Lab Soft News

Major IT Prediction for 2011 -- Apps Go Corporate

In an end-of-the-year article discussing IT trends, the WSJ tucked-in what I consider a highly significant and insightful prediction under the "apps" category (see: The Rise of Apps, iPad and Android; subscription required). I copy it below:

Coming next: Apps go corporate. AT&T, business-software developer SAP AG and other companies are working on apps that can help their employees track sales, monitor systems or check-out customers without being tied to their stations. The quick adoption of tablets by business users is helping fuel the trend.

I have posted a number of notes about the usefulness of smartphones in healthcare delivery and health education. I have also discussed previously the type of programs that run on smartphones -- generally referred to as apps (see: New Definition for "Apps": The Smartphone Market for Medical Software). The distinction between "applications" than run on PCs/Macs and "apps" that run on smartphones and iPads is non-trivial. These latter small computer programs can be automatically downloaded from an on-line app stores, are relatively inexpensive, and also tend to have a more specific functionality than their PC-based counterparts.

It's no surprise that various companies are developing apps that can assist their sales force and other employees perform their jobs more efficiently and effectively. Such a goal would be irresistible to nearly all employers. The exception, or course, will be hospitals. One would think that hospital executives would jump at the opportunity to equip house officers, hospitalists, and nurses with iPads with the ability to access complete patient records. However, this solution is going to take many years to deploy. One of the major barriers will nominally be the possibility of HIPAA breaches with these devices (see: Major HIPAA Breach in Las Vegas Hospital Investigated by FBI). The real and most significant reason, I think, relates to the fact that most hospital EMRs are based on outdated technology. Retrofitting the electronic hospital records to be accessed and viewed via a web browser will be a major, and expensive, undertaking. Meanwhile, many hospital physicians are already surreptitiously copying patient records to the "cloud" for ease of use. I will be blogging on this topic later.

Top Eleven Technology Innovations for the Past Ten Years

I tend to be a sucker for the various "top ten" lists and they are common at this time of year. I tend to always read them, mainly to see if I agree with the list. Hence my interest in the "top 11" technology innovations of the past ten years published by the IEEE (see: The top 11 technology innovations of the last 10 years, from the IEEE). IEEE is an organization that bills itself on its web site as "the world’s largest professional association dedicated to advancing technological innovation and excellence for the benefit of humanity." Why the top eleven? I suspect that there were some ties and controversy near the end of the list and they settled on eleven rather than ten. Here's their list:

• Smartphones.
• Social Networking.
• Voice over IP.
• LED Lighting.
• Multicore CPUs.
• Cloud Computing.
• Drone Aircraft.
• Planetary Rovers.
• Flexible AC Transmission.
• Digital Photography.
• Class-D Audio.

I have placed in bold face the technologies closest to the focus of this blog, information technology. They constitute five of the total of eleven and are grouped in the first six picks. The biggest surprise for me was the inclusion of cloud computing which many would categorize as a technology that is still very immature. The best may therefore come later. One more question. What's the best way to define technology? How about this: the practical application of science to commerce or industry. Or how about this: new stuff that works good. All of the five IT picks in the list have profoundly changed diagnostic medicine, particularly lab medicine and medical imaging. Perhaps the changes have been less dramatic in applied clinical practice based on the mediocre performance of many EMRs but let's see what happens in the next ten years.

Some Interesting New Facts about Twitter

I have been fascinated by Twitter for at least a couple of years. The service can be defined as a free, one-to-many social networking system. Messages are confined to 140 characters but allow embedding in messages of links to web resources, thus expanding the information content of the tweets. Twitter provides value in different ways for its subscribers. I carefully select people and organizations to follow who then provide me rapid and easy access to breaking healthcare and medical science news. I "unfollow" those who post personal data that I find irrelevant and distracting. Many of my blog posts are based on ideas that I first discover on Twitter. Here's an extract of an article discussing the rapid growth of the growth and estimated value of the company (see: Twitter valued in billions as popularity climbs):

More than 25 billion "tweets" were fired off during the past 12 months, with Twitter adding 100 million new accounts during that same time frame, the firm's chief executive Dick Costolo said in an online post. Venture capital firm Kleiner Perkins Caulfield Byers (KPCB) headed a new round of Twitter funding, which technology blog AllThingsDigital said tallied 200 million dollars. The investment was reportedly based on Twitter, a private firm with 350 employees, being valued at 3.7 billion dollars....Costolo, whose Web content distribution company Feedburner was purchased by Google in 2007, has been at the forefront of efforts to begin monetizing Twitter since he joined the company last year. Twitter, which allows users to fire off messages of 140 characters or less known as "tweets," has enjoyed skyrocketing popularity since it was launched in 2006 by Williams, Jack Dorsey and Biz Stone. 

