2010 Lab Predictions  

More of the same?

 “At least for the near future, I expect to see: (1) in the scientific area, more advances in molecular diagnostics but still slow acceptance due to costs and lack of perceived value; (2) in the operations area, improved informatics, both hardware and software; and (3) in the management area, tighter budgets. I also think that although we can foresee the technical improvements, it is how these are put together and used that make the consequences harder to assess. In a nutshell, I think 2010 will look a lot like 2009, only later.”

MLO's Editorial Advisory Board

Expanding career possibilities

 “Healthcare will get more complicated, not less; more expensive, not less; and staffing will be increasingly difficult. The overall numbers on uninsured will remain relatively constant in the near term. Lab testing, however, will get simpler — better technology, and more bedside and home testing. If there is a radical revision of healthcare delivery, large numbers of older pathologists will retire. If there is a resulting acute shortage in pathologists, look for states to expand the scope of practice for technologists to cover some of the shortfall, and reduce costs — creating new jobs and expanding career possibilities.”

— Barbara Harty-Golder, MD, JD, Pathology-Attorney Consultant, Chattanooga, TN, and member of
MLO's Editorial Advisory Board

Evidence-based lab medicine

“I think we are going to hear a lot about comparative effectiveness, evidence-based laboratory medicine, and laboratory utilization in the next few years. With the explosion of new tests and technologies, especially in the area of molecular diagnostics, the questions will turn to what tests can prove cost-effective in the bigger picture of long-term healthcare costs. A $2,000 test to predict chemotherapy response may be quite cost-effective if it avoids $100,000 of ineffective chemotherapy, while relatively inexpensive routine tests may be questioned if medical decisions are not changed by them.”

— Brad S. Karon, MD, PhD, Assistant Professor, Laboratory Medicine and Pathology; Director, Hospital Clinical Laboratories, Mayo Clinic, Rochester, MN, and member of
MLO's Editorial Advisory Board

Doing more with less

“As changes to the U.S. healthcare-delivery system become under increasing pressure, laboratories will be under intense scrutiny for ways to do even more with even less.”

 — Dennis Ernst, MT(ASCP), Director, Center for Phlebotomy Education, Corydon, IN and member of
MLO's Editorial Advisory Board

Healthcare reform rollout

“A key factor for 2010 will continue to be the topic of health reform. Despite our consistent objective of ensuring that any type of health reform is both comprehensive and transformational, it has become clear that, due to the compromises that were made, this new reform will not be either – but this is not necessarily disappointing. This is a sign that we are moving the ball down the field, which is a definite step in the right direction.

“The big question that remains, however, is whether we will be able to continue moving this ball in the direction of comprehensive reform in a way that does not jeopardize our current economy and prohibit other reform measures in the future. We must ensure that the public does not become disillusioned with reform and say that it no longer wishes to 'play.'

“Second, we must also pay close attention to the role that the states will play in selecting which measure of reform ultimately will prevail — many people, for instance, believe that the federal government will control where comparative effectiveness research will be implemented or what it will look like. In reality, however, it appears as though any reform measures will involve a hybrid of both federal and state governments. In fact, the states will have much more control than originally believed, which, in the end, will dictate how reform eventually does roll out, which will be significant.”

 —David Knowlton, board member for the national nonprofit HealthWell Foundation, and guest columnist for MLO's “Washington Report”

EMR + HIE = standardized terms

“The task of maintaining the laboratory information system (LIS) test catalog will be given more foresight and planning for the needs of passing that result electronically to the electronic medical record and health information exchanges (HIE). Hospitals and labs will strengthen and engage with their IT staff to begin examining the structure of their existing LIS architecture and databases more than ever before, to see about implementing standards and the secondary use benefits they may attain in addition to serving local HIE. The hospitals will become more aware of the need for a standardized display name for assay results coming from a variety of originators in the exchanges.”

