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Healthcare reform. Workforce shortage. Budget cuts. Dwindling reimbursement rates. Cut-throat competition. These are just a few of the forces pressing in upon today's clinical laboratory, making streamlined systems necessary and impeccable customer service and patient care an increasingly hard-to-reach goal. Lab managers are continually asked to do more with less-create more revenue, bring in more customers and improve patient satisfaction with fewer employees and less money.
How does the industry feel about the rapid changes and outside forces that seem to continually work against the lab's success? ADVANCE asked around, and it turns out, for many industry insiders, these challenges are expected, if not embraced, and there is a trend of confidence that the industry will overcome these obstacles just as they have in the past.
The Lab's Arsenal
The slew of ongoing hindrances will be met with an equal impressive cache of weapons and smart, efficient lab managers who have become adept at managing scarce resources to extract impressive results. Automation, increasingly intelligent information systems, Lean solutions and vendor partnerships all have a role in helping the lab to rise up to meet the challenges it continues to face in the rapidly changing healthcare landscape. Most importantly, a continued devotion to excellent patient care and customer satisfaction will guide laboratories everywhere.
The role of the laboratory information system is regularly changing and growing to help labs realize their potential, run smoothly, and avoid information silos. Consultant Dennis Winsten, MS, FHIMMS, FCLMA, president and founder of Dennis Winsten & Associates Inc., notes several areas of transformation that will impact labs:
1) The changing role of the LIS to become more focused on internal lab operations and accept and pass data to and from the EMR and HIS. Distribution and presentation of lab data will no longer be the responsibility of the LIS.
2) Use of digital imaging and whole slide image capture will change the workflows in pathology and provide for easier transmission of slide images for remote review and analysis as well as for retrospective studies.
3) Extensions of LIS capabilities to acquire, process, analyze and report molecular diagnostics data.
4) Adoption of radio frequency identification (RFID) and real-time location system technologies for specimen tracking, inventory management, etc., offers distinct advantages over bar coding.
Troy Galloway, senior director of Global Lab Automation Business for Siemens Healthcare Diagnostics, explains that Siemens' informatics solutions provide complete visibility in unique and time-critical ways, providing access to patient and QC data, plus data that is not always easy to collect-like turnaround time reporting, inventory management and workload statistics. Informatics in the lab has expanded well beyond results reporting.
Automation, of course, remains another important tool that will allow labs to manage increased workflows with fewer employees. Galloway notes, "The installation of a new automation system has an immediate effect on how a lab operates, bringing new efficiencies, allowing immediate growth, and freeing up technologists from manual tasks."
What's more, in addition to providing the technology behind advanced automation platforms, a growing number of suppliers are taking a more vested interest in the success of their laboratory customers by helping them respond to changes in their business and providing information to help them run their business over time.
For example, Galloway explains, "At Siemens, we can help labs respond by providing automation solutions that have the agility and scalability to adapt with the lab. We can easily and cost-effectively add more analytical horsepower in response to growth or build in additional pre- or post-analytical capabilities."
Steve Lee, PhD, executive vice president and chief scientific officer at OraSure, adds point-of-care testing (POCT) to the list of tools that will help keep the laboratory industry strong despite the ongoing external forces.
POCT devices are typically CLIA waived, expanding the diversity of the individuals that can operate them and increasing the settings in which the devices and tests can be used. Particularly for infectious diseases that are often underdiagnosed, having a test that can be utilized in doctor's offices, clinics, community health centers, etc., can help healthcare providers identify patients early on and get them on the right therapeutic track. The costs for managing a disease caught early are far more manageable than a late-stage disease that may have gone undetected for years.
 Reform & the Future
The healthcare reform bill passed nearly six months, but the ways in which it will pan out are still largely unclear. The reform package increases emphasis on prevention, better coordination of care and comparative effectiveness research, including personalized medicine. Ralph Taylor, vice president of Marketing & Medical Affairs at Sysmex America Inc., notes the importance of the question of who will pay for personalized medicine in the near future.
"As we shift from the traditional paradigm of chronic disease diagnosis and management to one of disease prevention, early treatment, tailored therapy and genome/proteome/cellulome-guided disease management, the value of laboratory testing will grow," Taylor claims, particularly because of the great volume of patient data produced by the lab compared to its relatively low cost.
"But," he points out, "Underfunding means that clinicians may not be able to perform tests which predict the risk of disease before symptoms occur. Underfunding may mean that tests enabling physicians to make better medication choices with safer dosing options may not be available, which in turn could impact patient outcomes. It may also mean that laboratories will not be able to employ the use of high-end testing such as genomics and proteomics in their diagnostic menus, leaving medical practitioners to decipher the human genome on their own."
For now, it remains a waiting game to assess the long-term future of the lab in these times of reform, changing technology and workforce shortages. Labs can find some reassurance in their cache of tools to help them move forward and meet these challenges head on.
Kelly J. Graham is associate editor.
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