Lab Soft News

Your Doctor in a Kiosk; A New Variant of Telemedicine

Various types of new healthcare delivery strategies and venues are constantly being introduced. For example, I have reported how retail drug stores are being used for both walk-in clinic visits (see: Details about CVS' MinuteClinic POCT Strategy) as well as patient service centers for national reference laboratories (see: National Reference Labs Expand Their PSC Footprint in Groceries & Retail Pharmacy). In this same spirit, various types of telemedicine are being offered from the care of minor problems (see: Details of Cleveland Clinic's MyCare Online Virtual Telemedicine Visits; Kaiser Permanente Announces that Virtual Visits with Providers Have Surpassed Face-to-Face Appointments) to surgical consultations (see: Surgeons Extol the Advantage of Telemedicine in Rural British Columbia) to virtual intensive care (see: Virtual Critical Care (YouTube video)). Now comes news that telemedicine kiosks are being installed in pharmacies in the U.K. (see: THE LATEST IN TELEMEDICINE COMES IN THE FORM OF MEDICSPOT, A DOCTOR IN A KIOSK). Below is an excerpt from the article:

Telemedicine may have reached a new peak with the latest development from the U.K. Meet MedicSpot, the self-proclaimed “most affordable, easiest and, quickest way to see a private general practitioner.” The catch? Your doctor will live in a kiosk. These little clinics are located in pharmacies throughout the U.K. and are meant to virtually connect you to a real live doctor. What’s more, all the kiosks come complete with the medical equipment you’d need for an examination, including a blood pressure cuff, stethoscope, pulse oximeter, thermometer, and a camera. Don’t worry — if you need to use these devices, MedicSpot promises that “a pharmacy staff member is always available to give you a helping hand if needed.”....You don’t need to make an appointment in order to see one of MedicSpot’s kiosk-based doctors. Simply visit your nearest MedicSpot pharmacy...and get a walk-in consultation with a U.K. registered general practitioner “within a matter of minutes,” the company notes....Thus far, however, the company notes that about 33 percent of the consults it’s made has dealt with coughs, colds, and ear infections. And about a fifth of visits have been booked by non-U.K. natives who may not want to deal with going to a real hospital. A consultation with MedicSpot will set you back about $40, and ought to take just 10 to 15 minutes.

One of the criticisms of telemedicine visits to patients in their living rooms is that they are suitable primarily for those who are not acutely ill. A British company, MedicSpot, is installing kiosks inside pharmacies with the necessary equipment for monitoring a patient's vital signs such as blood pressure, heart sounds, and temperature. This allows a more complete physical examination of patients. The location of these telemedicine kiosks in pharmacies ensures that the medical monitoring equipment will always be in working order and sanitary but also that patients can be instructed in their use. I am sure that each of these kiosks is expensive so their location in pharmacies also offers protection against vandalism. 

I found it fascinating that the MedicSpot web site has its own blog page. This strikes me as a sensible and innovative way to reach out to potential patients and also provide some useful information. Here's a list of some of the blog note titles referenced on this page:

• Stress & The City
• Is Your Daily Commute Harming Your Health?
• Everything you need to know about Urinary Tract Infection (UTI)
• A Guide to the NHS for International Students
• Everything You Need to Now about Eczema/Dermatitis

Deploying a DMT at the Front-End of Lab Orders for a Complex Patient

Dr. Mike Laposata who is Chairman of the Department of Pathology at UTMB in Galveston has been an advocate for diagnostic management teams (DMTs) and the clinical pathologist as a consultant for decades (see: The Clinical Pathologist as Consultant). He launched a conference about Diagnostic Management Teams (DMTs) last year that was highly successful and it will be repeated this coming February. In a recent article in CAP Today, Mike discussed the role of a DMT at the "front-end" of  test orders for presumably complex patients (see: The what and why of diagnostic management teams). Here is an excerpt from that article:

The concept of a diagnostic management team, or DMT, is simple. It involves a group of experts who meet daily and focus on the correct selection of laboratory tests and the interpretation of complex test results in a specific clinical field. The experts are typically pathologists focusing on the diagnosis of a specific group of diseases, but doctors and laboratory experts other than pathologists can participate effectively. The front end of the process is assistance [to the test-ordering physician] in selecting the correct tests. This often involves the creation of expert-driven algorithms that are updated regularly to manage utilization of laboratory tests and dramatically minimize overuse and underuse. Use of such algorithms with reflex testing makes it easy for treating health care providers to order the right tests and only the right tests.

