Why Labs Will Increase their Use of Middleware and Informatics

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“Across the globe, laboratories face similar and
significant challenges in how they use information technology and middleware to solve problems.”
—Jacques Baudin, Executive Vice President, Technidata America Medical Software

CEO SUMMARY: Middleware seems to be all the rage across the laboratory industry these days. Many lab organizations now use software provided by multiple vendors. One of the newest players in this market is Technidata America Medical Software LLC, based in Tucson, Arizona. But Technidata is not a new company. Its roots go back to the earliest days of laboratory information systems (LIS) in Europe in the late 1970s. Its parent company, headquartered in Grenoble, France, serves 700+ laboratories in 25 countries worldwide with installed laboratory information systems. No American healthcare IT company can match this installed LIS base globally. That is why THE DARK REPORT’s Editor-in-Chief, Robert L. Michel, caught up with Technidata America’s Executive Vice President and General Manager, Jaques Baudin. Baudin’s global experience with laboratory software provides plenty of useful insights about how American labs are likely to utilize software in coming years.

Part One of Two Parts

EDITOR: Because of Technidata’s years of experience providing LIS and software solutions to laboratories in France and 24 other countries worldwide, it has a perspective on healthcare information technology (IT) that is markedly different than most health IT companies in the United States. To help our readers understand your different corporate approach and business strategies, I would like to explore three general themes during our conversation.

BAUDIN: What would those be?

EDITOR: First is for you to share your views about how healthcare is evolving. That will be particularly interesting because you work with laboratories in Europe, North America, and the Pacific Rim. Second, we can discuss specific trends and market forces you now see changing how laboratories are organized and how they serve clinicians. That will set up our third theme, which is to explore the informatics strategies Technidata is developing to provide laboratories with middleware solutions that support their success at meeting the changing needs of clinicians and the healthcare systems they serve.

BAUDIN: That is an ambitious roadmap for this interview. It means we have a lot of ground to cover.

EDITOR: Then let’s get started. How does Technidata see healthcare changing during the next few years?

BAUDIN: Probably the single most important change will be the growing use of genetic testing and genetic therapies. The increased knowledge that clinicians gain from genetic and molecular tests will shift healthcare away from its traditional emphasis on fire-fighting and move it more into a preventative mode. In fact, genetic knowledge is likely to make medicine more predictive.

EDITOR: Does your use of the term “fire-fighting” describe the longstanding orientation of medicine to respond to acute and episodic events?

BAUDIN: Yes. Today’s healthcare system has been organized to intervene when a sick patient shows up at the doctor’s office or the hospital. Genetic medicine will allow physicians to shift to preventative medicine. For example, the capability already exists to predict, with a high degree of clinical accuracy, whether some individuals have a high probability of having certain cancers in their lifetime.

EDITOR: How quickly do you think this shift from reactive medicine to proactive medicine will occur?

BAUDIN: One needs a crystal ball to make that prediction. What is indisputable is that genetic knowledge will radically transform most aspects of the healthcare system we have today.

EDITOR: What’s another strategic healthcare trend on Technidata’s radar screen?

BAUDIN: I will answer that with a question. Why is it that no developed country has yet demonstrated a way to control the ever-increasing cost of healthcare? Whether it’s the socialized medicine model seen in Canada, the United Kingdom, and other European countries or the more market-oriented healthcare system of the United States, no country has yet demonstrated a way to control the increasing cost of care from one year to the next and effectively provide good health care for all.

EDITOR: That is an interesting point. Do you have any ideas or opinions about how cost control might be achieved?

BAUDIN: Bruce Friedman, M.D., Active Emeritus Professor of Pathology at the University of Michigan, frequently refers to what he describes as “medical tourism” on his labsoftnews.com blog. It’s the simple concept of people traveling across borders to be treated in countries where healthcare costs are much lower. I see signs that this is happening.

EDITOR: That’s an interesting approach to controlling the cost of healthcare, on a scale large enough to make a difference.

