The first webinar lecture in the API-Sunquest series for 2017 (see: Third Annual API/Sunquest Webinar Series Focusing on Pathology Informatics) was delivered by Dr. Brian Jackson who is the VP, Chief Medical Informatics Officer of ARUP Laboratories. His lecture was entitled "The Shifting Value Equation Between Hospital Labs and Reference Labs." It was an extremely interesting and stimulating presentation, discussing in detail what he envisions as the future of lab testing, the future role of hospital labs and pathologists, and the relationship between hospital-based clinical labs and reference labs. Click here to view the webinar recording. It is well worth your time.
I will be returning to some of Dr. Jackson's points in some of my forthcoming notes in Lab Soft News. For this note, however, I want to focus on his analogy between hospital-based clinical pathologists and hospital pharmacists. Hospital pharmacies have become almost totally automated with most drugs prepackaged by the manufacturer or distributor. Electronic drug orders are received via the EHR with the unit doses dispensed in patient care units with automated devices like Pixis. Because of this high degree of automation, the role of hospital pharmacists has radically changed from previous eras. Now, the major role of hospital-based pharmacists, in addition to management, is education and consultation with hospital physicians about topics such as drug dosages, the merits of different drugs including generics, and adverse drug reactions.
Dr. Jackson believes, as I do, that a large percentage of routine testing will move to point-of-care devices and even to the homes of healthcare consumers. Such decentralized testing holds the advantage over centralized lab testing of better integration into clinical care processes and consumer lifestyle. The cost of such decentralized testing will always be greater than that of central lab testing because of economies of scale. However, decentralized testing also has the advantages of rapid TAT (e.g., often minutes) and that clinicians can totally control testing processes. I hasten to add here that high level oversight and QC control over all hospital decentralized POCT devices will remain with the labs but most such supervision will be performed by medical technologists.
One of the major future roles of clinical pathologists, both in academic centers and community hospitals. will first be to act as consultants to clinicians about the selection and interpretation of lab tests. This particularly applies to molecular and genomic testing. Secondly, they will function as lab information managers in concert with the other major diagnostics specialty group, the radiologists. The dominant theme for test selection will be picking the right test at the right time for the right patient.