LabMind

Most healthcare professionals are frustrated by the lagging progress of health IT. In an era when Google and Facebook seem to know every detail of our lives, why can’t health IT do a better job of predicting the information needs of patients and clinicians? Or even modify their data displays based on clinical context? One reason is the nonstandardized nature of most healthcare data. Pam Banning has spent her career making health data more usable through standardized terminologies such as LOINC and SNOMED. In this conversation she describes how far we’ve come using semantic interoperability over the past 25 years, and why we still have a very long way to go.

The SARS-CoV-2 virus was first identified and sequenced using a technique known as “unbiased sequencing.” During this conversation, Robert Schlaberg, MD, Dr Med, MPH, takes us inside this technology, helps us understand how it works, and describes how it can significantly improve infectious disease diagnosis. He also explores how scaling up this technology will catalyze a quicker diagnostic response to future pandemics.

How do clinical laboratories report data to public health agencies, and what do those agencies do with the data? In this conversation Sam Marsden describes his experiences working in both the public health and clinical diagnostic arenas. He also dives into the critical role of public health agencies in gathering, analyzing, and applying data to improve the health of communities.

Antibody testing (serology) for COVID-19 has been eagerly awaited by the medical community and more broadly by our country's political and business leaders as we chart a path forward to ease physical distancing and the strain on our economy. Drs. Slev and Rychert have validated assays and platforms here at ARUP Laboratories. In this interview, they explain what clinicians need to know about COVID-19 serology, the inherent limitations of these tests, and the research data that's still to come.

During Mark Graber's academic nephrology career, he became interested in bringing diagnostic error out of the healthcare shadows. Diagnostic errors occur more frequently than either surgical errors or medication errors, but they've received less attention from the patient safety community. In this initial interview, he shares personal experiences encountering diagnostic errors in clinical practice. We also discuss the central role of laboratories in addressing these problems, including where labs struggle and where the opportunities lie.

Dr. Ila Singh, director of clinical laboratories at Texas Children’s Hospital, recently launched a collaboration with a broad set of clinical, IT and pathology stakeholders to improve the clarity of laboratory test names. She discusses why it is so challenging to create clear and helpful test names for physicians, given all of the informational goals and IT constraints. She also explains the importance of professional and geographic inclusivity for this project.

Ana Stankovic recently retired as senior VP of Worldwide Medical Affairs at BD, one of the best known in vitro diagnostic companies. Prior to her employment at BD, she worked as a basic science researcher, blood banker, reference lab clinical pathologist, and public health officer. In this interview, Dr. Stankovic describes what science looks like from the inside of the IVD industry, specifically how the selection process and character of projects differ from those of academic labs while scientific norms and patient-centered goals remain the same.

The Evidence-Based Medicine (EBM) Movement gained traction in the mid-1990s, spurring a paradigm shift in how we view the relationship between science and clinical care. While EBM was percolating, clinical pathologist Rita Horvath was beginning her medical career at the University of Oxford—a hotbed for EBM thinking. Since then, she has become a thought leader in how EBM principles should apply to laboratory medicine and what that looks like.

In the 1990s, Dr. Mike Laposata created the world's first Diagnostic Management Team (DMT) at Massachusetts General Hospital, in order to better care for patients with coagulation disorders. In this interview, he discusses the distressing and all too common issue of diagnostic errors, and how a collaborative, team-based approach can make a vital difference. Laposata also addresses the systemic barriers to team-based diagnosis such as the lack of insurance reimbursement, and suggests ways to surmount these barriers and scale up DMTs.

In this broad-ranging interview, long-time lab industry executive Khosrow Shotorbani asserts that laboratories should be actively engaged in population health management. He emphasizes that impacting health outcomes is what matters (e.g., shorter hospital stays, reduced emergency room visits, fewer complications) and not just the efficient delivery of test results. Shotorbani points out opportunities for the laboratory to impact cost savings from improving health outcomes which will far exceed savings achieved through efficient internal lab operations alone. He argues that by outsourcing lab operations, some health systems are squandering a huge opportunity. To promote these ideas, under the title of “Lab 2.0”, he’s teamed up with some of the most forward-thinking laboratory leaders in the nation’s largest health systems.

What role will pathologists play in the healthcare systems of the future, and what skills will those pathologists need? Andrew Fletcher, a pathologist with ARUP Laboratories, describes his own varied career, including time spent as a physician assistant, medical student, surgery intern, pathologist, and health system administrator. Along the way he addresses cultural divides, inter-professional communication, and that the unique contributions that laboratories and pathologists can bring to value-based healthcare.