I came across another news item that discusses some of the changes in usage patterns of Twitter during 2010 and provides a window about how others use it in comparison to myself (see: How Twitter Users Changed in 2010). Here is an excerpt from this article:

Twitter signed on more than 100 million new users in 2010. As they get acclimated to the information network, significant changes in usage are bound to take place. That’s exactly what social media monitoring company Sysomos found when comparing Twitter usage in 2010 to 2009. What stands out the most is that more Twitter (Twitter) users have much higher follower and following counts. Twenty-one percent of Twitter users now follow more than 100 people — that’s up from 7% last year — and 16% now have more than 100 followers, according to Sysomos, which looked at over a billion tweets from 20 million users in 2010 and compared them against data gathered in 2009. Twitter users in 2010 were much more likely to provide a bio (69%), detailed name (73%), location (82%) and website URL (44%) as part of their public profiles....Sysomos also found that 80.6% of Twitter users have made fewer than 500 tweets, which likely points to the relative newbie status of the average Twitter user. Also noteworthy is that 22.5% of users are responsible for 90% of all tweets.

Here is what I find the most interesting about this information: 21% of Twitter users now follow more than 100 people...and 16% now have more than 100 followers. Also, 22.5% of users are responsible for 90% of all tweets. By way of comparison, I personally follow 157 people and have 395 followers. I have accounted for 829 tweets, mainly a reposting of Lab Soft News blog notes. I take all of this of this to mean that a relatively large proportion of the top quarter of Twitter accounts are  "professional & business" or "celebrity" users as opposed to those who are communicating with friends for personal and social reasons. These former categories of users are more likely, it seems to me, to post tweets frequently and over the long haul. They are trying to reach a broader audience.

Health Insurance Companies Jump into Healthcare Network (HIE) Business

Mr. HIStalk comments below on the recent acquisition of Medicity by the health insurance company Aetna (see: Healthcare IT From the Investor’s Chair 12/9/10). Medicity is an HIE (health information exchange) company.

Speaking from my usual perch in the peanut gallery (as I’ve done work for neither company), I’m fairly astounded by the price [of Medicity’s acquisition by Aetna]. Rumor has it that $500 million (twice what Ingenix paid for Axolotl) is approaching 8x revenues, a princely multiple that dwarfs, say, Allscripts’ purchase of Eclipsys for 2x revs or even Ingenix’s purchase of Picis for 3x revs. Medicity appears to be the leader in its space, with over 750 hospitals and 125,000 physicians using its system. Still, it’s a huge bet on the HIE market that’s not quite emerged. I believe a good part of the excitement...around the HIE/clinical messaging space is that the emerging government regulations which mandate a minimum proportion of premium dollars that a payor spends on actually taking care of sick people (known as the medical loss ratios) appears to allow them to count this type of business towards the MLR (as opposed to say, marketing spend, corporate art, or even executive salaries). Therefore, I’d posit that United and Aetna see this as a way to improve their MLRs while actually improving patient care. With health reform reducing the payors’ arsenal to maximize their profits (by prohibiting them from underwriting away sick people and mandating certain forms of community rating), they now have a greater incentive to reduce loss through what HIEs can, in theory, bring: reduced duplicative tests, better access to patient data, etc. What I wonder most, however, is what will the fact that Axolotl and Medicity are now owned by payors do to their sales prospects, both near and long term? I’ve little doubt that a fair number of potential customers would rather douse their dollars in kerosene and torch them before giving them to the same insurance company that has tormented them (in their view) for years. The half-billion dollar question is: what percent of the market does this preclude them from selling to? I’d guess more than 15%, but less than 50%.

Mr. HIStalk approaches this purchase from primarily a business perspective. According to KLAS, the HIE space is quite crowded (see: KLAS: HIE software market is crowded, muddled). My primary concern about this news is that it allows a health insurance company easy access to clinical patient data. UnitedHealth, another health insurance company, demonstrated few qualms about tweaking "usual and customary cost" data generated by its wholly-owned company Ingenix to improve its bottom line (see: UnitedHealth Settles Suit with New York Attorney General Cuomo). Perhaps its unfair to group UnitedHealth with Aetna but put me down as nervous with a health insurance company as the parent of a provider of HIE services.

