Information Technology Series
Editor's note: This is the debut of a 3-part series that explores the value of information technology in the clinical laboratory and healthcare. Part 2, to appear in the June issue, will examine how cost management and quality improvement can begin in the lab.
The growing importance of clinical diagnostics in patient care is reflected in the increasing integration of test results into clinical practice, notably in cardiology, endocrinology and oncology. This is driven in part by powerful informatics to process massive amounts of data (e.g., in biomarkers and genomics). Significantly, a new generation of diagnostics information technology (IT) tools are getting results in the hands of the clinicians faster, improving the quality of the results and enhancing lab operational efficiency. All of this is making it possible for clinical diagnostics to increase its value to the healthcare system even as resources decline.
Parallel to these technological advances is the growing trend toward pay for performance and reliance on measurements of patient status-metrics that clinical diagnostics is uniquely suited to provide. And, labs themselves are more aware that their very survival in today's healthcare system will depend on their ability to establish their value to stakeholders: physicians, administrators, patients and payers.
Indeed, in a recent poll of 600 clinical lab professionals, "Increase visibility and understanding of lab's role" was chosen as the No. 1 business goal for the lab.1 In the past, labs thought of themselves as an unappreciated entity, says Martin Fleisher, PhD, chair, Department of Clinical Laboratories, Memorial Sloan-Kettering Cancer Center, but that perception does not reflect today's reality when labs and clinicians are forging a more collaborative relationship. James L. Januzzi Jr., MD, director, Cardiac Intensive Care Unit, Massachusetts General Hospital, explains why he works closely with the lab. "Everything in medicine, from diagnosis to establishment of prognosis and monitoring of therapy, is a biologically monitored process. In patients with coronary heart disease as well as in those with heart failure, we make pivotal decisions about treatments often based mainly on results from these important blood tests."
Heightened Expectations
As clinicians rely more on lab results for patient management, expectations of lab performance-first and foremost in turnaround time (TAT) and quality-are rising. Clinicians and lab directors agree that achieving improvements in TAT is a top priority today, and for good reason. As clinicians are pressed to see more patients, they rely on the lab to get results to them as quickly as possible so they can move patients through. But, while TAT is top of mind and often the one performance metric for which clinicians are likely to demand improvement, lab directors and clinicians agree that the accuracy of test results is paramount.
Increasingly, clinicians also expect labs to offer counsel in the use of tests. Inundated by information on new developments in medicine, they need help navigating through the numerous choices of tests to order. They look to labs to guide them through interpretation of test results with easy-to-understand test reports. More often, clinicians are inviting the participation of lab professionals as they develop practice guidelines. Dr. Fleisher speaks of the need for lab professionals to consider lab results in the whole clinical context; after all, this is how clinicians interpret patient results. He also emphasizes the importance of integrating test information from different sources (e.g., clinical lab, pathology and cardiac testing) to provide a cohesive, actionable report for the clinician.
The Role of Diagnostics IT
Clinicians' demand for more help from labs in supporting their patient management decisions is coming at a time when labs are faced with continuing budget crunches and labor shortages. Not surprisingly, labs are looking to automation and the use of IT to improve operations and facilitate access to and exchange of critical information for patient management. Our poll of 600 lab professionals showed that 72% expect that diagnostics IT will play a significant role in helping the lab achieve its most important goals; of these, 24% believe that IT will be the lab's focus in the immediate future.1
The use of diagnostics IT to improve quality and efficiency in lab operations has continued to evolve; the roles of diagnostics IT to improve processes and manage lab data are converging. Diagnostics IT is now critical to reducing human errors, streamlining human review, guiding operations and performing quality control. And labs are reporting a measurable reduction in errors concurrent with improvements in TAT and increases in test volumes by deploying diagnostics IT.2 According to Dr. Fleisher, "The IT component of the lab is critical."
Just as significant is the growing trend of developing patient information databases to improve access by healthcare providers and, thus, better coordinate patient care. This is happening at the institution level-such as at Memorial Sloan-Kettering, where patient results can be accessed by any authorized provider within the system, regardless of the physical location of the facility. At the health network level, such as at Partners Healthcare System (Boston), the use of electronic health records (EHRs) allows clinicians to access patient records when they need them (e.g., in the emergency room of a hospital where the patient has not been seen) and allows access even through mobile devices. At the next level, regional health information exchanges (HIEs) are being created by multiple providers through broadly shared databases, improving efficiency and reducing redundancy through coordinated care.
Incorporating lab results into such databases is the next step. Many labs are moving toward the implementation of one of the menu set objectives defined by "meaningful use" regulation put into place in January. The objective, "Incorporate clinical laboratory results into EHRs as structured data," along with its corresponding measurement, "More than 40% of clinical laboratory test results where results are in positive/negative or numerical format are incorporated into EHRs as structured data," clearly recognize the importance of lab results in patient care.
Thriving in an Inhospitable Environment
Day to day, clinical labs are already deploying diagnostics IT to optimize operations and deliver exemplary service by providing timely delivery of actionable information. Diagnostics IT is also enabling labs to take an active role in supporting initiatives coming from their own institutions, payers or government regulations. Now, lab professionals can go one step further in cementing their relationship with their customers-the clinicians. Dr. Fleisher, whose professional honors include designation as Mentor of the Month by the American Association of Clinical Chemistry in 2007, suggests actively engaging and communicating with clinicians. "Take time out of the lab to interact with clinicians. Go out and give seminars, deliver lectures, teach them about how to use lab tests in managing their patients. Offer them ideas on how to order tests and interpret results in a more efficient manner.
"Communication is so important," Dr. Fleisher continues. "Clinicians are busy, but they would love to hear more about what is being done in the lab. They would be interested to hear about the terrific new technologies available today, and it is the responsibility of the lab to get out there and tell them about it."
This interaction between the lab and clinicians is paying off at institutions such as Massachusetts General Hospital. "We've done an outstanding job of integrating the needs of the lab with the needs of the clinicians," says Dr. Januzzi, "We have a very collaborative relationship. I work with our lab director to make decisions such as which tests to include for diagnosis of MI [myocardial infarction] and how to implement them. This includes efforts in education after implementation as well."
In Dr. Fleisher's words, "It is so important that labs elevate themselves to the point of being the consultant of the clinician."
Connie Dubois is director of workflow solutions and Vesna Swartz is senior manager, global diagnostics IT marketing, Siemens.
References
1. Cummings D, Olson E, Stein D, Swartz V. Process management: A new standard in lab productivity. White paper published by Siemens Diagnostics Healthcare, 2011.
2. Stern S. Elevating patient care at University of Michigan Hospital. MLO 2010; 42(1):30-1.