Collaborating with Mayo Clinic Laboratories, UNC Health streamlined neuroimmunology test ordering — eliminating outmoded testing and elevating diagnostic accuracy.
A history of collaboration to advance neurologic care
UNC Health is North Carolina’s academic health system, dedicated to improving the health and well-being of all North Carolinians through patient care, education, research, and community engagement. With a statewide network of 20 hospitals, hundreds of clinics, and an affiliation with the UNC School of Medicine, UNC Health serves communities across the state with a mission-driven, not-for-profit approach focused on quality, access, and innovation.
The healthcare provided by UNC Health covers the spectrum of specialties. In addition, UNC Hospitals own and operate McLendon Clinical Laboratories, which provides diagnostic testing for clinic and hospital patients. The lab both performs in-house testing for several specialties, including pathology, molecular genetics, and cytogenetics, and sends out testing for rare and esoteric conditions to referral laboratories, including Mayo Clinic Laboratories.
Each year, UNC Health sends out orders for more than 140,000 tests, the majority to Mayo Clinic Laboratories, says Ryan O’Mara, manager of UNC Health’s Referral Testing Services department. Among the most common test orders sent to Mayo Clinic are for advanced, neuroimmunology assays.
One of the benefits of working with Mayo Clinic Laboratories, says O’Mara, is access to subject matter experts to gain clarity on ordering patterns, indications for new assays, and test utilization.
“Mayo is very responsive in helping us identify the appropriate testing pathways and in providing established testing algorithms.”
Ryan O’Mara, manager of UNC Health's Referral Testing Services department
“Mayo is very responsive in helping us identify the appropriate testing pathways and in providing established testing algorithms,” O’Mara says. “When questions arise, I can reach out directly to their team for guidance. In some cases, I will forward a provider’s question to Mayo, which leads to a more detailed discussion that helps ensure we are using the most appropriate testing approach."
Addressing redundancy to improve clinical clarity
An ongoing issue for UNC Health neurologists, however, has been redundant ordering of Mayo Clinic Laboratories’ autoimmune paraneoplastic antibody testing for patients with suspected immune-mediated neuropathies.
In past instances, both a particular antibody panel and stand-alone testing for the same antibodies included in the larger panel were ordered by physicians for patients treated in clinic. On the inpatient side, different physicians rounding on the same patient ordered duplicative testing, with one physician ordering a panel and another ordering stand-alone antibodies included in the panel.
“We were seeing a bit of an overlap there,” O’Mara says.
Adding to the confusion was new research from Mayo Clinic showing that the paraneoplastic antibody panel, which was commonly ordered by UNC Health neurologists, was no longer the best approach. The test was ordered nearly 600 times in 2024.
The volume of that paraneoplastic panel, combined with the repetitive antibody test orders, caught the attention of Matthew Quiet, the Mayo Clinic Laboratories neurology clinical specialty representative who supports UNC Health’s lab. Quiet reached out to O’Mara to better understand UNC Health’s test utilization patterns and frequent use of the paraneoplastic antibody panel. Included in the letter was a link to a Mayo Clinic Laboratories website that provided an explanation for the shift away from the paraneoplastic panel, testing alternatives, which included axonal and demyelinating phenotype-specific evaluations, and a testing algorithm. In addition, O’Mara received Mayo Clinic Laboratories’ autoimmune evaluation antibody matrix, which indicates the antibodies included in each test offering.
Turning insights into action
Upon receiving the letter, O’Mara ran a report in UNC Health’s electronic medical record to identify those providers who most frequently ordered the soon-to-be obsolete paraneoplastic panel. He then contacted those individuals to make them aware of the test change and the need to alter their ordering habits.
“From there, it was a long process to get those two tests ultimately removed,” O’Mara says. “But it was successful because we were clearly presented what alternative tests should be ordered.”
Within about six months, the axonal and demyelinating antibody evaluations and other antibody biomarker tests previously covered by paraneoplastic panel had been built into electronic test ordering system.
O’Mara also communicated more broadly with UNC Health’s neurologists by interfacing directly with Epic, the organization’s electronic medical record.
“There’s a section in Epic in the order composer where you can add a note, so I posted the note from the Mayo website right in there,” O’Mara says. “I did see, with that email having gone out and the note being in Epic, a drop-off in orders of about 50% in the first month or two.”
“From there, it was a long process to get those two tests ultimately removed, but it was successful because we were clearly presented what alternative tests should be ordered.”
Ryan O’Mara, manager of UNC Health's Referral Testing Services department
Confidence in every autoimmune neurology diagnosis
Mayo Clinic Laboratories has a decades-long history of pushing the envelope on autoimmune neurology testing, fusing scientific discovery, clinical expertise, and testing ingenuity to design and validate patient-centric evaluations that advance precision diagnosis. Grounded in a phenotypic approach, our industry-leading autoimmune and paraneoplastic evaluations empower physicians and healthcare professionals to order confidently based on clinical presentation.
Increased diagnostic confidence
- Between 2024 and 2025, the number of PAVAL test orders dropped from 594 to 7.
- Between 2024 and 2025, the number of axonal and demyelinating evaluations orders rose from 40 to 516.
While the paraneoplastic panel was not immediately removed as an ordering option when the alternative phenotype-specific evaluations were added to the EMR, within a matter of months it was clear that UNC Health neurologists had transitioned to the new tests and it was taken down.
For UNC Health’s neurologists, the availability of Mayo Clinic Laboratories’ differentiated phenotype-specific evaluations has supported better patient care.
“I have appreciated the new, more specific panels,” says UNC Health neurologist Rebecca Traub, M.D. “We are less likely to receive low or false positives for antibodies that don’t correlate with clinical phenotype.”
More importantly, access to Mayo Clinic Laboratories’ testing experts helps to reinforce testing appropriateness.
“We’ve had a lot of success just having our directors review the Mayo option and then connect to a Mayo lab director or representative,” O’Mara says. “This has helped us keep more of our send-out testing going toward Mayo Clinic Laboratories, which is great for Mayo but really good for us too because it streamlines ordering.”
“I have appreciated the new, more specific panels. We are less likely to receive low or false positives for antibodies that don’t correlate with clinical phenotype.”
Rebecca Traub, M.D., UNC Health neurologist