Five Cancer Avoidance Strategies to Adopt for the New Year

Cancer, like other diseases such as diabetes and coronary heart disease, has a connection to one's lifestyle. It follows logically, then, that some forms of cancer can be avoided or ameliorated by changes in one's eating, drinking, and exercise habits. A recent article spelled out clearly which lifestyle changes are necessary, perhaps in the new year, to help yourself. Below is an excerpt from it (see: Five holiday resolutions for cancer prevention strategies):

• Resolve to stop smoking. Lung cancer kills more people than breast, colon and prostate cancers combined and tobacco use is the No. 1 cause of this form of cancer. This is a particularly important gift to your children, as ‘secondhand’ smoke is also a strong risk factor, and children of parents who smoke are more likely to start smoking themselves.
• Watch your weight: According to the American Cancer Society, excess weight causes the body to produce and circulate more of the hormones estrogen and insulin, which can stimulate cancer growth. Obesity has been linked to several forms of disease, including breast, colon and pancreatic cancer.
• Add some cruciferous vegetables like broccoli, cauliflower, Brussels sprouts or cabbage to your holiday menu: Researchers...have documented a possible link between a diet rich in cruciferous vegetables and a decreased risk for breast cancer and colorectal cancer. “Cruciferous vegetables contain some compounds that may have a cancer-inhibitory effect,” explained [an expert]. “We were able to identify a group of women with a specific genetic profile who seem to particularly benefit from a high intake of these vegetables.”
• Substitute fruit juice, sparkling cider or water for alcohol: “High consumption of alcohol over several years has been linked to a risk for head and neck cancer which is the fifth most common cancer in the U.S.,” said [an expert]. “We encourage everyone to abstain from alcohol or drink in moderation to reduce their risk for this type of cancer.”
• Get some exercise: After a big holiday meal, encourage family members to take a walk or engage in one of the new video games that require physical activity. Exercise has been linked to a reduced risk for several types of cancer. Physical activity may reduce your cancer risk by helping maintain your weight, and can also improve your hormone levels and the way your immune system works.
  

What's remarkable about lists such as these is that the preventive medicine researchers are starting to put some good science behind their recommendations. Note, for example, the reference above to the fact that estrogen and insulin are elevated with obesity and they can act to stimulate cancer growth. In my mind, the reduction in cancer associated with exercise is still a little vague but there are certainly powerful cardiovascular reasons to work out regularly if you need some other incentive. I personally like cruciferous vegetables so eating them is not a reach for me.

E-Sampling: Another Blow to the Future of Pharma Sales Reps

If I were a sales rep working for a pharmaceutical company, I would be dusting off my resume and scanning the help-wanted ads. A great salesperson can always make a very comfortable living. I envision that most of the sales efforts of these companies will be moving to the web. I have covered this transition in a number of previous notes (see: How E-Detailing May Lead to Greater Knowledge by Physicians about Drugs; Effectiveness of "Direct-to-Consumer" Drug Advertisements; Growth of Online CME Interpreted as Bad News for Pharma Marketers; Pharma-Free CME Activities: Is This the Right Approach?). Below is an excerpt from an article discussing this new facet of this trend -- e-sampling  (see: Pfizer Joins the E-Sampling Crowd: How it Assuaged Sales Reps’ Concerns):

Big pharma gives out a lot of free samples every year — $3 billion in 2007 alone. Drug giant Pfizer is now joining rivals Merck and AstraZeneca in distributing some of those samples in response to online orders by physicians. As Dow Jones Newswires reports, Pfizer launched its SamplesDirect program in August. A spokesperson tells DJN that doctors are choosing to “engage and interact” online, so it makes sense to be there. As you can imagine, sales reps weren’t too keen on the notion at first. Big drug companies have been paring their sales forces in order to cut costs as they face a slowdown in growth from the so-called patent cliff and resulting generic competition. Meantime, doctors are increasingly giving sales reps the cold shoulder, with the number of “rep-accessible” physicians dropping by 18% from last year, according to a report released in May. The fear among Pfizer reps was that online sampling would only further erode their job function, DJN reports. But Pfizer reached a compromise with its reps: when a physician places an e-order, it’s flagged to his or her sales rep, who has 48 hours to step in and personally take over the order. If the rep doesn’t act, the order is filled electronically. AstraZeneca and Merck launched their own online sampling efforts in recent years, DJN says. Astra is winding down its U.S. sales force for heartburn pill Nexium, turning instead to call centers and online information. Online sampling of Nexium is expected to be available by the end of the year, DJN says.

