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The Medical Review Officer (MRO) – An Overview

The Medical Review Officer (MRO) – An Overview

Last updated on October 2nd, 2020 at 05:03 pm

Drug testing by employers is fairly commonplace, but it is not without potential difficulties.  The drug testing process must be conducted with strict adherence to established protocols and best practices. An essential part of this process is how positive drug test results are handled as they present issues of medical confidentiality that require expertise to appropriately manage.  A Medical Review has that expertise.

What is an MRO?

The Medical Review Officer (MRO) is a licensed physician with specialized training who is responsible for overseeing results for an employer’s drug testing program.  The MRO acts as an impartial and autonomous advocate for the accuracy and integrity of the drug testing process.  This includes ensuring protocols for specimen collection are followed, reviewing laboratory results, determining if there is a legitimate medical explanation for adulterated, substituted, invalid or positive test results, ensuring a timely flow of test result data, and protecting the confidentiality of private employee medical information.

MRO Qualifications

An MRO must have in-depth knowledge of the toxicology and pharmacology of illicit drugs and controlled substance abuse disorders, as well as alternative medical explanations for positive drug test results.

Comprehensive training and examination are required for certification as an MRO.  Qualified training programs provide instruction in

  • the process of collection for urine specimens
  • chain of custody, reporting and record keeping
  • interpretation of drug and validity test results
  • the roles and responsibilities of the MRO in Department of Transportation (DOT) drug testing process
  • interaction with other participants in the drug testing program such as TPA’s, collectors, collection sites, employees, employers, etc.

At the completion of training, the MRO candidate must past an examination administered by a nationally recognized MRO certification board.  The resulting certification is valid for a period of five years, at which time the MRO must undergo requalification training and subsequent successful re-examination in order to maintain certification.

MRO Restrictions

There are some restrictions regarding MRO’s.  An MRO cannot be an agent or employee of anyone with a financial interest in any lab or instrumental initial test facility (IITF) where the MRO is reviewing the results of drug tests.  Additionally, the MRO cannot receive any financial benefit as a result of recommending the use of a particular facility or be in an agreement with any lab or IITF that could be perceived as a conflict of interest.

Employer Protection

Ultimately, an MRO serves to protect the employer by assuming responsibility for the assessment of drug testing results and for handling the procedural response to positive drug tests, including the review and release of confidential employee medical information.  This includes conducting a verification interview with the employee following a confirmed positive drug test result.  The MRO informs the employee of the positive result and the specific drug or drugs which caused it.  Additionally, the MRO interviews the employee to determine if there is a legitimate medical explanation for the positive result, and makes a final evaluation of that result.  The MRO then notifies the appropriate parties of that final determination while adhering to confidentiality regulations.

An MRO review is not required in every state or for all employers.  However, the utilization of an MRO’s expertise is highly recommended for all drug testing programs.  By utilizing an MRO, an employer can feel confident knowing a highly trained, certified physician is ensuring the integrity of the drug testing process and handling the issues of confidentiality in a manner that will help to protect the employer from possible litigation.

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