Traditionally, clinical labs perform tests and send results back to the ordering physician —and that's that. The lab's relationship to the patient is peripheral, if not non-existent. But that relationship may gain importance in an era of value-based, prevention-oriented healthcare. For chronic diseases, lab results can point the way to effective management, and sometimes even help patients stay healthier; and helping patients use their lab results can cement the lab's value to both patients and the health system.
“The future of healthcare is keeping patients out [of the hospital]," says David Chou, chief information officer and chief digital officer at Children's Mercy Hospital, Kansas City. “We're not really utilizing data to keep patients out yet. We just know what we did at the hospital. When you go home, who know what's going on? You could be doing everything against medical advice."
Chou offers up an example: Given the right technology (and the patient's permission, of course), a health system might be able to sense when a diabetic, hypertensive patient is visiting a fast-food drive-through. A tracking app might be aware of his latest glucose and blood pressure readings, and attempt to steer him toward a grilled chicken sandwich, a bottle of water, and a side of coleslaw, rather than a high-sodium, double cheeseburger, a sugary shake, and fatty onion rings. A series of healthy choices— however minor—could head off a hospital stay, or even prolong a life.
Carroll says the technological sophistication of players like Amazon will present challenges for traditional providers who aren't used to operating in a 24/7, on-demand environment. “Our ability to utilize the same kinds of capabilities that these companies are bringing to the table is going to be a huge challenge for us, because they're not models that we're used to."
Genomic testing could give labs a major opportunity to offer counseling and advice directly to patients—if they can figure out how, says Peter Gershkovich, director of pathology informatics at Yale University Medical School. “We give people these lists of DNA variants, and tell them this or that is a driver of mutation, or the combination is the key," he explains. “But we are not saying what is the right treatment. We don't assist in showing the outcomes. And more tools like that would empower the lab to be an equal player in driving these precision medicine decisions."
It's going to take a major culture change to make the lab a proactive participant in patient care, says Brian Jackson, associate professor of pathology at the University of Utah, and chief medical informatics officer at Associated Regional and University Pathologists, a national reference laboratory. “The impact of lab testing on clinical outcomes is always pretty indirect" and is measured by whether the lab results pointed the clinician toward optimal treatment of the patient's condition.
Jackson says labs should take their cues from pharmacists, who have seen some success in becoming part of the care team. “Everyone loves pharmacists on the floor" because over-prescribing and drug interactions are well-known problems that pharmacists can prevent by working closely with clinicians and patients. “[The value of the lab] is a more subtle story," Jackson notes, but there is just as much potential value, in both improving the accuracy of diagnoses and averting errors, if the lab is more involved with the clinicians who use lab results.
Driving these types of change will require determination at the top levels of the organization, says Terry Carroll of the SPRING Network, an organization that focuses in on organizational strategy design. “The challenge is to create the right incentive for smart, interdependent ecosystems of people to come together to bring the best of the various disciplines to operate and function together." It will only take a few obvious improvements in outcomes for those ecosystems to see the value of working together, but “it takes a courageous set of leaders to set that expectation and back it up with incentives that create the activation energy for those things to happen."
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