It's not that the pharma sales reps were not effective. Nothing beats a one-on-one sales call. It's just that the pharmaceutical companies are trying to reduce their cost structures. The industry is also highly regulated and some of these physician office conversations were making the FDA nervous. Also under attack have been some of the "freebies" that the companies were offering physicians. The web provides an adequate, alternative sales and education channel and, now, the opportunity to order drug samples fedexed to the office. Not much that I can add beyond this other than to suggest that you sell short your Dunkin' Donuts stock. Ooops! The company is privately held by Bain Capital.

Software Born in the Cloud Different Than Software Moved to the Cloud

I have posted a number of notes about cloud computing but have not paid particular attention to differences between applications born in the cloud as opposed to those that are moved to the cloud. Luckily, the Forbes blog Quicker, Better, Tech has reprinted a column on this topic by Aaron Levie who is the co-founder and CEO of Box.net. Below is an excerpt from his musings (see: The Open Social Enterprise). Read the whole thing if you have time. It's worth the effort.

When Steve Ballmer declared that Microsoft was “betting the company” on cloud computing earlier this year, he cautioned that “the goal can’t be to throw out all the world’s software and start again.” Microsoft and the other enterprise technology behemoths may be embracing the cloud, but in many cases they’re doing so by offering watered down, hosted versions of their legacy solutions – solutions that were designed years ago for enterprises that achieved security through information lock-down and rigid workflows. There’s a fundamental difference between software moved to the cloud and software born in the cloud. The emerging solutions in this latter group are exciting not because they’re delivered in a modern way, but because they fundamentally rethink the purpose and spirit of the desktop-centric software that came before them. They’re more open. They’re more social. They can scale to meet the needs of small businesses and large enterprises alike. And with these new platforms, we’re seeing the wholesale trade of control – or rather, the illusion of control – for heightened visibility and productivity in a fundamentally more open organization....The rise of social networking and media consumption online have demonstrated to today’s knowledge workers that there’s no technical reason why sharing has to be so difficult.  The web makes sharing and collaborating easier than ever before – we know this from our usage of consumer cloud services, like YouTube, and Flickr. But if we adopt user-friendly, web-based business applications that make it too easy for employees to share information, doesn’t that pose a security threat? The reality of business today is that workers need to collaborate beyond the firewall, and if enterprise software makes collaboration too difficult, users will simply go around the system and use ad hoc applications over which the IT department has no control. With cloud-based business services like Google Apps, Box and Jive, it’s generally true that employees have more freedom, but they’re also far more likely to use a platform that’s flexible, intuitive, and integrated with other business applications, meaning they’ll stay within IT’s oversight.

I see a parallel in this discussion between the culture of cloud computing and opposition to sharing medical electronic records with patients. HIPAA has become the best friend of many hospital CIOs. It allows them to block solutions such as PHRs that enable the sharing of information (see: Some Hospitals Hold Hostage the Medical Records of Their Patients). I now perform most of my work (and thinking) while in the cloud. The cloud and social media have become synonymous in my mind. You can't understand one without the other. My cloud work involves, in part, writing this blog. I share my ideas with hundreds of readers each day. With my Google Apps, I can share a document with anyone in the world by merely supplying their email. I then can choose whether they can edit a document or only read it. If I allow them to edit it, we can work on the same document simultaneously. With a simple setting, I am able to automatically copy the first 140 characters of each my blog notes to Twitter. Again, painless sharing of ideas. It's so natural in the cloud that you don't need think about it. Compare this with the desk-top computing model where you need to plan ahead about how to share documents with others, even in the office next door.

Aaron Levie has it right. Microsoft will laboriously try to move its software to the cloud but will probably never get it right because the company doesn't really understand the culture of cloud computing but is reluctantly adopting it for competitive reasons (see: Google, Microsoft Compete for GSA "Cloud Mail" Business; More Information about Google's Chrome OS; The Decline of Microsoft: The Clues Seem to Be Obvious). in this way, Microsoft is merely reflecting the ideas of its corporate clients who don't really "get" the cloud and are searching for reasons to avoid moving information to it.