Ultimately, we are going to deploy algorithms at the front-end of the the lab test ordering process, as Mike notes, that will assist the clinician in selecting a set of sequenced test orders for complex patients. This will allow the treating physician to generate the correct diagnosis as quickly and inexpensively as possible. Until such algorithms become widely available, however, we need to deploy a team of lab experts, the DMT, who will substitute for the diagnostic algorithms or perhaps even use them to select the best tests. The question then arises about how a clinician "activates" the lab-based DMT to assist his or her management of complex patients. I think that the answer to this question is relatively simple.

By way of an analogy, I will refer to a type of order that has been in use for many decades for ordering crossmatched blood; the surgeon requests X units of crossmatched blood for a patient prior to surgery. The surgeon requires a product, blood for transfusion, but may have no idea whether the patient has an unusual blood type or atypical antibodies that will affect the provision of crossmatched blood. The surgeon thus depends on the expertise of the blood bank (diagnostic management) team to fill the blood order. In summary, an order for crossmatched blood is a general order for a product (i.e., safe blood) with no specificity as to what blood bank tests are necessary to actually fill the order.

I foresee a similar process when a clinician needs to diagnose a complex patient. In such a case, the physician merely checks the DMT box on the blood bank order form. The lab-based DMT receiving such an order would then review the patient's EHR record, perhaps round on the patient, and then generate the optimal set of sequenced test orders to arrive at the final diagnosis for the patient. Needless to say, the relevant treating clinicians are kept in the loop by the DMT concerning the diagnostic strategy that it is recommending on a consultative basis. 

Surgeons Extol the Advantage of Telemedicine in Rural British Columbia

Telemedicine is one of my favorite topics because it provides the solution for the challenge of providing healthcare to a larger segment of the population without incurring the expense of adding bricks-and-mortar structures (see: The Future of Healthcare: Virtual Physician Visits & Bedless Hospitals; The Design of Bedless Hospitals Continue to Evolve Based on Cost and Technology; Some Additional Ideas About the Bedless Hospitals of the Future). Another problem we are facing is inadequate healthcare coverage in rural parts of the country (see: Doctor Shortage In Rural Arizona Sparks Another Crisis In 'Forgotten America'). Telemedicine can also help solve this problem (see: Kelowna doctors hail the benefits of telemedicine). Below is a article on this latter topic:

...[T]wo Kelowna [British Columbia] doctors are hailing the benefits of telemedicine for patients who live in remote or rural areas. The doctors said the technology can drastically cut down on travel time and help deal with the challenges of providing health care over B.C.’s large and relatively sparsely populated regions. The report is based on work done out of Kelowna. A group of....[surgeons], working in the field of thoracic surgery and based out of Kelowna General Hospital, provided follow-up appointments and new patient consultations via secure video conferencing for over a decade. Over a thirteen year period, starting in 2003, they used videoconferencing for over 15,000 appointments to treat patients from around the Interior Health and Northern Health regions....“It’s often better than seeing the patient ‘in-person’ as I now see them with a family member who might not have been able to travel to Kelowna, [said one of the participating physicians].....The doctors did not feel like their work was compromised by not being able to physically examine the patients during video conferencing appointments.“We do not consider the inability to do a physical examination to be a serious weakness of telemedicine,”....“All patients have been previously examined by their referring physicians. The surgeon conducting the telemedicine session can request a local physician to perform an examination.”

