internal style guides, were evaluated, and produced highly variable names given the same test name prompt. Further, existing guidelines also varied in their ability to avoid pitfalls previously identified as associated with poor understandability. Together, these studies highlight the aspects of existing laboratory test names that lead to confusion among ordering providers, and identify the inability of existing laboratory test naming practices to adequately address these issues. Efforts are ongoing within TRUU-Lab to use these results to inform novel laboratory test naming guidelines that promote universal human understandability. Work is also ongoing to apply these novel guidelines to generate new candidate test names, and conduct survey analysis to evaluate the effects of new test naming guidelines on understandability and correct test utilization.