Has the pandemic changed the way we think about laboratory systems?

Martin Wilkinson, director of product introduction and user adoption, InterSystems, explores how labs can change and utilise data to urgently to improve health delivery systems today and in the future.

The nature of laboratory testing is rapidly changing, prompting an urgent rethink of historical models of delivery to improve patient care. The recent, significant increase in testing required to cope with the COVID-19 pandemic, continued market consolidation, rapid advances in automation, genomic testing, and the increased use of point-of-care testing (PoCT) has prompted major shifts regarding where, when, and how testing takes place. A joined up and collaborative model of service delivery, focussed on efficiency, will be mandatory for the future of today's laboratories.

Accurate, timely testing is crucial to patient care 

Pathology services are critical in the context of overall patient care. 70% of clinical decisions made rely on a pathology test and if the patient is on a care pathway for a chronic disease, 90% of clinical decisions involve a lab result. Accuracy of the result has to be assured, but it’s also about timely delivery of that result to the right Healthcare Professionals (HCPs), as well as the ability for labs to provide that speed and accuracy at scale.

Rapid turnaround time is often seen as a key performance indicator that labs use against their tests. Being able to reduce turnaround times will drive a better service to the patient. If they get their test result today, instead of tomorrow, it could reduce the length of their stay in hospital and, in turn, free up a bed for someone else who might need it. In the same way, rapid COVID-19 testing, allows those with a negative result to get back to normality quickly.

Yet we all see laboratories are being driven to do more with less and even though healthcare environments are becoming increasingly connected, many labs remain information silos, to the detriment of both healthcare professionals and patients. This needs to change urgently, to use the wealth of information in such systems to examine and improve health delivery systems today.

A revised implementation approach drives laboratory agility

In countries with a regional or national testing infrastructure in place, including Russia, South Africa and the UAE, tests are all brought into a central patient record, regardless of which hospital they are carried out in, so HCPs can access test data from anywhere, removing the need for, and cost associated with, duplicating tests.

A unified, national database of patient information – if available – including consolidated laboratory records, has numerous benefits, including less room for errors that can come from compiling data from multiple different sources. Joining the dots manually means that HCPs must be able to correctly match up a patient’s details, as well as compile the patient’s history in date sequence, all of which can introduce points of failure in the examination of a patient history. If the treatment a patient gets is a matter of life or death, errors such as these could lead to misinterpretation and, more importantly, inappropriate patient care delivery.

Wales, which already has a national laboratory network, has been working to integrate this with the recently created Lighthouse Labs that are currently processing much of the UK’s COVID-19 testing. By extending their current Laboratory Information Management System (LIMS) to include this new network of diagnostic testing facilities, they can ensure that a timely and complete record for Welsh patients is visible to HCPs, no matter where their tests are carried out. This includes if and when a COVID-19 test has been done, if the results are pending, and whether the result is positive or negative. The data is also available to Public Health Wales, who help to compile national COVID-19 statistics as well as assist in effective contact tracing.

By connecting lab information to primary and secondary care records, healthcare trusts can give HCPs across the eco-system a joined-up view of patients, be they GPs or specialist care providers. This leads to better decision-making and higher quality care. 

Collaboration through change is fundamental for success

However, successful collaboration among HCPs is key to ensuring that any new service is integrated smoothly across regions. Lab systems were one of the first IT systems in healthcare and have been around since the 1970s, so organisations may now be on their fourth or fifth generation system. Used to upgrading based on their exact needs, not those of nearby trusts, adopting a new approach requires a different mindset.

These distinct entities must first agree on holistic criteria for adopting a national or regional system – one that meets everyone’s requirements. They must also agree on a common standardisation – what’s included in a full blood count, for example, may vary from one region to another. There may also have to be compromises made when it comes to its configuration, to ensure that what’s adopted works best for the greatest number of people.

By driving these initiatives from the top down and finding a standardised approach that can be rapidly executed by all parties involved, organisations can help to ensure a successful transition that gives patients better access to testing going forward and adapts to change in the future.

To survive and continue to provide the best possible patient care – during the COVID-19 pandemic and beyond – labs must now look to take a fresh approach, and adopt and run coordinated and co-operative national systems. Only by continuously evaluating and adapting their delivery model can they meet changing requirements to improve efficiency, turnaround, and capacity across the national environment. The pandemic has brought many challenges but these can also be seen as opportunities to look at our models of service delivery into the future.