The Professional Value The Professional Value of Laboratoriansof Laboratorians

State Of Health Care

Complexities of Health Complexities of Health CareCare

Individual careIndividual care– Acute careAcute care– Preventive carePreventive care– Chronic careChronic care

Public health carePublic health care– Environmental HealthEnvironmental Health– Emerging infectious diseaseEmerging infectious disease– Life stagesLife stages

Acute Health Care Traditional foundation of individual Traditional foundation of individual

health carehealth care ChaoticChaotic Uninformed decisions madeUninformed decisions made

Lack of good data on appropriateness of Lack of good data on appropriateness of treatments, preventive strategies, and utilizationtreatments, preventive strategies, and utilization

BiasedBiased Slanted by special interest groupsSlanted by special interest groups

Subject to public opinionSubject to public opinion

Prevention Aging boomers are trying to avoid Aging boomers are trying to avoid

diseasedisease Demand for information and direct Demand for information and direct

access increasingaccess increasing Science and medicine still Science and medicine still

developingdeveloping Laboratory’s lack of information and Laboratory’s lack of information and

access drive customers elsewhereaccess drive customers elsewhere

Chronic Care

Demographics of health care consumer– Doubling of population over age 85

will occur twice by 2050 Health care “migration”

– From system of acute care to one of prevention and maintenance

– Maintenance is the new chronic care

Public HealthPublic Health

Safeguarding communitiesSafeguarding communities– Monitoring the environmentMonitoring the environment– Food safetyFood safety– Infectious diseaseInfectious disease– Emergency preparednessEmergency preparedness– Newborn ScreeningNewborn Screening– Linking with all health care settingsLinking with all health care settings

Challenges of Health CareChallenges of Health Care

ResourcesResources– MonetaryMonetary– FacilitiesFacilities– Information technologyInformation technology– ProfessionalsProfessionals

Successful interaction and Successful interaction and integration of all of these integration of all of these resourcesresources

Trends In Laboratory Medicine

1970’s – Push to automate1970’s – Push to automate Produce more data on growing number of testsProduce more data on growing number of tests

1980’s – Demand for faster turn-around 1980’s – Demand for faster turn-around timestimes

Near patient testing with traditional instrumentsNear patient testing with traditional instruments

1990’s – Push to miniaturize1990’s – Push to miniaturize Waived category expanded point of care technologyWaived category expanded point of care technology

2000’s – Demand for personal control2000’s – Demand for personal control Direct access Direct access ?OTC?OTC

Trends in Laboratory Medicine

Digital and virtual services changing how we work in microscopy

Drifting towards Diagnostic Services which combine diagnostic imaging and anatomic and clinical pathology– Joint reports for surgical specimens– Molecular imaging

Value of Laboratorians

Provide information for:Provide information for:– PreventionPrevention– DiagnosisDiagnosis– TreatmentTreatment– PrognosisPrognosis– RiskRisk– Appropriate utilizationAppropriate utilization

The Future Is BrightThe Future Is Bright

Laboratory testing provides patient-specific information necessary for the prevention, diagnosis, treatment, and management of disease or establishment of health.– Genetic testing, proteomics and

pharmacogenomics enhance utility of lab tests in personalized medicine

– Evidence based medicine and clinical pathways rely on lab tests

The Future Is BrightThe Future Is Bright

Laboratory data essential component if Health Information Technology is to be considered high functioning

Decision making at every level of health: prevention, acute and chronic requires laboratory information

Laboratories should be prepared to assume a greater advisory role and provide other support to promote informed self care by consumers.

Trend in Health Care

Patient centered carePatient centered care What is patient-centered? According to What is patient-centered? According to

Gerteis et al. Through the patients’ eyes: understanding and promoting patient-centered care. San Francisco: Jossey-Bass, 1993.

Patient Centered

– Respect for patients’ values, preferences, and expressed needs

– Information, communication, and education

– Physical comfort – Emotional support and alleviation of fear

and anxiety – Involvement of family and friends – Coordination and integration of care – Transition and continuity

Patient-Centered in Lab

A patient-centric testing cycle starts when a patient presents to a provider and ends with clinical action or self care based on test results; for us, this– Extends the pre-analytic and post-

analytic phases– Requires open communication and

education– Changes from traditional testing sites

Drivers for Change

Increasing numbers of people with multiple chronic conditions who require greater skill in self management and self testing.

Increasing availability of community-based retail sites for health care (e.g., in large national retail and pharmacy chains) expands direct access to affordable services.

Drivers for Change

Marketing of new and innovative testing technologies (e.g., genetic testing) directly to consumers via the Internet increases demand for laboratory services.

Increasing patient cost-sharing creates consumer need and demand for trusted, readily available information to support informed choices.

Drivers for Change

Consumers who express greater desire for ownership of their health care information (including laboratory test results).