Some Hospitals Hold Hostage the Medical Records of Their Patients

Major Increase in CT Scans in Hospital Emergency Departments

It will come as a no surprise to readers of this blog that the practice of medicine is changing radically, particularly the use of CT scans and other diagnostic studies. Part of the shift is due to the fact that younger physicians are losing their ability to diagnose at the bedside. Part is due to the increasing sophistication of imaging technology itself. Certainly part is due to the pressure to practice defensive medicine. A recent article puts some real numbers to this shift in the use of CT scans in hospital emergency departments (see: Use of CT Scans in Emergency Departments 'Skyrocketing'). Below is an excerpt from the article:

The use of computed tomography (CT) scans in emergency departments (EDs) throughout the United States has increased dramatically in recent years, and this increase shows little signs of slowing, according to a study presented [at RSNA]. From 1995 to 2007, the number of visits in which a CT scan was performed increased 6-fold, from 2.7 million to 16.2 million, representing a growth rate of 16% per year, said [the author of the study]  The percentage of visits that were associated with a CT scan also increased substantially, from 2.8% of all visits in 1995 to 13.9% of all visits in 2007, [he] said. He and his team examined data from the Centers for Disease Control and Prevention's National Hospital Ambulatory Medical Care Survey, which collects data on approximately 30,000 emergency visits each year. CT use was greater in older patients, white patients, patients admitted to the hospital, and in hospitals located in urban areas. Toward the end of the study period, most CTs were for abdominal pain, headache, and chest pain....According to [the study author], it is not just the magnitude of the growth in CT scanning that is so striking, but the nature of that growth. "When you look at the model of how technology diffuses in a population, it usually starts with accelerating growth and then, after a period of time, it begins to decelerate and taper off. But the use of CT scans is still in the acceleration phase, at least in 2007. It hasn't even started to taper by this time period, so we've seen very rapid, steady, and sustained growth." He added that there is no question that in the setting of a life-threatening injury or severe illness, a CT is appropriate. "The real question is when an indication is less clear, where there is less severe illness. At what point do you draw the line and say no to CT? It is such a great test, it is an excellent modality, and in some ways it's harder to make the decision not to do it."

Managing an emergency department (ED) in a hospital is a complex task. All hospitals are seeking ways to increase patient through-put in their EDs including the use of scribes to input data into the EMR (see: Shift of Hospital EMR Data Entry Tasks from MDs to Scribes). In many hospitals, problems arise in the staffing of the units, causing hospital administrators to turn to hiring more hospitalists (see: Specialist Staffing Problems Arise in General Hospital ERs). A large percentage of hospital inpatients are admitted through the ED so it's important to rapidly triage the patients who arrive at the door. Three major patient categories include those that can be quickly diagnosed as having minor problems, those who required a short stay for observation, and the sickest among them who need to be admitted for acute care. To provide care to those who require short-term observation, units staffed by hospitalists are being opened (see: Taking charge of observation units: With hospitalists at the helm, these units aren't just for chest pain any more). This allows the high-intensity hospital beds to be reserved for the most sick.

Obviously, the increased use of CT scans drives up the cost of healthcare (see: CTs, MRIs, and PET Scans Drive Cost of Healthcare Upward). However, the expectation of most people who arrive at the ED these days is that their abdominal pain, headache, and chest pain complaints will be rapidly and accurately diagnosed. It is therefore unlikely that this trend toward the increased use of sophisticated imaging in the ED will be reversed at any time in the near future. Look for these CT number to continue to increase. Hopefully, increased volume, new technology, and pressure from payers will drive down the cost of the procedure.

Shift of Hospital EMR Data Entry Tasks from MDs to Scribes

Some Hospitals Hold Hostage the Medical Records of Their Patients

It may strike you as sour grapes that the president of a personal health record (PHR) company, is griping about hospital CEOs holding hostage the clinical data that they control. Mr. HIStalk recently published the following tidbit, quoting Colin Evans of Dossia (see: News 12/8/10):

Colin Evans, president and CEO of PHR vendor Dossia says ...HHS and the FTC need to make big providers and health plans stop holding the medical information of their patients hostage and using liability or privacy concerns as an excuse. He says they refuse to share patient information even when patients request it, hoping to forestall competition based on service, price, and quality. He also points out that lots of them are selling the data of their patients anyway or are using PHR information to display targeted ads.