Most articles on telemedicine relate to support for primary care physicians so the one cited above praising the use of the technology by surgeons is useful. As telemedicine is more broadly utilized, new advantages may also come to light that are not always previously understood. For example, one of the surgeons quoted above refers to the value of having a family member of a preoperative patient participate in a televisit visit. In this way, there are two sets of "eyes and ears" listening and participating in the visit. Although telemetry can provide real-time physiologic monitoring during a patient visit, this has not been necessary for the thoracic surgeons quoted above because the patients have already been seen by the referring local physician. Virtual critical care centers employing such telemetry are now the norm in many smaller hospitals so remote physiologic monitoring is well understood and safe (see: Staffing An Intensive Care Unit From Miles Away Has Advantages).

Much of the Future for Pathology and Lab Medicine Rests with Analytics

I have posted a number of notes in the past about "analytics" as it relates to pathology and lab medicine (see, for example: Lab Analytics Emerges as Hot Area for Software Development; Using Lab Analytics Software to Manage Customers Relationships in the Clinical Labs; Using Lab Analytics Software to Manage Customers Relationships in the Clinical Labs). Simply put, analytics is the systematic computational analysis of data or statistics. Pathologists will always be involved with various types of analytics because they are responsible for a large hospital computer system, the LISs, and thus are responsible for the management of large databases.

For definitional purposes, I divide pathology analytics into three categories: clinical, operational, and research. For the purposes of this discussion, I will only address only these first two. Clinical analytics involves the analysis of lab test data for the purpose of diagnosing and monitoring disease. Operational analytics is the analysis of laboratory databases in order to understand and improve the efficiency and cost-effectiveness of clinical labs operations (see: Using Lab Analytics Software to Manage Customers Relationships in the Clinical Labs). 

The next annual conference of the Digital Pathology Association (DPA), Pathology Visions, will take place on October 1-3, 2017, in San Diego. One of the workshops is entitled "Deep Learning – The Future of Computational Pathology." I found the abstract for the workshop to be fascinating and present a portion of it below:

Computational Pathology will be a powerful driver of change in digital health and has the potential to improve diagnostic, prognostic and predictive pathology. Building powerful and scalable algorithms for tissue analytics allows quantitative and objective analysis of H&E tissue samples for a variety of interpretative challenges. 

This abstract was interesting for me because it emphasized an emerging category of clinical analytics, tissue analytics. Digital pathology has now been approved by the FDA for primary diagnosis using one platform (see: FDA Approves the Philips Digital Pathology WSI Solution for Primary Diagnosis). From the perspective of size, the AP database, which encompasses whole slide imaging (WSI) data, will eclipse all other pathology databases. Tissue analytics also differs from other types of clinical analytics in that it involves image analysis and interpretation.

John Glaser of Cerner Discusses Ways to Fix the EHR Usability Problem

A recent article by John Glaser, Senior VP of Population Health at Cerner, discussed how to fix EHR usability problem (see: Cerner's John Glaser: How to finally fix the EHR usability problem). As I would expect from John who has been a visionary in healthcare IT for decades, the article is filled with pearls of wisdom. I am thus not able to capture in this blog note all of the wisdom that it contained. Nevertheless, below are some of the highlights from it about which I will not provide without any additional editorial comments. Read the whole article for more insights.

Why have usability issues come to dominate so many discussions about EHRs?

[C]hange is hard, and EHRs are a big change, especially for clinicians who spent decades perfecting their use of paper charts....

...[I]f...[a physician] used to whipping off a prescription in five seconds, spending thirty seconds to enter the same information into the computer must seem like an absurd imposition, even if it does make the information exquisitely readable and simultaneously accessible to all authorized users....

...[T]he user interface design of EHRs can be sub-par. 

...[I]n our collective efforts to improve care, we have moved more and more work onto the shoulders of the clinician.....In some ways, beating up EHR vendors on usability is a form of shooting the messenger.

There is no single strategy or tactic that will address all these factors [on the part of EHR vendors]. We can make significant strides with a multi-faceted approach:

We must continue our efforts to move to value-based reimbursement. Not only is this model good for patients, it will help us focus on what information we really need out of our EHRs in order to assess value and identify ways to increase it.

We can give clinicians appropriate incentives by basing their compensation on outcomes so that they see a clear reward from using the EHR to ensure that their care follows the evidence.

