The impact of diagnostic IT
At a meeting hosted by Siemens at AACC 2010, an expert panel shared perspectives on IT in the clinical lab. Representatives from Henry Ford Hospital (Detroit, MI), Alegent Health (Omaha, NE) and Johns Hopkins Bayview Medical Centre (Baltimore, MD) spoke about the increasing importance of IT in helping today’s lab to meet the challenges of cost containment, quality of care, increasing workload, and staff recruitment as well as retention
Eric Olson MA, Vice-president of Informatics & eBusiness at Siemens Healthcare Diagnostics, reviewed results from a recent survey of US clinical laboratories that point to the labs’ needs for real-time alerts of testing and operational status; centralised access to instruments, data management and LIS from one screen, and lab productivity reports. These needs are paralleled by statistics that showed a continuing and dramatic decline in lab training programmes and the number of graduates in clinical laboratory science and medical technology. Eric Olson proposed two ways of meeting today’s challenges: giving labs access to the same kinds of process management technologies used to manage complex operations in other industries, and a new approach to training, whereby labs could provide standardised, yet personalised, training plans for each employee, on an ongoing basis, with an aim towards a more holistic approach that embraces skills beyond operations and technical competency.
In lively discussion with the media, the panellists expanded on diagnostic IT needs and conveyed a bold vision of patient-centric clinical diagnostics in which the clinical lab plays a more significant role in patient care, delineating the tools and infrastructure needed to realise that vision.
Even as diagnostic IT systems reduce the amount of data needing review by flagging exceptions, labs are beginning to look for more capabilities to guide the technologist in triaging situations, such as quality control (QC) failure. Veronica Luzzi PhD, Associate Director of Chemistry, Henry Ford Hospital, suggested that IT should provide guidance, perhaps in the form of ‘more advanced QC algorithms.’ Sheryl Wilson BS, Senior Executive at Laboratory Services, Alegent Health, concurred and noted that standardised guidelines will further help technologists respond appropriately to real-time alerts in a high-pressure environment. More flexibility in rule development is also desired, whereby labs can fill in gaps based on specific lab needs.
IT can help manage scarce human resources through process management and having centralised visibility and control of all facets of lab operations. Veronica Luzzi gave patient specimens tracking as one example. Being notified that a specimen is waiting, or one needed for a critical test ordered by a clinician has not yet arrived, is very important to the lab and could avert difficult situations, e.g. losing a specimen. All three panellists embraced the notion of central control, as in an air traffic control room, where all facets of lab operations can be viewed and real-time updates keep the lab abreast of upcoming requirements and ongoing progress. This central control cuts across disciplines (e.g., haematology, chemistry) and has no geographic boundaries, expanding beyond individual hospitals to entire networks, in a future where telemedicine is integrated into lab operations.
Sheryl Wilson pointed out that technologists are sometimes hesitant to cede control to technology. She spoke of her lab’s experience in posting policies and procedures online to help lab personnel be less dependent on printed information. All agreed that simpler, easier-to-use operator interfaces will make IT less intimidating. Above all, personalised training makes sense, as does a more holistic approach to training, which embraces not only techniques but also other skill sets, such as management. Reticent in the past, lab personnel now see the productivity gains in quality and effectiveness and beginning to embrace technology as key to their success and improving the quality of their jobs.
The whole patient
Importantly, the panel members spoke of the need for clinical diagnostics to become engaged in the ‘whole picture of the patient, not just in the lab,’ she said. ‘Rather than numbers, we want to see patients.’ This means putting patient results in the context of the patient’s medical history, current status, results from other diagnostic modalities, such as imaging, current treatment and, ultimately, available genomic/proteomic profiles. The goal is to allow the lab to deploy clinical science in supporting clinicians with actionable diagnostic information that goes beyond numbers or levels. This will not only help clinicians make sense of test results, it will help labs determine when patient results should be brought to the attention of the caregivers.
Sherrie Hoffman, BS, MT (ASCP), Technical Specialist at LAB/LIS, Johns Hopkins Bayview Medical Centre, noted that labs want to have a valid reason to ‘pull clinicians away from something they are doing’. Achieving this goal will place several demands on IT -- not just diagnostics IT in the lab, but the HIS, LIS and EMR. It means an integrated, seamless system that enables appropriate access to needed patient information -- connecting the dots between the many sources of patient data. ‘The next challenge is to integrate all this technology into one IT system that simplifies everything. How many hospitals can use that? I think we all can,’ Sheryl Wilson concluded.
Into the future
Real-time, centralised control and the deployment of IT in enhancing productivity and quality; a view towards a more important role for clinical diagnostics in patient care supported by a standardised, integrated healthcare IT system, and a new paradigm for designing and implementing training were recurring themes during the invigorating dialogue between the clinical lab, media and Siemens Diagnostics Healthcare.