September 2008 Chair's Message, ASCP Council of Laboratory Professionals by E. Susan Cease, MT(ASCP)

According to the online encyclopedia Wikipedia, informatics is the science of information. It is concerned with the structure, algorithms, behavior, and interactions of natural and artificial systems that store, process, access and communicate information. For laboratory professionals, informatics involves taking the data we generate and managing how it is stored, retrieved, combined and accessed for the purpose of providing better, safer patient care – not only to make an immediate difference in people’s lives, but to help us advance our knowledge and improve testing methods. I believe informatics may well have a greater impact on the future of laboratory medicine than anything else.

Benefits

Improved patient safety, fewer mistakes, more effective test utilization, and better health outcomes – these are the benefits we can expect from a growing ability to access, manipulate and interpret data using sophisticated software applications.

The Institute of Medicine report, “To Err is Human,” highlighted the role human error plays in medical mistakes and pointed out the need to use computerized technology to reduce or eliminate this factor. We know, for example, that testing errors are significantly reduced when we utilize such things as provider order entry, bar-coded patient/specimen ID, standardized workflow and automated results reporting. Similarly, the development and use of standard algorithms to determine testing protocols, along with standardized follow-up procedures, has vastly improved outcomes for emergency room patients who arrive with chest pain or stroke symptoms.

All laboratorians realize that test results must be delivered in a timely manner for them to be useful to clinicians. It is equally important that results be delivered in a meaningful, easy-to-interpret format that allows clinicians to quickly grasp their significance. The use of powerful informatics systems can help us achieve both these goals, but it means we must start focusing as much energy on the post-analytic phase of testing as we do on the testing itself.

Challenges

We must also overcome several challenges before we can utilize informatics to its fullest. One is our present inability to interface/exchange data with others involved in patient care. Besides the laboratory, this includes a variety of health care providers, health care organizations, third party payers, and even departments within the same hospital.

Harnessing the information requires more than increased computing power. It requires an effective system for multi-directional communication – one that connects the laboratory information system (LIS) with pre-analytic processing components, specimen transportation, laboratory analyzers, post-analytic interpretation, archiving, and a multitude of non-laboratory information systems. We simply must have the ability to communicate with and draw data from many disparate systems.

Another challenge is created by technology itself. With the growing number of genetic, proteomic, pharmacogenomic, and nutrigenomic tests becoming available, both the complexity and volume of test data are skyrocketing. Just look at the new digital imaging technology being used in pathology, which has some very unique requirements for high-power computation, data storage, image formatting, and algorithm processing. Likewise, we will need to make information available in different formats depending upon who is receiving the information. This will become even more important as patients gain access to their own Electronic Health Record.

Opportunities

It sounds like informaticists are not much different than LIS specialists. They both work with software systems and generate results. But, traditional information systems are more contained and limited in scope while informatics systems reach out beyond laboratory walls and are much more powerful. In the future they will drive decision-making about the need for additional testing and provide alerts, reminders, order sets and even a list of differential diagnoses based on patient test results.

This has important implications for how laboratories will have to operate in the future. My own laboratory is pretty typical. We have specialized staff to register patients and order tests, phlebotomists to collect blood samples, client service representatives to handle communication with clients, and a specialized marketing team to work with clinicians. One of our stated goals is to keep phone calls and interruptions out of the processing and testing areas. Doing that, however, isolates laboratorians from patients and clinicians. By treating the pre- and post-analytic functions as equally important, we can shift our profession from one of semi-isolation to one of real value to the health care team.

The Future

Health care is under increasing pressure to improve efficiency and patient outcomes while also reducing costs and improving regulatory compliance. The lab is under the same pressures, but we have an important advantage – the large volume of data that we collect and retain.

I believe informatics will change the way we deliver health care. It will become more individualized, with diagnostic and treatment decisions custom-made to meet individual patient needs. Blood draws may replace some biopsies and imaging procedures. Health “care” will be replaced by health “maintenance,” with patients playing a larger role in managing their own health.

The laboratory has the capacity to play a major role in this future, but it is important to recognize the magnitude of change required. For most of us, the challenge will be to move the focus of our profession from generating results (raw data) to delivering the information needed to improve health (informatics).