We must continue to work with CMS, state Medicaid programs and private sector health plans and purchasers to focus on changing reimbursement, so that those who are doing quality work see a reward for their efforts.

We should strive to rationalize and coordinate the demands for quality measures and documentation so that our clinicians don't have to jump through multiple hoops with data entry in order to report essentially the same piece of information to multiple places.

We must also push for national usability standards and industry-wide efforts to improve our knowledge of best usability practices.

[Appropriate actions going forward on the part of the EHR user/provider community:]

Providers must keep the pressure on their vendors to explore ways to smooth the collection of information and review of results.

Context-aware software can whittle down choices to a manageable number so that users don't have to scroll through dozens of options every time they need to enter an order.

Advanced data visualization can help users focus on the most important information and correctly interpret that information.

Providers should also insist that their EHR vendors take advantage of the wealth of knowledge about best user-centered design practices. EHR vendors can learn from other industries and from consumer-oriented technologies.

Some tasks can probably be taken off the physician’s shoulders and given to other members of the care team [such as scribes] or even to the patient....

Organizations can also learn from themselves. It's crucial to have an open, candid, and ongoing internal dialogue about what's working and what isn't.

Progress on Cloud Storage by UC San Diego Health

I started blogging about cloud computing ten years ago (see: A Closer Look at the Vertical Cloud in Healthcare Computing). Here are some other examples of my notes about cloud computing over the years with consideration of its relevance for healthcare (see, for example: The Term "Cloud" Used in Web-Enabled Computing Takes Another Turn; Salesforce Health Cloud as One Possible Solution to Health Data Interoperability; "Extinction" for Hospital Data Centers Predicted in Five Years). Now comes concrete news that one large health system is deploying its EHR in the cloud (see: Epic's cloud-based EHR). Below is an excerpt from the article:

University of California San Diego Health ...is putting its Epic electronic health record in the cloud. The transition from managing its own on-premise Epic EHR to a cloud-based service has already involved moving some 10,000 workstations and integrating more than 100 third-party apps with Epic’s cloud....While hospitals and health systems have historically been somewhat tentative about mass migrations to the cloud, industry luminaries such as Beth Israel Deaconess Medical Center John Halamka, MD, have been making bold predictions of late about datacenters vanishing as hospitals go the cloud for analytics, EHRs and clinical decision support. Halamka, for one, backed that claim up by placing 7 petabytes of BIDMC data on Amazon’s cloud. UC San Diego Health, for its part, said the move is an early milestone in its three-year plan to migrate all of its data storage needs to the cloud -- not just Epic’s hosting environment....UC San Diego Health Associate Chief Information Officer Mark Amey said shifting to Epic’s cloud enables the hospital system and its clinics to be more agile and responsive while maintaining disaster recovery capabilities.“By creating greater operational efficiencies,” Amey said, “we can invest more time and resources in patient care.”

I have stated many times in the past that the slow migration of health systems to the cloud and away from local hospital machine rooms was partly due to the fact that healthcare IT lags a decade or more behind other industries. This is a reflection of the innate conservatism in this highly regulated industry. Another factor is that most health systems are "captives" of their EHR vendor and will not drive IT innovation without cooperation from their vendor. As noted in the excerpt above, this new cloud initiative is referred to above as Epic's cloud. For a couple of years, there have been a number of articles about Epic offering "hosted services" to its clients (see: Epic Systems Preparing to Offer EHR Cloud-Based Solutions).  Here is a quote from that article:

“New advances in computing power, virtualization, and high-speed connectivity have combined to make possible a hosted option that meets our customers’ high performance standards,” Epic VP Stirling Martin told VentureBeat. “While our ‘cloud’ actually lives in a state-of-the-art underground data center, it provides the same benefits — allowing a flexible future for our customers who may seek a cost-effective alternative to internal investments in infrastructure and technology.”

