Cleveland Clinic Laboratories provides a wide variety of tests to meet labs' reference needs

Oct. 19, 2014


Thomas Daly
Medical Director
Cleveland Clinic Laboratories


Cleveland Clinic—6 years; CCL Medical Director since June 2014. Eli Lilly & Co.—Biomarker development for oncology portfolio University of Alabama, Birmingham—section head, Clinical Chemistry


BA in Chemistry—Case Western Reserve University MD—Washington University in St. Louis

What does your position entail?

“As Medical Director, I provide CCL with senior medical leadership and guidance for strategy, service, and support operations, including medical oversight of functions related to strategic development and expansion. I also serve as the primary medical support resource for laboratory staff in their interactions with clients. I am pleased to join CCL’s leadership team including Kandice Kottke-Marchant, MD, PhD, chair of the Robert J. Tomsich Pathology and Laboratory Medicine Institute, and David Bosler, MD, head of Cleveland Clinic Laboratories.”

What services does Cleveland Clinic Laboratories provide for the clinical lab? How does it serve laboratories of different types and sizes? Cleveland Clinic Laboratories offers a broad test menu of both routine and esoteric testing, including anatomic, molecular, and clinical pathology services. Physicians and healthcare facilities rely on our specialists to provide expert diagnosis, second opinions, and subspecialty consultation that are the basis for effective patient care. With this structure, CCL can provide full-service laboratory support for smaller practices, as well as being a resource for specialized niche testing to support larger hospital laboratories.

What attributes of CCL distinguish it as a reference laboratory alternative for clinical labs? How has its test menu changed during the past year or two? With a menu of more than 2,400 tests, CCL is a major provider of esoteric clinical laboratory testing, providing clinicians with the most appropriate test, rapid turnaround, affordability, and superior customer services. As the primary laboratory for the Cleveland Clinic Health System, we have the advantage of access to one of the largest clinical practices in the country. CCL staff members work closely with clinical content experts throughout the Cleveland Clinic system to identify the most useful laboratory testing to support patient care, which allows us to develop diagnostic offerings that are closely tied to clinical practice. The CCL test menu is continuously evolving to address these goals by providing a more comprehensive portfolio of testing, particularly in areas of specialization such as anatomic pathology and hematology. Substantial growth has been seen in our immunohistochemistry and molecular offerings in recent years.

What kinds of considerations should labs have in mind when they are making decisions about utilizing reference laboratory testing? As healthcare models change, appropriate test utilization is emerging as a major focus to help control costs. For clinicians who are ordering the types of esoteric testing provided by reference laboratories, selecting the right test for the right clinical situation is a critical factor. The use of disease-specific diagnostic algorithms with built-in testing cascades can be very helpful in this regard, helping to ensure that the correct combination of testing is run for each patient. In addition, hospitals should try to incorporate ongoing analyses of test utilization patterns into their routine practice, for both internally and externally performed testing. CCL has a Test Utilization Support program in place to help hospital clients decrease unnecessary laboratory testing. Decreasing unnecessary testing can result in decreased phlebotomy, increased patient satisfaction, and reduced overall healthcare costs. Utilization analyses can be very helpful in identifying the major cost drivers for laboratory testing from an institution, and can suggest potential approaches to control these costs via education, utilization control, or internalization of testing.

Labs must make decisions today in terms of changing regulatory requirements and reimbursement models (e.g., value-based vs. fee-for-service). How do these factors affect the benefits that CCL provides to its customers? One of the most difficult challenges facing laboratories today is determining what part of their menu to perform internally versus sending out to a reference laboratory. While a portion of this decision will be driven by cost considerations, an equally important factor is maintaining the critical volume needed to ensure an adequate knowledge base of the testing. The subspecialty model of CCL helps to provide that benefit to potential clients, particularly for niche areas of testing such as endocrinology, coagulation, and anatomic pathology.

How do the technological changes happening today in pathology—anatomic, clinical, and molecular—affect CCL’s internal procedures and outreach to its customers? Our medical directors are dedicated to responding to customer needs through the application of leading-edge technology to achieve accurate results and rapid turnaround. Internally, informatics solutions have allowed us to construct clinical dashboards which capture real-time snapshots of data patterns generated within the laboratory. These dashboards are used by many laboratories to provide ongoing monitoring of test performance for parameters such as turnaround time, test utilization patterns, and quality metrics necessary for laboratory operations. Technological advances are also being applied to interactions with our external clients. One example is the recent adoption of secure, web-based digital imaging (eSlides) to allow remote viewing of IHC-stained slides by clients. This provides a mechanism for ordering clinicians to rapidly review IHC-stained slides within 24 hours of receipt at CCL and allows additional testing to be ordered following an algorithm, which minimizes the need to initially order a large panel of stains.  

More broadly, how is CCL positioning itself to address changing customer expectations? The laboratory of the future will need to be more than just a provider of test results. Ideally, the laboratory should provide mechanisms to help support clinicians in the selection, utilization, and interpretation of laboratory testing, particularly for uncommonly used tests that clinicians will have little experience with from prior use. The ability to provide this support requires two major components: the technical capability to provide a wide range of testing in a timely and high-quality fashion, and the clinical knowledge to provide meaningful recommendations for use. By expanding our test menu, developing clinically-supported diagnostic algorithms, and expanding interpretive reporting for complex testing, CCL is positioning itself to provide these services to clinicians in the years to come.

Concerns about the shrinking skilled workforce in laboratory medicine are one factor that lab managers must take into account when planning for the long term. What do you see as the future of the industry, and how will it impact CCL’s services? A shrinking workforce is just one of many challenges that face laboratory leaders. As healthcare moves from volume-based to value-based reimbursement models, pathologists and laboratorians must continually examine the impact that their services have on the entire episode of patient care, and be able to articulate the value of those services in terms of improved outcomes and cost avoidance both inside and beyond the lab. Within Cleveland Clinic, this means engaging with clinical leaders wherever possible to enhance the diagnostic component of care pathways, and understanding, for example, where the right test can be applied to aid in avoiding unnecessary admissions or readmissions, or shortening length of stay. As a reference laboratory, we'll seek to collaborate with our clients on diagnostics utilization management, helping them by sharing our experience and offering tools where it is of value to their practices.