Commercial Laboratories

Commercial laboratories are an important component of the medical delivery system in the United States. A commercial laboratory is a laboratory that is free-standing; that is, it is not associated with a hospital or other healthcare organization. Commercial laboratories may specialize in clinical specimens, environmental specimens, or both.

Commercial laboratories can be important partners for organizations that wish to develop biosurveillance systems because of size of the laboratories and their use of information technology. Commercial laboratories have grown significantly in size during the past decade as a result of mergers and consolidations, and they may offer tests that are not readily available. Many of these laboratories began as specialized reference laboratories, offering tests that could not be economically provided by smaller laboratories. Small laboratories merged with larger laboratories that were, in turn, purchased by large laboratory corporations. Regional consolidation of clinical laboratories that provided services to healthcare organizations led to the formation of large commercial laboratories. These commercial laboratories, such as Lab Corp, ARUP, and Quest, have developed service systems that allow them to provide clinical testing at their headquarters and at distributed sites around the country.

Large commercial laboratories have established elaborate courier systems that collect samples locally for overnight distribution to the appropriate laboratory in their network. Although a sample may be transported to a distant laboratory, the results, nevertheless, frequently become available overnight. The commercial laboratories use information systems referred to as laboratory information management systems (LIMSs) to track tests and results. These systems monitor test requests, capture test results, and electronically report the results, often within hours of the sample being received.

As discussed in Chapter 5, clinical laboratories are required to report notifiable diseases to local health departments. The large, multistate commercial laboratories face challenges in complying with notifiable disease reporting requirements that vary by state. Further, reporting requirements frequently change as new diseases of public health interest are identified and many states have expanded laboratory reporting requirements to include suspected cases of notifiable diseases. Commercial laboratories are increasingly using electronic laboratory reporting to satisfy these complex and changing requirements.

Commercial laboratories may specialize in environmental testing. These commercial environmental laboratories provide testing on a variety of samples, such as water, air, hazardous materials, dust, and soil. These laboratories often contract with governmental agencies, such as EPA, Department of Defense (DoD), and U.S. Department of Agriculture (USDA) at the federal level and with environmental and regulatory agencies at the state and local level.

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