[Histonet] High Complexity Testing

Victoria Baker bakevictoria <@t> gmail.com
Tue Feb 8 10:58:55 CST 2011

The performance of ISH/IHC is in many laboratories considered high
complexity testing - however - as the technologist doing the work does not
make the diagnosis it is considered to be a part of specimen processing.
(How's that for political double talking!)   Use of automation in these
procedures provides standardization of the protocols, but it is still a
'machine' it would not know how to recognize a staining or processing issue
along with other possible faults.  The purpose of automation was to provide
standardization and consistent reproducibility of protocols, reduce
antibody/reagent amounts, free the technologist for other needs in the lab
and reduce turn around time required for this procedure.  In essence it is
hands off BUT not brains off.

Short history is that when CLIA and CAP first started doing these ratings of
low - high complexity testing Histology was a grey/special area in that the
staff performed the technical aspect of the work, but did not sign off or
make the diagnosis.  Since then we have had revisions in CLIA and even with
CAP guidelines there is still an aspect of subjectivity based upon the
inspector's interpretation of the guidelines.  It's frustrating, infuriating
at and at times totally exasperating as you are trying to comply with all
the requirements and regulations that are supposed to be clear.

If your pathologist is considering all Histology work as low complexity I
would wonder why they thought that?  Is the lab participating in any of the
CAP QA/QI programs?  Does he/she participate in doing any In services with
the staff?  Do they interact with the staff and share anything  with them in
regards to the work or any specific concerns they may have?  Does the
department have reference material available to the staff for further study
or understanding of the work they do and how important it is to patient
care?  Is the department willing to assist with $$'s for in-house CE courses
or local Histology societies to further the laboratory staff development?
One thing that I would wonder most is if they think that what you do is 'low
complexity' could they go into the lab and perform the work themselves?

Okay my morning rant is complete --- now I guess I should take my Estrogen

If I have offended anyone, I apologize in advance.  Hope everyone has a nice

On Tue, Feb 8, 2011 at 10:06 AM, O'Donnell, Bill <
billodonnell <@t> catholichealth.net> wrote:

> I don't actually have an answer, but rather an observation.
> How many med techs are still doing glusoses in test-tubes, or manual
> drug screenings or hcg's? It would seem, by deduction that an automated
> glucose, if only because who it performing it, is a complex test. If
> measuring a bowel biopsy is now "complex", why should the critical
> judgements and skills needed to cut a section, place it correctly on a
> slide and load the machine be considered not complex.
> If it comes down to "who" is doing it, then all of our efforts to
> elevate the field, gain higher and more competative wages and education
> requirements have done little except in isolated regions or
> laboratories.
> Morning rant.... Need to start getting more sleep.
> -----Original Message-----
> From: histonet-bounces <@t> lists.utsouthwestern.edu
> [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Sheila
> Fonner
> Sent: Tuesday, February 08, 2011 6:45 AM
> To: histonet <@t> lists.utsouthwestern.edu
> Subject: [Histonet] High Complexity Testing
>  Hello All,
> I would really appreciate it if anyone has information on whether
> IHC/ISH are considered high complexity testing for histotechs.  Our
> pathologist believes that ALL histology low complexity testing since a
> "machine" is doing the work.  Can anyone help me out with some
> guidelines, literature, etc. that says otherwise?  I would really
> appreciate it.  We just want to know which one it is.
> Thanks so much Histoland!
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