A new wrinkle on all of this is that Epic recently bought the Mayo Clinic’s data center for $46 million in a sale-leaseback deal for the 62,000-square-foot facility. Epic will lease it back to Mayo for four years with an option to continue doing so in perpetuity (see: Epic buys Mayo Clinic data center in $46 million sale-leaseback, report says). This means that Epic is now very serious about promoting its cloud/hosting services to its hospital clients. Although this seems like a fairly radical shift, I reported that its rival Cerner was offering a similar service called its "remote hosting option (RHO)" more than ten years ago (see: Comments about Cerner's Remote Hospital Option (RHO)). To the credit of UC San Diego Health, however, their move toward cloud computing with Epic is only part of an overall cloud strategy to address all of its data storage needs.

Is Judy Faulkner's Interaction with Joe Biden Only an Example of Medical Paternalism?

In a recent post, I commented on an interaction between Judy Faulkner, CEO and founder of Epic, and former VP Joe Biden (see: Do Patients Really Need Access to Their Access to Their Health Records?). The debate about this incident continues to simmer on social media and a subsequent article added to the temperature of the discussion (see: Joe Biden just brought the debate over medical records into the limelight). Below is an excerpt from it:

For some, this discussion seemed to a rare window into her psychology -- Faulkner...is notoriously reluctant to speak to the press. Others see this exchange as indicative of Epic's unwillingness to share patient health data, which serves the company's bottom line. Patient advocates stressed on Twitter and other forums that Epic's patient interfaces are not well-designed, and are extremely difficult to use....Former White House CTO Aneesh Chopra, who was in the room, said the conversation was actually fairly cordial to his recollection.....Chopra stressed that Faulkner is neither a hero nor a villain, and that the problem is a lot more nuanced than that with many stakeholders involved. Fundamentally, the problem is that Epic, like many other medical record vendors, was initially designed for the purposes of billing -- and not for data-sharing.

Another former health IT expert, former Department of Health and Human Services' employee Arien Malec, agreed that Faulkner's words weren't nefarious. If anything, he said, they seemed paternalistic. Many in the health sector hold the view that providers, such as doctors, should own medical records as they will act in the patient's best interest."I suspect Epic and other provider organizations believe they know best about how to present to patients," he explained. "I also believe that Epic has committed to patient access and has demonstrated commitment for a long time." If Faulkner is the villain, Biden has emerged a hero.

What's interesting about this discussion is the inference that medical paternalism is somehow more benign than other reasons for the reluctance to share medical records with patients. Here's a useful summary of medical paternalism from the Wikipedia (see: Medical paternalism):

Medical paternalism is a set of attitudes and practices in medicine in which a physician determines that a patient's wishes or choices should not be honored. These practices which were current up to the early to mid 20th century, and were characterised by a paternalistic attitude, surrogate decision-making and a lack of respect for patient autonomy. It is almost exclusively undertaken with the intention of benefiting the patient, although this is not always the case. In the past, paternalism was considered an absolute medical necessecity, as there was little to no public understanding of medical procedures and practices. However, in recent years, paternalism has become limited and blind faith in doctors' decisions has come to be frowned upon. By the end of the 20th century and into the 21st, paternalistic medicine was increasingly seen as inappropriate in the West with guidance from professional bodies such as the General Medical Council [in the UK] indicating that it is ethically unsupportable.

In my opinion, the reluctance on the part of healthcare and EHR executives as well as physicians to share medical records with patients is a mixture, to varying degrees, of the following:

• The financial interests of hospital and EHR executives militating against efforts to make medical records more portable.
• Inherent limitations of EHRs that make major change difficult and expensive.
• Exposure of the fact, as noted in the excerpt above, that the primary purpose of EHRs is for patient billing.
• Also exposure of the fact to a broad patient audience that many medical records are bloated and incoherent (see: EHR Copy Feature Has Promoted "Note-Bloat"; Vendors, Hospitals Seek Solutions).
• Inertia among healthcare providers such as physicians, based on former habits and paternalistic attitudes, to provide more clinical information to patients.

There is thus no one culprit regarding the controversy regarding patients' access to their medical records but attitudes are changing in the U.S. and in other countries. The brouhaha raised by Faulkner's comments has been useful in terms of shedding light on this problem.

Do Patients Really Need Access to Their Access to Their Health Records?

