Toward harmonization of interpretive commenting of common laboratory tests

Interpretive commenting (IC) is an integral part of postanalytical activities of laboratories when the clinical interpretation of laboratory results in the context of the clinical situation of a patient is provided. Harmonizing practices in IC can be an approach to ensure high-quality comments, which if followed by adequate clinical actions has a great potential in improving patient outcomes. This paper reviews basic work prior to harmonization of IC of common laboratory test results. Practices in IC are considerably diverse both within and between countries. The quality of comments is diverse and often clinically misleading in studies that characterize and estimate error prevalence in IC. Systems that can initiate, monitor, and maintain harmonization in IC are in an evolving state. Despite international initiatives, harmonized, implementable performance indicators and goals in IC are not yet available. External quality assurance (EQA) schemes are accessible mainly in English-speaking countries. A proposal for the standard structure of EQA schemes for interpretive comments in clinical chemistry and best practice recommendations for IC are available. Few studies that demonstrate evidence on the clinical utility of IC are available in the literature. To set a strategy on further steps toward harmonization in IC, well-controlled clinical studies need to be conducted, in collaboration with laboratories and their users on the clinical usefulness of IC. Until enough evidence on the value of IC in patient outcomes accumulates, standards of qualification and training for performing IC and more EQA schemes in native languages of the users are required to improve the quality of IC.