Bulletin 220302 — 2022–2023 Community Access Pilot for Laboratory Services
The Ministry of Health will continue piloting a list of laboratory services available at no-cost to the patient at community laboratories
To: Ordering Clinicians (Medical Practitioners, Dentists, Midwives, Registered Nurses in the Extended Class, as applicable pursuant to Regulations 682 and 683 under the Laboratory and Specimen Collection Centre Licensing Act)
Category: Physician Services, Primary Health Care Services, Dentist Services, Midwife Services, Registered Nurse in the Extended Class
Written by: Laboratories and Diagnostics Branch and OHIP, Pharmaceuticals and Devices Division
Date issued: March 30, 2022
There is no change to the current ordering practice for the ordering clinician to participate in the Pilot. Any ordering clinician in Ontario [as defined for specimen collection in Regulation 683 and as defined for laboratory testing in Regulation 682 under the Laboratory and Specimen Collection Centre Licensing Act (LSCCLA)] can request services included in the Pilot by using the existing ordering practices that is currently in-place.
The services that are included in the Pilot are as follows:
- Category 1 Services: Ordering clinician can support patients in their choice to have their specimens collected at a community laboratory for any genetic test (for only those tests performed in a laboratory listed in Table 1);
- Category 2 Services: Ordering clinician can support patients in their choice to have their tests (listed in Table 2) performed by a community laboratory.
Participation in this Pilot is voluntary; however, the ministry encourages ordering clinicians to provide this pathway to their patients when it is appropriate. Any specimen collections requiring specialized or complex ordering and/or handling requirements should continue to be collected in the appropriate setting (e.g., hospital).
Additional details about participating in the Pilot can be found below.
Category 1 Services
For Category 1 Services, there is no change in the current ordering practice for the ordering clinician when completing a requisition form for genetic testing. The only change is that the patient can now take the requisition to a community laboratory (or the Specimen Collection Centre it owns or operates) for any genetic test that will be tested by a laboratory listed in Table 1.
The ordering clinician should only refer patients to have their specimens collected at a community laboratory if it is a routine collection with no special collection methodologies and if all of the services requested fall within either or both of the two categories of services in the Pilot, in order to avoid “requisition splitting”.
The goal of this service is to improve patient choice and increase access to testing services, including specimen collection, closer to home.
Table 1: Molecular genetics & cytogenetics laboratories
|1||London Health Sciences Centre|
|2||Hamilton Health Sciences Corp|
|3||Trillium Health Partners|
|4||University Health Network|
|5||The Hospital for Sick Children|
|6||Sinai Health System|
|7||Sunnybrook Health Sciences Centre|
|8||Unity Health Toronto|
|9||North York General Hospital|
|11||Kingston Health Sciences Centre|
|12||The Ottawa Hospital|
|13||Children's Hospital of Eastern Ontario|
|14||Health Sciences North|
|15||Newborn Screening Ontario (NSO) Molecular Laboratory|
|16||The National Inherited Bleeding Disorder Genotyping Laboratory|
|17||William Osler Health System-Brampton Civic Hospital|
|18||Lakeridge Health Oshawa|
|19||St. Joseph’s Healthcare|
Category 2 Services
For Category 2 Services, there is no change in the responsibilities of the Ordering Clinician for completing the requisition for tests on the list of services in Table 2. The only change is that the patients would now have the choice to have these tests performed by a community laboratory, as these tests would be covered under the Pilot.
The ordering clinician should only refer patients to have their specimens collected at a community laboratory according to the criteria in Table 2, and if all of the services requested are included in the two categories of services in the Pilot, in order to avoid “requisition splitting”.
The goal of increasing access to these services is to improve patient choice and access to testing services that are appropriate for a laboratory to be providing in the community setting.
Table 2: List of Services
|Name of Test||Collection and/or Testing|
|Trichomonas (NAAT)||Testing Only||Polymerase Chain Reaction (PCR) test (NAAT) only-no changes to existing clinical guidance.|
|Gonorrhea (NAAT)||Testing Only||PCR test (NAAT) only-no changes to existing clinical guidance.|
|Testing Only||PCR test (NAAT) only-no changes to existing clinical guidance.|
|C. difficile-EIA stool antigen and Toxin A/B||Testing Only||Enzyme Immunoassay (EIA) as initial screen. If EIA results for antigen and toxin A/B are concordant, confirmatory NAAT is not needed.|
|C. difficile-Confirmatory NAAT||Testing Only||NAAT for confirmatory testing only.|
|Apolipoprotein B||Collections and Testing||As per the 2021 Canadian Cardiovascular Society (CCS) Guidelines|
|Lipoprotein a [Lp(a)]||Collections and Testing||As per the 2021 CCS Guidelines|
|Celiac tTG-IgA||Collections and Testing||For the purposes of the Pilot, should be ordered for the diagnosis of celiac disease only with the following criteria:|
If patient is IgA deficient (see "serum IgA" test below), additional testing required will not be funded through this Pilot.
|Celiac serum IgA||Collections and Testing||Used alongside Celiac tTG-IgA to determine whether a patient is IgA deficient.|
|NT-proBNP||Collections and Testing||Clinically indicated only in patients with suspected heart failure.|
The Pilot will run from April 1, 2022, to March 31, 2023, and the data collected from the Pilot will contribute to healthcare system planning efforts.
The ministry will continue to maintain a Questions & Answers (“Q&A”) document to support the implementation of the Pilot. The Q&A document will be updated by ministry staff as needed and shared with community laboratories and implementation partners upon request.
Community Access Pilot; Community Laboratories; Laboratory Services; Patient Access