I strongly support broad access by patients to their medical records and EHR interoperability and have blogged frequently about both topics (see, for example: Patients Often Lukewarm about Patient Portals; Problems with Training?; NYT Op-Ed on EHR Interoperability Blames Vendors and Greedy Hospitals). A recent article discussed Judy Faulkner of Epic and her questioning of former VP Joe Biden about the need for patients' access to their medical records. The article also touched on the topic of EHR interoperability (see: Cancer moonshot head recounts exchange with Epic’s Faulkner). Below is an excerpt from the article:

Former Vice President Joe Biden took to task an Epic executive who questioned during a January [2017] meeting of the Cancer Moonshot why patients should have their full medical record....Epic CEO Judy Faulkner asked Biden during ...[a] private meeting between EHR executives and administration officials, “Why do you want your medical records? They’re a thousand pages of which you understand 10,”....Biden responded, “None of your business,”....“If I need to, I’ll find someone to explain them to me and, by the way, I will understand a lot more than you think I do,”.....

....[A source close to Biden says the] account of the event offers a glimpse at the frustration the Obama White House faced in getting EHR companies to share patient records, despite giving billions in incentives for doctors and hospitals to buy systems. The software wasn’t reaching its potential despite years of investments. “We’ve made billionaires of the executives of these companies,” ...[he] said of EHR vendors. “They’ve had fun. Now, it’s our turn. Let’s get this thing changed.”

A perspective shared by many hospital executives, EHR vendors, and HIMMS representatives is that patient access to medical records and EHR interoperability is over-hyped. Hospital execs take this position, in my opinion, because they want to protect their market share and don't want patient records sufficiently portable such that patients can easily "doctor and hospital shop." EHR executives support their hospital clients in this regard and also favor the position because their systems are monolithic and not easy to change (see: How EMRs Will Change in the Near Future; Avoidance of Monolithic Systems; Why Is It So Hard to Promote Meaningful Changes in EHRs?). HIMMS clings closely to the hospital and vendor party line because it depends on them for the revenue generated by its annual conference and other activities.

There are two reasons why I think that patients need to have broad access to their medical records: price transparency and patient education. We always insist on appropriate and relevant documentation for any business that we transact: buying gasoline, buying a book on the web, or paying for any professional service. If the cost or quality of the goods and services we receive is unacceptable, we then turn to these records for proof. For the most part, patients don't have good access to their clinical record and the hospital billing is a disaster (see: Price Transparency In Medicine Faces Stiff Opposition — From Hospitals And Doctors; Coding for Hospital Services; One Reason for the High Cost of Healthcare; Two Reasons Why Medical and Hospital Bills Are Such a Mess; Those IndecipherableMedical Bills? They’re One Reason HealthCare Costs So Much). Also, patient education would be greatly improved by access to clinical records. Appropriately, Epic is now saying publicly that it absolutely supports patient access to medical records (see: Epic says it absolutely supports patient access to medical records despite reports of tense chat with Biden). 

Patients Often Lukewarm about Patient Portals; Problems with Training?

Patient portals are an underused and unappreciated asset available as part of an EHR. I have blogged about them in the past (see: Next Step in Patient Portals: Secure Messaging and Administrative Functions; Publishing Test Results in Patient Portals: Holding a Tiger by the Tail). Below is an excerpt from a recent article suggesting that patient are "fed up" with them (see: GAO finds further proof patients are fed up with portals, EHRs):

 

Despite the fact that close to 90 percent of providers participating in meaningful use offer their patients online access, only about one-third of patients actually log in to see their data, according to the...[GAO]. On the GAO's WatchBlog, the agency explored some of the reasons for that (see: Online Access to Your Health Record). Part of it has to do with the confusion of keeping tabs on separate portals for different providers....Patients often receive access to a different portal for each provider they visit, and must manage separate login information for each one...The patients we interviewed were frustrated with the amount of time and effort it took to set up these portals, understand each portal’s user interface, and manage all the different passwords....[M]any patients say the information available to them was incomplete and inconsistent across providers, and were unclear about whether it could be electronically downloaded, transmitted, or aggregated in one place. Those patients who did use online portals said they liked being able to communicate with their physicians, schedule appointments online, refill medications and share their own data with other providers. But more needs to be done to encourage active patient engagement with their health records.