In this particular case Evans is surely correct. The last thing that some hospital executives want is to provide their patients easy access to their own medical records. You can probably obtain a print-out or copy of some portion of your medical records if and when you request it. However, what is really required is all, or most, of one's record in an organized, electronic format. Evans is also correct when he says that these execs cite liability and HIPAA issues as the basis for their go-slow, uncooperative approach. The real reason, also cited by Evans, is anti-competitive. They don't want patients carrying these record to competing hospitals and running cost-comparisons of care (see: Comparing the Details of Hospital Charges in the State of Oregon). HIPAA gave patients the right to read and even amend their own medical records long ago (see: Should Patients Be "Allowed" to Read Their Medical Records?).

Although Evans calls for the HHS and FTC to force these executive to stop holding hostage the medical information of their patients, I view this as primarily as a consumer pressure issue. I would not look for relief from the large bureaucratic federal agencies. Instead, I believe that the solution lies with local groups interested in consumer rights.

The first thing for such groups to do would be to acquire a basic understanding of the rights given to patients under HIPAA. Here's a link to an HHS web site that can provide some useful information. Next, I would suggest that some members of a community request from a local hospital a complete copy of their medical records in electronic form in an easily accessible and understandable format such as a PDF file. This applies to hospitals that have an EMR. If and when a hospital is unwilling or unable to supply such copies of their electronic records, this fact should be made known in the community. I hasten to add here that some progressive health systems are making clinical records readily available via PHRs and I commend them for this (see: Three Million People Now Using Kaiser Permanente's PHR – My Health Manager). My complaint is with the hospitals that are dragging their feet on this issue.

County Medical Society Web Site Provides Direct-Access-Testing to Consumers

Direct access testing (DAT) has been a special interest of mine over the past many months. In general, it provides a way for healthcare consumers to obtain lab tests at a reasonable price by ordering them on the web. Mr. HIStalk alerts us to one such site launched by a physician in Ohio and using his county medical society web site as the test ordering vehicle (see: News 12/10/10). His goal was to provide such testing for uninsured patients but anyone can use it. Here's the initial report:

An Ohio doctor, angry that his uninsured patients can’t afford the lab tests they need, strikes a deal with LabCorp and an online lab test marketer to offer his patients discounted tests (example: a $148 lipid panel costs his patients $18). The patients simply order their tests from the county medical society’s site, pay by credit card, and go to LabCorp to get the tests.

Here's a link to the original report on the CNN web site that inspired the HIStalk piece (see: Doctors slash patients' lab-test costs). Below is an excerpt from the article:

So the Fairlawn, Ohio, family physician [Dr. Doug Lefton} decided to do something about [expensive blood tests]. Working with other doctors and an online marketer, Lefton devised a way to slash the cost of lab tests not only for his patients but for almost anyone, anywhere. As a former newspaper reporter, Lefton understood how publicizing a problem can generate solutions. He contacted the Akron Beacon Journal, which subsequently published a story highlighting the high cost of lab tests. He was soon contacted by Tom Patton, CEO of PrePaidLab, an Avon Lake, Ohio, online marketer of lab tests. Working with the Summit County Medical Society, Lefton struck a deal with LabCorp, one of the largest testing companies in the country, and PrePaidLab. The arrangement allows patients to get lab tests done for a small fraction of the normal cost, simply by ordering them through the medical society's website.

My understanding is that most of the various DAT web sites use LabCorp as the back-end performing laboratory. Such a relationship is absolutely necessary because of the requirement of a large network of blood drawing stations (i.e., patient service centers) plus accredited clinical labs to perform the actual tests. It's always been of interest to me that LabCorp was willing to do this DAT work and risk channel conflict. As the second largest commercial lab in the country after Quest, the company performs lab tests originating in physician offices. However, in this high volume, low margin work, apparently every additional test order helps. Moreover, LabCorp keeps a very low profile on the various DAT web sites. If you point your browser to the Pre-PaidLab.com web site, you won't find a reference to Lab Corp other than the locations of the blood drawing centers, which will be LabCorp facilities. Also of interest is that Pre-PaidLab has an "affiliate program" and offers a 17% commission on blood test orders referred to their site from other web sites. It may be that the Summit County Medical Society is picking up some extra income from these lab tests intended for cost-conscious consumers.