Laboratory Stewardship Focus: Quarterly Section in Clinical Laboratory News

PLUGS is supporting CLN’s new Laboratory Stewardship Focus section! The editors of Laboratory Steward­ship Focus welcome you to this experi­ment in stewardship education. We are a diverse group of editors consisting of a clinical chemist, an informaticist, two pathologists, and a genetic counselor. Our goal is to cover all aspects of laboratory stewardship using a variety of engaging formats including interviews, articles, literature reviews, cases, and more. New articles are published quarterly!

Read our latest articles:

Read about why PLUGS is supporting CLN’s Laboratory Stewardship Focus

ARUP Lab Stewardship JeoPARODY


In their Lab Stewardship Lecture Video, PLUGS Gold Sponsor ARUP Laboratories invited Dr. Astion to play host for a day in a laboratory stewardship-themed parody of Jeopardy!™, with Dr. Jane Dickerson (PLUGS) and Dr. Andrew Fletcher (ARUP) providing expert commentary. Although no Alex Trebek, Dr. Astion just might be the Alex of PLUGS. Grab some popcorn and test your stewardship knowledge.

Click here for more information about the contestants, Continuing Education credit, and to watch Lab Stewardship JeoPARODY!


Mayo Clinic Laboratories and Change Healthcare White Paper Series

This three-part series of white papers was developed in collaboration with Mayo Clinic Laboratories (Mayo Clinic Laboratories is a silver sponsor of PLUGS) and Change Healthcare (Change Healthcare is a corporate member of PLUGS). It provides frontline data, perspective and commentary from experts and physicians on the application and value of implementing a clinical decision support (CDS) system in the laboratory. The third paper includes early-adopter proof points from several hospital laboratories that have successfully implemented third-party decision support to achieve their stewardship goals, including EHR interventions and ongoing monitoring of utilization.

#1 — Clinical Laboratories Under Pressure: Exploring Options to Re-establish Critical Relevancy and Maintain Independence

As a clinical laboratory leader, it’s important for you to understand why selling the lab will not solve core problems like overutilization, low-value testing, inappropriate use of high-cost testing, and provider confusion over best test choice which can lead to irrelevant results.

#2  — Critical Factors for Launching a Clinical Decision Support System in the Hospital Laboratory

part 2 of a three-part series— provides practical pearls on how a proven decision support solution and one that is a good fit for your lab can be the foundation of an effective laboratory stewardship program, and can greatly assist in controlling utilization and meeting the challenges of value-based care. As well, the paper also clearly explains the points for “buy versus build” laboratory decision support.

#3 — Case Studies in Clinical Laboratory Test Stewardship: The Financial and Clinical Impact of Clinical Decision Support in Hospital Laboratories

This white paper – the third in a three-part series developed in collaboration with Mayo Clinic Laboratories and Change Healthcare – provides frontline perspective and commentary from experts and physicians on the application and value of decision support in the laboratory. It also includes early-adopter proof points from hospital laboratories that have successfully implemented third-party decision support to achieve their stewardship goals, including EHR interventions and ongoing monitoring of utilization.



Member Series: COVID-19

PLUGS is dedicated to providing our members with relevant COVID-19 related education and innovative solutions from national laboratory experts.

Date: April 30, 2020
Panelists: Mike Astion, PhD, MD, Seattle Children’s Hospital & PLUGS, Jane Dickerson, PhD, Seattle Children’s Hospital & PLUGS,, Mark Wener, MD, University of Washington, Elise Occhipinti, MD, Ochsner Health System

Laboratory testing is one of the pillars of the response to the Covid-19 pandemic. Some of other pillars include social distancing, health system capacity, supply chain, and logistics. The main assays for Covid-19 are PCR to detect active infection and antibody testing to detect those previously infected. Both types of testing have distinct challenges that will be addresses in this LabTalk discussion. In addition, we explore the experience of two different systems in two different states that illustrate the challenges and opportunities related to laboratory services during the Covid-19 pandemic.

Date: April 2, 2020
Presenters: Mike Astion, MD, PhD, Seattle Children’s Hospital & PLUGS, Geoffrey Baird MD, PhD, University of Washington, Mark Wener, MD, University of Washington, Jane Dickerson, PhD, Seattle Children’s Hospital & PLUGS

The COVID-19 pandemic has a profound effect on laboratory services in two clear ways: 1) laboratories must either standup COVID-19 testing or procure it from a reference lab, and 2) the pandemic deflects testing resources away from a variety of vulnerable patients. In this member meeting we discuss both of these effects on the clinical laboratory.

Date:March 19, 2020
Presenter: Mike Astion, MD, PhD, Seattle Children’s Hospital & PLUGS

Dr. Mike Astion presents an update on COVID-19.

PLUGS® Patient Toolkit – Complex Lab Tests: How to Get Them Covered

PLUGS is excited to introduce our new patient toolkit, Complex Lab Tests: How to Get Them Covered. The toolkit provides information about payment for complex lab tests. It also provides checklists to help patients and families get complex lab tests covered and to prepare an appeal if the claim or request is denied.

The toolkit is now available to download here!

Rapid Genome Sequencing Coverage Policy

PLUGS has published a rapid genome sequencing coverage policy that’s now publically available!  You can view it here!