Increasing availability of health information on the Internet and

News media attention to personal health issues such as patient safety risks and medical errors enhances consumer interest in understanding, directing, and managing their health care

Value of Laboratorians

Laboratorians can support (aLaboratorians can support (at the patient level)::– communication and partnership

between patients/consumers and health care providers,

– patient/consumer education,– patient/consumer self management of

chronic conditions, and – the needs of special patient

populations.

Needs/Gaps

Patients/consumers must comprehend or be able to utilize laboratory information in both the preanalytic and postanalytic phases of the testing cycle.

Preanalytic communications: consumers need information about:– why a particular test is being ordered,– how the test is performed, and – what the risks are.

Needs/Gaps Postanalytic communications for

patients:– Discussion about laboratory test results

that should clarify what the results mean for patients’ health and medical care.

– Despite the benefits of such communications, few patient-provider interactions meet criteria for completeness in informed decision making.

Needs/Gaps

Inadequate consumer-centric information to help communication between providers and patients is a major contributor to the gap in patients’ knowledge, awareness, and understanding of their health care and health status.

Needs/Gaps

Large discrepancies often exist between the level at which the materials are written and patients’ functional literacy levels.

Future Value

Laboratorians will work with health care providers and patients to develop:– a patient/consumer-friendly, standardized

nomenclature and summary format for laboratory results that

facilitates understanding of important information about screening, diagnostic, and monitoring tests.

Future Value

Laboratorians can design educational materials that will improve patients’ understanding of their health conditions

Lab Tests Online great example

A Different Future?

Several trends increase the value of laboratorians– the continued proliferation of new, complex

laboratory tests; – greater emphasis on patient safety in medical

practice; – inadequate medical education on laboratory

testing despite its growing importance in clinical care; and

– the variable quality of “curbside” consultations with pathologists.

PressuresPressures

Information access – amount, Information access – amount, quality, immediacyquality, immediacy

Service sitesService sites– Moving from traditional settings for Moving from traditional settings for

both public and individual health both public and individual health systemssystems

– Pose major coordination challenges Pose major coordination challenges

Other InitiativesOther Initiatives

Development of evidence-based Development of evidence-based methods to identify and evaluate methods to identify and evaluate Best Practices in Laboratory Best Practices in Laboratory Medicine.Medicine.http://wwwn.cdc.gov/dls/bestpractices/LabBestPractice.pdf

   

Other InitiativesOther Initiatives

Network of laboratories and Network of laboratories and partnerships with key stakeholders partnerships with key stakeholders in laboratory medicine to support in laboratory medicine to support identification and foster adoption of identification and foster adoption of evidence-based Best Practices.evidence-based Best Practices. To learn more about participating in To learn more about participating in

the pilot test network, click here: the pilot test network, click here: http://wwwn.cdc.gov/dls/bestpractices/participation.aspx

Rituals Of A ProfessionalRituals Of A Professional

What they do for a living defines who What they do for a living defines who they arethey are

Associate with colleagues to affirm Associate with colleagues to affirm themselvesthemselves

Get new ideas, new energy, re-creation, re-Get new ideas, new energy, re-creation, re-newal of selfnewal of self

Reason for attending annual meeting of the Reason for attending annual meeting of the professionprofession

Develop and adhere to an ethical codeDevelop and adhere to an ethical code From Beginning to End - The Rituals of Our LivesFrom Beginning to End - The Rituals of Our Lives

Excellence In Excellence In PerformancePerformance Research on elite performersResearch on elite performers The biggest difference between them The biggest difference between them

and lesser performers is the cumulative and lesser performers is the cumulative amount of practice they’ve hadamount of practice they’ve had– The most important talent was the talent The most important talent was the talent

for practicefor practice– Top performers dislike practice as much as Top performers dislike practice as much as

othersothers But they have the willingness to keep at it But they have the willingness to keep at it

anywayanyway From From Complications Complications by Atul Gawandeby Atul Gawande

ProfessionsProfessions

Their own languageTheir own language A recognized body of knowledgeA recognized body of knowledge Insulated from the rest of the Insulated from the rest of the

world by the work experiences world by the work experiences and the mandatory and the mandatory responsibilitiesresponsibilities– Only fellow professionals know what Only fellow professionals know what

it is really like to do what you doit is really like to do what you do

Professional GatheringsProfessional Gatherings

Where new and better can be foundWhere new and better can be found– Almost an obligation to attendAlmost an obligation to attend

Where there is a place full of people Where there is a place full of people who know what it is really like to do who know what it is really like to do what you dowhat you do

Sense of belongingSense of belonging For the length of the meeting, “our For the length of the meeting, “our

own nation” existsown nation” exists From Complications by Atul GawandeFrom Complications by Atul Gawande

What Are We Doing?What Are We Doing?

Two stone cutters were cutting Two stone cutters were cutting stone for the building of a great stone for the building of a great cathedral. Sir Christopher Wren cathedral. Sir Christopher Wren asked them what they were asked them what they were doing. One stone cutter said: “I doing. One stone cutter said: “I am cutting stone”. The other am cutting stone”. The other answered: “I am building a answered: “I am building a cathedral”.cathedral”.