BAUDIN: It’s not just rising cost. Growing demand for healthcare services can outstrip the capacity of hospitals and physicians. One solution is to send patients to another country. The examples are easy to see. In my home country of France, for instance, we treat patients from the United Kingdom.

“For the laboratory industry, Technidata believes these economically-flush consumers will spend quite a bit of money on proactive diagnostic testing.”
-Jacques Baudin

EDITOR: We have the same situation in the United States. Certain Canadian provinces refer patients across the border to our doctors and hospitals because they don’t have enough resources to provide care in a timely fashion.

BAUDIN: What’s important in both these examples is that the health systems of the U.K. and Canada are opting to refer patients to a source of healthcare that shortens the wait time for care and costs less than adding more doctors and hospitals in their own healthcare system.

EDITOR: You make a subtle point. It costs lots of money to expand capacity. Thus, the U.K. and Canada are already practicing medical tourism as a way to shift care to a lower-cost environment.

BAUDIN: Correct. Plus there is another, inter-related trend. Growing numbers of people in Europe and North America are already traveling to Asia to be treated. These examples show how our earth is shrinking and medicine is already in the process of becoming internationalized.

EDITOR: Does this directly affect laboratory testing services?

BAUDIN: Yes. It impacts laboratory medicine on a number of levels.

EDITOR: Please explain.

BAUDIN: First, this creates a need, along with the economic incentive to serve paying customers, for patient data to flow electronically across borders.

EDITOR: That is true.

BAUDIN: Second, it creates the need for a HIPAA-type of solution that is planet-wide.

EDITOR: Is that because privacy and controlled access to patient information are universal concerns?

BAUDIN: Yes. That’s why I predict electronic information systems will emerge specifically to support medical tourism.

EDITOR: If medical tourism continues to grow, would that act as a brake on increases to healthcare costs in many developed countries?

BAUDIN: That would be an expected outcome. Elements of this are falling into place. For example, Singapore and Thailand are deliberately developing and expanding their healthcare resources specifically to become an international healthcare service hub.

EDITOR: In your experience, are there other hints of this trend?

BAUDIN: You can see it in the expansion of healthcare accreditation organizations that cross national borders. They see opportunities to enhance their credibility and generate more revenue by going international.

EDITOR: Since you’ve addressed these planet-wide trends, what observations do you have about healthcare in the United States?

BAUDIN: Wealthy people here will pursue a high quality of life. And wealthy doesn’t mean multi-millionaires. There are many, many middle class Americans with the economic capability to spend substantial dollars on things they consider to be life-enhancing.

EDITOR: That’s an interesting insight. For example, during the past decade, sales of second homes have skyrocketed. It takes a significant financial commitment for someone to live in one house and buy another, whether for vacation or investment.

BAUDIN: Precisely my point. For the laboratory industry, Technidata believes these economically-flush consumers will spend quite a bit of money on proactive diagnostic testing.

EDITOR: That’s consistent with existing trends.

BAUDIN: Remember, this strata of the population—me, included—wants to enhance its quality of life.

EDITOR: As another example, there are already Web sites offering genetic testing directly to consumers. And in a disturbing number of cases, the genetic tests offered by these Web sites lack valid scientific justification.

BAUDIN: There you have the good and the bad that result when consumers have money to spend and are not careful about what they buy.

EDITOR: I am curious as to whether you see patient safety as an important international healthcare trend?

BAUDIN: I do and it is a trend that directly affects laboratory testing services.

EDITOR: Please explain.

BAUDIN: Just about every developed country is actively encouraging its healthcare system to reduce and eliminate errors in patient identification, medication, and the like. What is important to note is that improving patient safety inevitably leads to improvement in outcomes.

EDITOR: Would you explain that?

BAUDIN: Because, as data is collected on medical errors, that same data now makes it possible to measure outcomes. Use of integrated IT solutions, like electronic medical record (EMR) systems, also makes it possible to collect and monitor this data in real time.

EDITOR: THE DARK REPORT has written about this development for several years. When detailed data on outcomes is available in real time, it then becomes possible to rank providers by outcomes and use this data to support pay-for-performance programs.

