CEO SUMMARY: In just six years, experts at the AACC’s E-Lab gathering predict that 50% of all diagnostic testing will be done as point-of-care, homecare, or kit testing. If true, this will be a swift transformation in how labs organize themselves to manage the diagnostic testing needs of physicians, payers, and patients. Here are key insights from the meeting that affect both clinical labs and anatomic pathology groups.
NEW INFORMATION MANAGEMENT technologies are about to enable speedy and far-ranging changes in how laboratories perform and manage diagnostic testing for healthcare.
This was a consistent theme at the AACC’s “The E-Laboratory: A Critical Element in Laboratory Medicine Of The Future,”? held ten days ago in Miami. A carefully-selected faculty drilled in on how the full range of technologies—genomics, proteomics, Internet, software, hardware, and the like—will rapidly provide laboratories and anatomic pathology practices with incredible new capabilities.
Moving To A New Paradigm
This rapid change was probably best characterized when panelists agreed that, by 2008, as much as 50% of all diagnostic testing will be done in the form of point-of-care, homecare, and kits. For laboratories, this raises serious issues that include: 1) maintaining test quality and integrity; 2) capturing test results and getting them into the patient medical record; and 3), managing the dispersed testing process.
The predictions were potent and based upon how these new technologies are already shaping the lab testing market. For example, the impact of e-commerce can already be seen reshaping clinical transactions, according to Bruce Friedman, M.D., Director of Ancillary Information Systems, at the University of Michigan Health System. He expects clinical laboratories to be heavily engaged in e-commerce with the majority of transactions (OE/RR) Web-mediated.
Dr. Friedman’s new lab information management highway integrates pagers, voice, PDAs, other gadgets with HTML browsers, voice services and secure on-line transactions. He pointed out that growing numbers of physicians can already access lab results and AP images in real time–with hands-free capability, allowing for “just-in-time”? consultations. This creates opportunities for lab professionals to become contemporaneous consultants to help clinicians deal with the anticipated increase in genomics-based assays and other esoteric testing.
One of the lab industry’s shrewdest minds had two key observations. “Most laboratories use only half of their LIS’s available features and functions,”? declared Sidney Goldblatt, M.D., Chairman and Program Director, Department of Pathology, Conemaugh Memorial Hospital, Johnstown, Pennsylvania. Dr. Goldblatt is the co-founder of Sunquest (recently acquired by Misys). “They already have the tools to do more with lab information, like data mining, that adds value to the lab’s customers.”?
Dr. Goldblatt’s second point involved strategic positioning for hospital laboratories. “Hospital labs have an advantage over Quest Diagnostics and LabCorp,”? he said from the podium. “Hospital labs have strong physician relationships, local access, inpatient and outpatient services, and complete patient records. These are assets that hospital labs should use to provide a better quality of lab testing services.”?
Learning About Options
As laboratory testing decentralizes outward from the core lab and into near-patient and point-of-care (POC) settings, laboratories that supervise this testing need to electronically link with the remote testing site. That underpins the recommendations of Gerald Wagner, Ph.D., Senior Vice President, Laboratory Testing Systems, Bayer Corporation, Tarrytown, New York.
“There are already devices in the marketplace which monitor populations in their home settings,”? said Dr. Wagner. “For example, Matsushita’s Vital Signs Box remotely monitors blood pressure, glucose, temperature, and similar items. It is used in conjunction with an ASP (application service provider) for managing the data,”? he explained. “Results can be fed into a database, delta-checked, and sent wirelessly via the Web.
…panelists agreed that, by 2008, as much as 50% of all diagnostic testing will be done in the form of point-of-care, homecare, and kits.
“In this type of situation, the laboratory can improve patient prognosis by linking other patient data or disease knowledge into results,”? noted Dr. Wagner. “This creates a higher service level, with data available 7/24. In doing this, the laboratory positions itself as a medical and diagnostic advisor even as the focus shifts from treatment to prevention. To succeed, laboratories must stake a claim to Web real estate and factor these issues into their strategic plan.”?
Echoing an emerging theme of specialized laboratory services was Jonathan Braun, M.D., Ph.D., Professor and Chair, Department of Pathology and Laboratory Medicine, UCLA School of Medicine, Los Angeles, California. He sees labs moving away from the generalist role, organized around core labs that pro- vide almost any testing.
Labs Learn To Specialize
“I believe laboratories will increasingly specialize,”? he said. “They will spot opportunities and fill the emerging niches of risk assessment for various disease states, intervention planning, monitoring healthcare populations and providing clinical trials services.”?
Putting laboratory data to better use was the emphasis of Michael J. Becich, M.D., Ph.D., Director of the Center for Pathology Informatics, at the University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania. “There are significant benefits for laboratories to marry pathology and oncology informatics with clinical trails data,”? explained Dr. Becich. “The Cancer Registry established a standards-based informatics system that now provides nationwide reporting consistency.
“However, silo mentality in fractured AP, CP and oncology departments often prevents such lab data from getting combined in useful ways,”? he added. Dr. Becich described an innovative project between UPMC and Cerner Corporation that is actively developing a link between a tissue bank containing enriched anatomic pathology data and the Cancer Registry.
“…the silo mentality in fractured AP, CP and oncology departments often prevents such lab data from getting combined in useful ways.”?
Of course, all the data flowing into laboratories can create “information overload”? for management. This is particularly true of integrated and consolidated laboratories in multi-hospital health systems. In Milwaukee, Wisconsin, ACL Laboratories, the lab division of Aurora Health Systems, has attacked this problem.
“We’ve developed a sophisticated management reporting system,”? stated Jay Schamberg, M.D. General Manager at ACL Labs. “It’s linked to 13 applications and data bases and can be accessed over the Internet. It gives us real time data on almost every aspect of the lab’s activities.”?
In a live demonstration of the system, Dr. Schamburg could rapidly call up various key parameters of lab management, such as labor or supplies. From any starting point, this remarkable system allowed him to drill up or down to identify the specific management variable he was seeking.
After two provocative days of mixing futurist predictions with practical advice about changes already underway, the faculty sat as a panel. It offered two particularly relevant points. First, most existing LIS systems run on old software technology that is commonly eight or more years old. Thus most labs are not ready to meet the already-changing demands of the healthcare system.
Second, laboratories are focused on cost per test, not cost per disease. This is a mistake that lab managers must correct. Laboratories should begin integrating data from several sources for various disease states. The goal is to give physicians a complete picture to support improved outcomes. Panelists recommend that laboratories begin moving beyond simply producing and reporting data and offer physicians an analysis of the lab test data.
An E-Laboratory World
THE DARK REPORT concurs with E-Lab’s experts. If their collective pre- diction is true and a sizeable volume of testing moves out of core labs during the next six years, then laboratories must reassess their strategic plans.
Those labs willing to partner with other industries, break down existing barriers, and be less risk-adverse will become a part of the E-health continuum and will be positioned to provide significant added-value to clinicians.