Where should clinical labs invest their limited money to best position themselves for the future?
It's tempting to funnel money to areas that managers already understand—such as upgraded equipment for doing specific tests or adopting the next version of the laboratory information system—but they should really be looking at investments that tax their comfort level, says Brian Jackson, Associate Professor of Pathology, University of Utah and Chief Medical Informatics Officer, ARUP Laboratories.
“A lot of academic labs have put tons of money into expensive, next-generation sequencing instrumentation, because it's frankly a really sexy area right now, and a lot of lab leaders have enough familiarity with genetic testing to feel comfortable," he says. “But in many cases, that's just not the area that is strategic for a particular lab." For large national reference labs, their existing sequencing instrumentation might be adequate for the moment, and the lab should consider increasing its bioinformatics capabilities in order to take advantage of the data being collected, or increasing capacity and throughput by automating.
For smaller labs, Jackson explains, that massive investment in sequencing probably doesn't make sense, and money might be better spent looking outward, investing in the ways they communicate with their customers. “I'd like to see many labs making bigger investments in their physician and customer-facing communication platforms," Jackson says. They can minimize the cash outlay by using off-the-shelf software. The biggest investment is in staff time to redesign workflows and procedures to take advantage of the new capabilities.
Labs can invest more effectively by keeping an eye on their core mission of providing diagnostic testing for patient care, and not overreacting to new reimbursement models that seem to affect their position as a profit center for their institutions. “A common mistake is for health systems to think of their labs as profit centers," notes Jackson, "and then when things like MACRA come along, they panic and sell off their labs to one of the big commercial labs, which is totally short-sighted." Labs should focus on investments that improve their ability to provide value to their organization regardless of payment model.
Labs can use a four-quadrant model to analyze where they are, where they want to be, and how to get there, says Terry Carroll, a long-time health system CIO who's now a principal with the SPRING Network, advising healthcare organizations on how to position themselves for the future. The horizontal access goes from “traditional" to “revolutionary," and the vertical axis goes from “current/legacy technology" to “advanced technology."
The four quadrants of the model can help labs evaluate any particular investment, and identify:
The ability to adapt an investment plan to changing conditions is as important as the ability to make a plan in the first place, Carroll says. He compares it to a military model. “You can plan how a battle will be executed, but the minute you step on the battlefield, it changes."
“If you took a static approach, you would miss the mark" by the time you reached the end of a long-term plan, Carroll adds. “You have to be highly adaptive, constantly measure the performance of the plan, and fix things before they get too far out of hand."
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