— Pam Banning, MT(ASCP), PMP, Medical Informatics, 3M Health Information Systems, Terminology Consulting Services; and guest columnist for MLO's “Washington Report”

QM, molecular to highlight 2010

 “During 2010, there will be continued acceptance and adoption of quality-management principles, including, LEAN, Six Sigma, and ISO 15189. These quality methods are helping labs improve analytical accuracy, reduce errors, and eliminate unnecessary costs. Another visible trend during 2010 will regular introduction of new assays that incorporate genetic and/or molecular technologies. This will be particularly true in oncology. Collectively, this flow of new genetic and molecular tests will give laboratories increased sensitivity to detect specific diseases, along with information to guide clinicians as they decide on appropriate therapies.”

—Robert L. Michel, Editor, The Dark Report

Overcoming current challenges

“With healthcare reform looming in the future, it is hard to predict exactly what will be the next 'big' issue for laboratories. Overcoming the current issues is challenge enough for years to come. With predicted cuts in Medicare reimbursement, shortage of competent testing analysts, implementation of electronic health records, and the likelihood test utilization will increase due to healthcare reform, the industry will seek out resourceful means to become more efficient and business savvy.”

—C. Anne Pontius, MBA, CMPE, MT(ASCP) Senior Medical Practice Consultant, State Volunteer Mutual Insurance Company, Brentwood, TN, and member of MLO's Editorial Advisory Board

Health-promotion screening

“I see continued decentralization of testing, increased emphasis (and perhaps enhanced reimbursement for) lab testing linked to health-promotion screening for diabetes among at-risk populations (depends on what happens with healthcare reform!), more individuals personally choosing to pay for genetic testing (e.g., testing for risk of hereditary hemochromatosis) via online labs, and more individual use of routine screening or diagnostic rapid-testing kits if consumers can buy the kits at CVS or Walgreens.”

—Sharon M. Miller, PhC, MT(ASCP), CLS(NCA), Professor Emeritus, Clinical Laboratory Sciences, College of Health and Human Sciences, Northern Illinois University, DeKalb, IL, and member of MLO's Editorial Advisory Board

Putting public health at risk

“State and local governmental laboratories performing tests of public-health significance are facing unprecedented pressures as they are forced to contend with the impact of the continuing economic downturn. The reduction in state and local revenues has compelled budget reductions at these institutions, known as “public-health laboratories,” and these budget reductions have reduced the number of laboratory professionals by at least 10% over the course of the past year. What is worse, the laboratories anticipate that additional reductions will be necessary in the near term, with at least one laboratory planning on a 20% reduction in funding in the next year.

“Unfortunately, federal funding to provide an economic stimulus never reached the state and local governmental laboratories, and less than $20 million of the billions in federal funding directed toward the H1N1 pandemic influenza made its way into these laboratories. The last glimmer of hope for an improvement lies with the federal health-reform effort where both the House and Senate bills contain sizable amounts of federal funding in grants to state and local government, and directly to the Epidemiology and Laboratory Capacity program at the Centers for Disease Control and Prevention.

“To overstate the obvious, it is not possible to sustain robust capacity in the state and local governmental laboratories under these circumstances. The dramatic loss of staff has resulted in a fundamental restructuring of laboratory operations in most laboratories. The elimination of entire divisions of laboratory testing and the greatly reduced testing that will occur in other areas puts the public's health at risk because it will take longer to recognize outbreaks of infectious and food borne diseases. This untenable situation must not be allowed to continue until the economy improves some two to three years from today. Immediate federal funding for workforce retention would improve the desperate situation of state and local governmental laboratories.

— Scott J. Becker, MS, Executive Director, Association of Public Health Laboratories, and guest columnist for
MLO's “Washington Report”

Risk management, accreditation

“First, the concept of risk management will permeate the clinical-laboratory sector from manufacturers, to regulators, and to laboratories. In particular, clinical laboratories will be increasingly expected to take a critical look at how their activities (i.e., testing processes) and conditions (i.e., personnel management, turnover, etc.) within the laboratory contribute to risk of harm to the patient. Second, as the global clinical-laboratory community grows larger and seeks harmonization, international laboratory practice standards will begin to influence U.S. accreditation requirements.”

—Max Williams, Global Scientific and Professional Affairs Manager, Quality Systems Division, Bio-Rad Laboratories, and former guest columnist for
MLO's “Washington Report”