A recent post (see: Comparison of "Traditional" Lab Testing with Direct Access Testing) marked an effort on my part to begin to establish a naming convention for all clinical lab testing. Here's a quote from the note:
The key difference between traditional lab testing (TLT) and direct-access-testing (DAT) is that physicians order the former and they are always performed by someone other than the patient/consumer. Patients/consumers order and frequently pay out-of-pocket for the latter and they may or may not perform the tests themselves.
In response to this note, I received the following comment from Mark Terry:
I'm the author of the article [quoted in the blog note]....Although I don't disagree with your definitions in general, they are very, very broad, which poses a lot of difficulties in terms of market research and analysis. DTC, Direct-To-Consumer, would include pregnancy tests, ovulation tests, even blood sugar urine strips and test kits, which is a very different market (and market size) than DAT, Direct Access Testing, which is typically referring to Minute Clinics and Doc-in-The-Box or online services that provide laboratory testing without a physician's order, but generally send the samples to an independent laboratory (most often LabCorp and/or Quest Diagnostics).
I think that I will hold firm to my original idea to label all lab tests not ordered by physicians as direct-access-testing (DAT) instead of direct-to-consumer testing. After all, the consumer is "directly accessing" the tests without a physician as an intermediary. Having made this first cut of physician-ordered versus consumer-ordered tests, it seemed necessary to continue this naming schema to include additional levels. Below is a diagram of this work-in-progress.
There will be little question or argument about the left side of the diagram: traditional lab testing (TLT). On the right side of the diagram is what I refer to as direct-access-testing (DAT), all of which is ordered by patients/ consumers. What is slightly confusing about this right side of the diagram is that some of this testing involves involves self-collection and submission to a professional lab (e.g., submission of cheek swabs to the DNA labs), some involves self-collection and home testing with a kit or home instrument like a glucometer, and some involves collection in a patient service center (PSC) and test performance in a professional lab. This latter category, as well as DNA testing, is the "classic" form of DAT advertised and brokered by a web site.
I anticipate that there will be more variations on this DAT theme in months to come despite the attacks on genomic testing by the California lab regulatory body (see: Direct Access Genetic Testing in California). As noted above, this naming and classification schema is a work-in-progress so I am interested in any comments from readers of this blog about whether it makes sense and also how it can be improved.