BAUDIN: I agree with your observations. What is important for our discussion is that most developed countries are making patient safety a priority within their healthcare systems.

EDITOR: This is a good place to shift our discussion and move to contemporary issues in the United States. We can also concentrate on the specific changes that will have the greatest impact on clinical laboratories and anatomic pathology groups.

BAUDIN: What jumps to the top of my list is the drive to adopt EMR systems.

EDITOR: That’s interesting. Why do you say that?

BAUDIN: Because EMRs will form the core of healthcare integration. All relevant patient data must electronically flow into the EMR and be readily accessible to the patient’s care team.

EDITOR: What should laboratories know about this trend?

BAUDIN: The best answer is that there is no answer…yet! “How” is still the unanswered question.

EDITOR: Give me some “how” examples.

BAUDIN: How will information be normalized to populate EMRs? How will EMRs be standardized in the way they present information to physicians? How w ill clinical decision support systems develop within EMRs to guide clinicians?

EDITOR: Why do these remain undefined?

BAUDIN: That’s a question that dogs healthcare policymakers in every country. You would think that, in countries with nationalized healthcare systems, standardized solutions could be imposed. But that hasn’t happened and is not likely to change soon.

EDITOR: What are other obstacles for EMR adoption?

“In many settings, laboratories do not have a seat at the table when planning for the enterprise EMR occurs.”
-Jacques Baudin

BAUDIN: People move all the time. When they do, the continuum of care is broken. That’s a second obstacle that awaits an effective solution.

EDITOR: Thus, we have a “Tower of Babel” in healthcare IT, with many different EMR produc ts, but no standardization.

BAUDIN: That is today’s status quo. What is needed is a standard setter that can dictate parameters for a country or a large region. Everyone needs to utilize the same standards.

EDITOR: Ah! That is the type of answer that one often gets from information technology experts. Software development needs common standards to pro- vide universal solutions. Any other developments on the medical records front?

BAUDIN: What about our informed, affluent consumer who wants to carry his or her medical record around on a card—or a flash drive? Not only does that shift the medical record away from the hospital or doctor’s office, but how does it get accurately updated?

EDITOR: To bring up this point, you must be seeing something already happening in the marketplace.

BAUDIN: Definitely. I offer the example of collecting glucose testing numbers. In recent years, there are more efforts to gather this data into the patient record, regardless of whether the testing was done by a lab, in the doctor’s office, or as a patient self-test.

EDITOR: Certainly this specific trend impinges upon a traditional role for the clinical laboratory.

BAUDIN: Yes, and that’s the reason laboratories should more closely track the efforts of health systems and physician groups to build a full and complete electronic health record for every patient. In many settings, laboratories do not have a seat at the table when planning for the enterprise EMR occurs. I know of one hospital where the laboratory had no role in the EMR project planning and implementation. That hospital is now spending considerable money to patch the laboratory information system (LIS) so it can get the lab test data into the EMR.

EDITOR: Jaques, this is a good place to stop Part One of our two part interview. You have certainly provided some provocative insights about the common themes and trends reshaping healthcare services in developed countries across the globe.

BAUDIN: Thank you. Despite the differences in local healthcare practices, the similarities from one country to the next are consistent on major points.

EDITOR: In our next session, I’d like you to discuss the remaining points we set out to cover in this interview. The first is your views about the more practical issues triggered by improvements in healthcare information technology that will alter existing laboratory informatics practices.

BAUDIN: And there are several issues which need a strategic response by individual laboratories.

EDITOR: Our final point is to discuss the third theme of this interview. That theme is Technidata’s response to global healthcare trends. How is it reshaping its products and services to support the needs of clinical laboratories in meeting the challenges of both global and regional trends?

BAUDIN: That part of our discussion will be particularly interesting. It will reveal how our strategic analysis of these trends is being translated into different products and services designed to keep laboratories at the forefront of their healthcare community.

EDITOR: Good. That gives us a game plan for part two of this interview. Many thanks for sharing your insights and experiences.

BAUDIN: You are most welcome.

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