 

In general, I think that hospitals are usually not adept at patient engagement strategies which are (or should be) embedded in their marketing plans. Patient portals problems are thus only one facet of hospital marketing ineptitude (see: How Hospital Marketing Improves Patient Engagement, Outreach). I think the problem stems in part from the fact that many hospitals do not face much competition in their markets -- their major problem is managing reimbursement rather than attracting more patients. Also, few hospital executives are trained in the for-profit sector where marketing strategies are more important. A newer facet of hospital marketing is the use of social media like Twitter which is also largely ignored (see: Tweeting and Treating: How Hospitals Use Twitter to Improve Care; Facilitating Engagement of Consumers using E-Health Tools Like Twitter).

 

Regarding education about patient portals, I think that it's insufficient merely to provide brief instructions to patents about, say. how to log-on to a portal because they will immediately be faced with columns of data such as lab test results which they don't always comprehend. There needs to be some educational support built into such systems. For example, links can be provided to web sites that will assist them in the interpretation of test results like HCT and MCV in a CBC report. Hospitals spend large sums teaching their physicians and nurses how to use EHRs, sometimes without sufficient "gratitude" in return (see: What do physicians hate about EHRs? (infographic)). They need to also devote time and resources to coaching patients about patient portals.

National Reference Labs Expand Their PSC Footprint in Groceries & Retail Pharmacy

The Dark Daily recently discussed the accelerated pace of patient service center (PSC) development by Quest and LabCorp (see: Quest Diagnostics and LabCorp Ink Deals to Put Patient Services Centers in Grocery Stores and Retail Pharmacies, But Not for the Same Reasons as Theranos). This trend started in Arizona and California in relationship to Theranos' ill-fated expansion but is now spreading to other states. Below is an excerpt from the article:

Greater use of retail stores as the location for patient services centers (PSCs) may be an important new trend for the clinical laboratory industry. That’s because, historically, medical laboratories placed most of their patient service centers in hospital campuses or near medical office buildings. However, in recent months, both of the nation’s billion-dollar lab companies signed deals with national retailers to put patient service centers in their stores. Dark Daily believes that the motivation for a lab company to put a PSC into a grocery store or retail pharmacy is to make it easier and more convenient for a patient to get their specimen collected at a location that is closer to their home or office. In other words, it is faster for the patient to get to their nearest grocery store for a blood draw than to travel to the hospital campus in their community.

I would like to dwell here on the strategic implications of this expanding number of PSCs by the two large national reference labs. Much of their lab testing business is generated in private physician offices and clinics. Blood draws are performed on the premises with samples then picked up by reference lab couriers and transported to large regional labs with test results transmitted back to the physician offices electronically. Patients are also directed to PSCs for their blood draws. A counterbalance to these large reference labs are the large health systems and academic medical centers. They will increasingly dominate the healthcare scene given that the majority of young physicians are choosing hospital and salaried positions and physicians in private practice are a shrinking breed. These systems/hospitals always run their own labs and only outsource super-esoteric tests that are too rare or complicated to perform in-house.

Patients with insurance who are cared for by hospital physicians will always always opt to have their blood draws and lab testing performed in the ambulatory care setting where they are cared for in part because their test results are quickly available in the EHRs. Such patients constitute a kind of captive audience for whom the number or location of Quest or LabCorp PSCs in their local area is largely irrelevant. However, it's my personal opinion that a substantial percentage of ambulatory care will be delivered via telemedicine during the next decade with patients remaining in their own living rooms (see: Treatment of Patients with Chronic Diseases: Important for the Future of Telemedicine; A New Perspective on Telemedicine: Patient Visits with Multiple Providers; Major Impending Transformation Predicted for Clinical Lab Business Model). If lab testing is required for such telemedicine patients, many may opt to travel to the most convenient blood drawing site rather than fight for a parking space at a large hospitals or ambulatory care center. In short, the large national reference labs with their abundant PSCs may become a more attractive option in the near future for health system patients.