Health News | Team Members

While Heather Duncan, the director of ECU Health Medical Center’s laboratory services, knew she wanted to work in health care from an early age, her career plans changed when she learned about the medical technologist program at her school. “I thought I’d be a dermatologist,” she recalled. “But I liked biology and science, and the medical tech program fit my interests. That steered my career, and I’ve never looked back.” The South Carolina native has served in her current role at ECU Health for six years, and she is now wrapping up her four-year term with the Clinical Laboratory Improvement Advisory Committee (CLIAC), which is an appointed position. During her time with CLIAC, Duncan has been instrumental in bringing positive change to her profession.

CLIAC is a federal advisory committee that provides guidance to the Department of Health and Human Services (HHS) and is managed by the Centers for Disease Control and Prevention (CDC). The advice and guidance the committee provides pertains to general issues related to improvement in clinical laboratory quality and laboratory medicine practice.

Duncan said she didn’t even know CLIAC existed until a former co-worker approached her to gauge her interest in being nominated for a position. “They asked me if I would be interested, and it was exciting because CLIAC is so impactful.”

In the past four years, Duncan said she’s been privileged to collaborate with 20 other professionals to develop educational resources for the lab community and update the CLIA regulations. During her tenure, Duncan chaired the CLIAC Certificate of Waiver (CoW) and Provider-performed Microscopy (PPM) Procedures workgroups.

Heather Duncan

“The work that has come out of those groups has allowed CLIAC to make recommendations to modernize our regulations, which impact the laboratory community at large. We’ll see those impacts here at ECU Health,” Duncan said.

One such regulation restricts who is allowed to train new personnel to perform certain functions in the lab. With Duncan’s work, the regulation has now expanded to allow more people in the lab community to perform that training. “Because there is such a workforce shortage with laboratory technicians, this is impactful by expanding who can provide training, and it improves the overall quality of lab testing,” Duncan said. Caryl Havasy, the system administrator for laboratory services, sees Duncan’s work with CLIAC as instrumental in gaining more lab technicians. “ECU Health, like other health systems, faces an ongoing shortage of laboratory testing personnel. Heather’s experience in laboratory operations and regulatory compliance in our rural-focused health system brings a much-needed perspective to the work of CLIAC, specifically its role in creating the regulatory structure that defines the qualifications for frontline laboratory roles,” Havasy said.

Another exciting recommendation that emerged from the most recent CLIAC meeting would allow for virtual competencies, which would expand training capability and incorporate cutting edge technology into practice. “Because we serve rural communities, having this technology would cover a huge network,” Duncan shared. “We have benefitted from having a direct pipeline to the work CLIAC is doing. For example, our lab was one of the initial beta testers for virtual lab safety training. They sent us four Oculus headsets and they push new training programs to us.”

While this technology isn’t widely used yet, Duncan said being a part of an organization that promotes advancements in technology and makes recommendations on a federal level is gratifying. “This work allows for a forward-thinking process, and it will impact our whole community,” she said. “Our vision is to be the national model for rural health care, so we should use every tool available. Being a part of CLIAC means I’ve been able to make a real difference.”

Havasy highlighted other areas CLIAC and Duncan’s work with the committee makes an impact, including, “a change to rules surrounding histocompatibility testing (performed to match organ donors with recipients, i.e., kidney transplants) that will remove specific requirements for obsolete methods and practices, accept newer testing techniques and eliminate redundant requirements. This will result in a decreased compliance burden on the laboratory and more efficient testing for our eastern NC kidney transplant patients.” Duncan also worked with the CoW workgroup, which addresses regulations as they pertain to labs with a Certificate of Waiver. This waiver is granted to labs that only perform waived tests, which are simple laboratory procedures and examinations with a low risk of an incorrect result (including urine pregnancy tests or blood glucose monitoring). Labs must pay certification fees every two years to acquire and maintain the certificate. Duncan explained that one area her workgroup focused on was an updated fee schedule. “CLIA is a self-funded program, and they haven’t updated their fees in a long time,” Duncan explained. The group also worked on establishing a broader range of sanctions for laboratories that operate under a Certificate of Waiver but are not compliant with the CLIA regulations.

Because of her work with CLIAC, Duncan said ECU Health has a seat at the table and can provide input for advancements in laboratory operations. “Through these efforts,” Havasy added, “Heather embodies the ECU Health vision of bringing our rural health care system needs and potential solutions to a national stage, impacting not only our own operations but those of every health care system across the country.”