Hospital laboratory outreach has largely developed in a fee-for-service environment. The economic rationale was straightforward: use existing laboratory infrastructure to serve additional non-hospital testing volume, lower unit production costs, and generate an attractive contribution margin. That model was well aligned with the healthcare environment in which it evolved.
Healthcare delivery is becoming more longitudinal and distributed across an often-fragmented network of patient care settings. Over the course of an illness or chronic condition, a patient may receive care in hospitals, physician practices, specialty clinics, urgent care centers, post-acute facilities, home health organizations, hospitals-at-home programs, and virtual care settings. While the patient moves through those settings, the patient’s laboratory diagnostic information, the largest objective source of data in their medical record, may not move as easily.
Diagnostic integration is more than an access issue
For patients with chronic conditions, complex illnesses, or care spanning multiple settings, access to their individual diagnostic results is only one aspect of effective integration. When testing is performed by different laboratories, those individual results may only be available to the providers involved in that patient’s clinical visit, while the patient’s broader laboratory history remains distributed across various practices and information systems.
Access is the first step toward integration. Clinicians and staff may need to locate prior results and reconstruct a patient’s laboratory history. When prior results are difficult to obtain, testing may be repeated so clinicians have the information needed to make a timely clinical decision.
There is an important distinction between access to an individual result and the utility of that result within the context of the patient’s broader laboratory diagnostic information and course of care. The significance of a laboratory result depends in part on how it relates to the results that preceded it. A series of results viewed over time can provide information about the patient’s clinical course that may not be apparent when each result is viewed as an isolated event. Greater continuity, when available, may support more efficient provider decision-making, with the potential to reduce episode-of-care costs.
An IT interface can connect results. It cannot necessarily make them comparable.
An IT interface can accurately transfer laboratory results from one information system to another. That improves access and can give clinicians a more complete view of the patient’s testing history. However, the interface in isolation does not determine whether results for the same test generated by different laboratories are directly comparable.
Differences in analytical methods, instruments, reagents, and calibration can affect reference ranges and results. Each laboratory may be operating appropriately within the specifications of its own testing methods without producing results that are directly interchangeable with results generated by another laboratory.
Proficiency testing provides an important illustration. Passing proficiency testing demonstrates that a laboratory is performing within established method-specific requirements; it does not necessarily establish that results generated by different testing methods are directly comparable.
Doctors Klee and Kisabeth of the Mayo Clinic Department of Laboratory Medicine and Pathology reviewed national proficiency testing data across multiple methods and testing platforms. Their review of cholesterol testing on specimen LP-09 illustrates the issue.
Individual methods met proficiency testing requirements, yet the acceptable ranges varied substantially. Similar variation was observed for other analytes included in Klee and Kisabeth’s review.
The point is not that the laboratories or methods were performing incorrectly. It is that acceptable laboratory performance and comparability between testing methods are different considerations.
That distinction becomes clinically relevant when results from multiple laboratories are assembled into a longitudinal patient record. An observed difference between two results may reflect a change in the patient’s condition, a difference in the methods used to generate the results, or some combination of the two.
Electronic connectivity and laboratory diagnostic consistency are therefore related, but they are not the same issue. Connectivity addresses whether laboratory information can be brought together and made available. Consistency addresses whether results generated at different times and locations can be appropriately interpreted together.
Achieving and sustaining consistency across different methodologies, testing platforms, and laboratory practices can be difficult and time-consuming. Performing more of a patient’s testing within an integrated hospital laboratory offers another approach that can reduce the number of laboratories and methods contributing to the longitudinal patient record and therefore create consistency in a more efficient manner.
Where hospital laboratory outreach may enter the discussion
Hospital laboratory outreach already links the hospital laboratory to physicians and other care settings throughout the hospital’s service area. In doing so, outreach programs have developed provider relationships, courier and logistics networks, IT connectivity, client services, specimen management processes, and laboratory operations to support testing beyond the hospital. The changing care environment raises a broader question: could that existing outreach infrastructure also support greater diagnostic integration across the community?
If more testing across the patient’s continuum of care can be performed within an integrated hospital laboratory, laboratory information can be more readily available across care settings, with fewer laboratories and testing methods contributing to the patient’s longitudinal record. This may provide greater continuity of diagnostic information and greater consistency for longitudinal interpretation.
The core economic value of outreach remains important. Testing volume, revenue, contribution margin, and efficient use of laboratory infrastructure continue to matter. The potential clinical and health system effects of greater diagnostic integration may introduce a unique total-cost-of-care value proposition for hospital laboratory outreach.
A resource and value question
Greater diagnostic integration could require additional personnel, logistics, information and data management technology, client services, and laboratory operational resources. Those investments would increase the laboratory budget.
In evaluating this investment, one component of laboratory outreach’s ROI concerns the economics within the laboratory itself. Additional testing volume can make greater use of existing infrastructure, potentially lowering unit production costs and improving contribution margin. But the potential value of greater diagnostic integration may extend beyond the laboratory and its operating budget.
A second, potentially broader component of laboratory outreach’s ROI concerns greater continuity and consistency of diagnostic information and its potential to support more efficient clinical decision-making and care coordination. To the extent these effects influence resource utilization, total cost of care, or health system operating performance, the resulting economic value may be realized elsewhere within the health system rather than within the laboratory itself. Depending on the magnitude of these effects, that value could exceed the traditional financial ROI associated with laboratory outreach.
Those effects should not be assumed. Their relevance and magnitude would need to be understood within the circumstances of an individual health system.
That is why this discussion benefits from both laboratory and health system leadership perspectives. Laboratory leaders bring expertise in diagnostic capabilities, testing methodologies, operations, and laboratory economics. Clinical, nursing, operational, and financial leaders bring complementary perspectives on patient care, clinical decision-making, care coordination, resource utilization, and enterprise performance.
Together, these perspectives are well positioned to consider the following question:
How should the incremental resources required for greater diagnostic integration be considered alongside their potential effects on the speed of clinical decision-making, care coordination, total cost of care, and health system operating performance?