Interested in our other policies? find them all here! Have a policy or template you’d like to share? Have a policy that you’d like to see? Send us an email at

We are excited to announce our partnership with Accumen!

We are excited to announce our newest corporate sponsor Accumen!

Accumen Inc. is the premier healthcare performance partner providing end-to-end strategy, technology and healthcare industry expertise to create sustainable and profitable integrated hospital systems. Our functional expertise includes clinical lab, outreach services, patient blood management, anemia management, and imaging services. Our growing technology catalog supports each of these functional areas while leveraging legacy systems hospitals have invested heavily in.

Engagements start with a comprehensive diagnostic revealing opportunities for measurable improvements within the organization, from there a customized transformation blueprint drives innovation leveraging technology and our esteemed team for sustained results. Accumen has a shared success funding model partnering with hospitals and health systems to set new standards of performance for healthcare at no risk.


PLUGS would like to thank our sponsors for their support!




New Sponsor: National Decision Support Company

PLUGS would like to welcome National Decision Support Company as the new corporate sponsor! We are excited to work together with National Decision Support Company towards our shared goal of improving laboratory stewardship!

Pediatric laboratory test utilization is often over-looked, but has a significant impact not only on cost, but most importantly, on patient care. The CareSelect™ Lab team is proud to be involved in helping to provide excellent care to pediatric patients. Through CareSelect Lab, clinicians can reduce test misutilization and leverage data analytics to help drive behavioral change. The collaboration with Seattle Children’s Hospital allows us to focus on and implement more detailed guidelines in pediatric health and utilize first-hand testing knowledge from one of the top children’s hospitals in the country.

PLUGS would like to thank our sponsors for their support!




PLUGS Summit 2019 Abstract Presentations

You have heard of speed dating, and speed networking, now we bring you speed laboratory stewardship presentations! Our recent member meeting featured presentations by PLUGS experts regarding posters shared at the PLUGS Summit in June.  The presentations highlight a variety of laboratory stewardship topics, interventions and successes:

  1. Hear from Lee Zellmer at Children’s Mercy Hospital in Kansas City, MO about implementing a solution to reducing ordering errors for complex genetic testing using Cerner PowerForms
  2. Nicole Collier from Dayton Children’s Hospital describes the success of multiple quality improvement initiatives using recent screening guideline changes and cross departmental collaboration to reduce unnecessary testing which resulted in a nearly $300k reduction of laboratory charges for celiac screening in pediatric patients.
  3. Lauren Moissey from Blueprint Genetics explains the tailored NGS solutions implemented to improve the quality and coverage of highly homologous PKD1 gene to enable high diagnostic yield.
  4. Hsuan-Chieh “Joyce” Liao from Seattle Children’s Hospital shares her award-winning poster comparing the laboratory send-out ordering patterns of naturopathic doctors to general practitioners in a pediatric patient population by retrospective analysis to help target interventions and improve laboratory test stewardship.
  5. Erin Schuler from University of Kentucky describes a data-driven approach to evaluating urine drug screening strategy in the Emergency Department – which in their case supports the benefits of implementing a 2-tiered approach.
  6. Dustin Bosch of University of Washington School of Medicine highlights the superior sensitivity of serology for non-invasive pylori testing using evidence-based diagnostic algorithms in this patient population, despite recent guidelines to the contrary.
  7. Learn how Jessica Shank and her team at Ann and Robert H Lurie Hospital of Chicago implemented a time tracking system within their laboratory utilization management program to identify how their 3 genetic counselors allocate their time. Through this real-time data collection endeavor her team is better able to track genetic test ordering volume, divide the resource burden, plan for short-term leave, and advocate for additional support.

If you missed the July Member Meeting, access the recording to listen to the mini-presentations and follow up Q&A/discussion.

Individual posters are included in the slide deck found here.

Also share your topics, interventions, and successes in our discussion forum!

Precision Medicine Podcast: a Laboratory Stewardship Program to Foster Precision Medicine Best Practices

PLUGS’ Dr. Michael Astion was a featured guest on The Precision Medicine Podcast! Listen to the full podcast here.

Laboratories could be considered the epicenter of the precision medicine industry, so we were thrilled to have Dr. Michael Astion, Medical Director for the Department of Laboratories at Seattle Children’s Hospital join us. In this episode, he introduces us to PLUGS, (Patient Centered Laboratory Utilization Guidance Service) a grassroots program he co-founded that exists to promote and strengthen laboratory stewardship.

As a company that promotes collaboration in precision medicine, the Trapelo team was excited to learn more about the PLUGS program, which promotes laboratory stewardship with the goal of bringing all stakeholders together for more accurate molecular testing. Dr. Astion summarized the four key goals of PLUGS as:

  1. ensuring providers are ordering the right molecular tests;
  2. making sure they are retrieving that test;
  3. interpreting the test correctly; and
  4. negotiating fair payment for everyone involved.

In order to pursue those four aspects of laboratory stewardship, PLUGS helps its members create stewardship programs and share tips, policies, procedures, educational materials, and best practices with each other.

During our time with Dr. Astion, we discussed some astounding numbers with regard to laboratory ordering and management.