Most discussions about the future of hospital laboratories focus on familiar challenges—reimbursement, staffing shortages, automation, laboratory budgets, and advances in diagnostic testing.
Those are important issues. I believe, however, that a more fundamental change has been taking place.
This change wasn't driven by a single scientific breakthrough or a new reimbursement strategy. Rather, it emerged gradually as patient complexity increased, precision medicine expanded, care extended across a growing number of community settings, and clinical decisions became increasingly data-intensive.
Historically, healthcare evolved within a fee-for-service environment that naturally rewarded departmental performance. Accordingly, laboratory leadership appropriately focused on analytical quality, operational reliability, and efficient service delivery. Those responsibilities remain fundamental today.
However, healthcare delivery continues to evolve, changing the environment in which laboratory diagnostics create value.
As hospitals have worked to reduce inpatient length of stay, an increasing share of patient care has shifted beyond the hospital into physicians' offices, critical access hospitals, ambulatory facilities, skilled nursing facilities, home health agencies, and virtual care environments. Accordingly, diagnostic information supporting a patient's care is now often generated by multiple laboratories across this broader continuum of care. As that information becomes more fragmented across multiple laboratories and care settings, it can become more difficult to fully leverage it in support of coordinated, efficient patient care.
Viewed in that context, it may be helpful to think about hospital laboratory diagnostics less as a departmental testing service and more as a community-wide clinical resource supporting nearly every specialty across the continuum of care.
That distinction matters.
Departments are generally evaluated according to how efficiently they perform their own responsibilities. Community-wide resources should also be evaluated by how effectively they contribute to broader clinical and operational performance across a variety of care settings.
The clinical laboratory occupies a unique position within the health system. It generates much of the objective information contained within the patient's medical record while supporting virtually every clinical specialty. As care increasingly extends across multiple settings, laboratory diagnostics also have the opportunity to contribute to a longitudinal diagnostic record that connects patient information across episodes of care.
None of this changes the laboratory's traditional purpose.
It should, however, broaden how health system leaders think about its contribution.
If hospital laboratory diagnostics are increasingly functioning as a community-wide resource rather than simply a departmental service provider, an important question naturally follows:
Are we measuring the contribution of hospital laboratory diagnostics in ways that reflect their broader role in health system performance?
