Talking with Quest Diagnostics Dr. Surya N. Mohapatra

Testing, 1, 2, 3, testing Interview by Dottie Dunham, Associate EditorDottie Dunham: Quest Diagnostics is a major player in diagnostic testing. What trends do you believe will influence the direction of the clinical laboratory industry in the next five years?Surya N. Mohapatra: Advances in technology, particularly gene-based testing, will continue to have a significant impact on our company and on the industry. New diagnostic tests are continually being introduced, enabling physicians to predict and prevent disease, detect disease at an earlier stage and more effectively tailor treatment options.In addition to technology advances, we believe there will be an increased focus on the quality of healthcare services. Quest Diagnostics is highly focused on quality in all aspects of our business. We were the first major healthcare company to pursue Six Sigma, a rigorous approach aimed at achieving virtual perfection. We are in our fourth year and have seen improvements in customer satisfaction, process efficiency and financial benefits. We are using our commitment to Six Sigma quality as a differentiator. Quality providers should and will be paid a premium. Some payers are providing additional payments to physicians who meet defined criteria.Finally, we will see an expansion in the number of people likely to use diagnostic testing services, driven primarily by a growing and aging population increasingly informed about their availability and importance.Dunham: Among Quest Diagnostics personal health testing products, liquid-based Pap technology increases the early detection of pre-cancerous cells in cervical cancer screening. What other significant personal health testing products has Quest Diagnostics introduced in the last year? What can we expect in the coming year that will advance improvements for patients?Mohapatra: First, it is important to emphasize that, in general, no single test alone is used to make a diagnosis or medical decision. We look at how physicians diagnose and treat disease, and offer the broadest testing menu so that we can support the way physicians practice medicine. We focus on conditions with sharply increasing prevalence: cardiology, cancer and infectious diseases.Epidemiology has taught us that a significant percentage of cardiovascular disease cannot be attributed to lipids in fact, a significant number of people who have heart attacks have low cholesterol. Important diagnostic markers independent of cholesterol, such as homosycteine and C-reactive protein (CRP) offer important insights into patients cardiovascular health. Our Cardio CRP test, a sensitive marker of systemic inflammation, has emerged as a powerful predictor of cardiovascular diseases, and increasingly, physicians and patients are embracing its predictive value.Today, through relationships with biotechnology companies, we are able to offer potentially life-saving screening tests for the early and accurate diagnosis of cancers when they are still at a curable stage. we have recently introduced InSure, an FDA-cleared fecal immunochemical and patient-friendly test that represents a dramatic improvement for patients over traditional colorectal cancer screening tests. we expect InSure to improve average-risk patient adherence with routine screenings, which would save lives. We also examine biopsies from patients undergoing colonoscopy where pre-cancerous lesions are suspected, and we offer a test to detect a genetic predisposition to colorectal cancer.Dunham: Has bioterrorism stimulated strategic planning within your company, which counts among its customers government agencies? What kinds of testing, information and services have been or might be generated by Quest Diagnostics in response to such threats?Mohapatra: Bioterrorism and emerging infectious diseases, such as SARS and the West Nile virus, present potential public health crises, underscoring the need to rapidly respond to new health threats. We believe that collaboration with governmental health organizations through our trade association, the American Clinical Laboratory Association, is central to an effective national response. we are moving to establish a closer working relationship with the Centers for Disease Control that is predicated on rapid information reporting for public health surveillance purposes. Governmental health agencies can benefit from our unparalleled access to important trend data derived from our nationwide testing, as well as our sophisticated logistics and operations network that swiftly moves specimens around the nation and quickly delivers test results.Today, we offer testing for a number of potentially lethal bioterrorism agents that cause serious disease, including anthrax, tularemia, plague and botulism. As a sentinel clinical reference laboratory for government health agencies, formerly referred to as classified level A laboratory, we accept patient samples with the goal of ruling out the presence of these bioterrorism agents. If we are unable to do so, we are then required to send out specimens to a governmental health laboratory for confirmation and a definitive diagnosis.Dunham: What are the most significant challenges that the company will face in the near future with regard to the genetic-testing area of its business? Can you address the most likely expansions in gene-based testing products?Mohapatra: The gene-based testing arena is undergoing rapid change. Technology advances and new tests reflect those advances. Our new test efforts are focused in the areas of cancer, cardiovascular disease and infectious disease the leading killers today. We believe the next wave of new tests will be protein-based, such as the recognition of protein patterns. the human body has approximately 30,000 genes and more than 300,000 different proteins.Physician acceptance of new tests takes time. The tests showing the most rapid growth today were introduced one or more years ago. A challenge we face is helping physicians stay abreast of these changes and appropriately incorporate new tests into their standard practices. We are focused on introducing new tests for our customers that provide better or timelier medical information, as well as having our medical staff available to answer questions about test use or interpretation of test results.Dunham: What challenges have you faced and what solutions has the company begun to provide to aid in resolving the issue of the growing shortage of clinical laboratory professionals?Mohapatra: It is an industry-wide challenge to find qualified clinical laboratory professionals to fill certain positions. Personnel shortages have not affected our ability to meet the needs of our customers. We have taken steps to help rebuild the medical technologist personnel pool and are developing recruitment strategies at three levels local, regional and national to attract and retain qualified laboratory personnel. Among the strategies are a loan program at the lab-aide level to encourage further med tech training; university scholarships and internships; distance-learning programs through local colleges and universities; periodic evaluations of total compensation packages to ensure competitiveness in the marketplace; and on-the-job training.Additional recruitment strategies include exploring affiliations with schools where online education is developing rapidly, as well as establishing and maintaining affiliations with state universities that run programs.Dunham: How does Quest Diagnostics service its customer base via the Web? How has this changed the way you do business? Does the company plan to expand such interaction in the future? Also, would you give an update on your direct-to-consumer testing service?Mohapatra: Online communication with our customers enables us to make our services easier to use and increases our stickiness with the physicians and hospitals that use our services every day. Just a year and a half ago, we started a secure orders and reports online capability, enabling physicians to use the Internet to order tests and to receive the results online wherever they may be. We have gone from a zero starting point to having approximately 20% of our orders and 25% of our test results transmitted over the Internet. That is a tremendous change over a short period of time, and makes getting timely and secure access to their results easier for customers.Our eMaxx patient-centric physician portal offers doctors a secure electronic patient record that lets them share information with other authorized doctors, regardless of physical location. No other patient-centric data repository has this level of clinical and administrative functionality, which does not require physicians to change their workflow.Regarding our consumer-directed health testing, we are still in the early stages of establishing a new business. In Tampa, Florida, we have had a successful collaboration with CVS, offering QuesTest consumer-testing services in CVS/pharmacy stores for the past year. This year, we launched QuesTest services in Stop & Shop stores throughout Connecticut. Results from this service are available through a secure Internet connection, as well as in printed reports.Dunham: What does Nichols Institute do? Is it your only source for new tests, or do you rely on relationships with other technology developers?Mohapatra: Quest Diagnostics Nichols Institute fulfills a number of distinctive roles in the laboratory industry. In addition to being our hub for new test development, Nichols Institute is a valued supplier of low-volume, complex tests that would be cost-prohibitive for each hospital to set up and perform. Nichols Institute is also home to our esoteric-testing specialists who serve in a consultative capacity to our hospital and physician customers, providing consultations on complex-test interpretation. One of the most significant diagnostic test contributions to recently come from Nichols Institute is the comprehensive laboratory-developed CF Complete test, which is able to identify up to 1,000 rare mutations that cause cystic fibrosis.