The laboratory journey to become a decision engine: a roadmap for diagnostic transformation

Where are we?

There are four elements which will continue to shape healthcare of the future and digital innovation could play a key role across all. These four elements are: demographics, financial, technology and consumerism.

1. Demographics, since population over 65 will double by 2050. This will impact the disease burden with more chronic diseases. Furthermore, and associated with this trend, we will see more workforce shortages, such as physicians and nurses.

2. Financial, as healthcare spend will grow faster than the economy. Unfortunately, we will experience great variability in outcomes which not necessarily will be aligned with the spend in healthcare. In this area, we will see further progress in the shift of business models to payments for value, not for volumes.

3. Technology, advances in digital innovation and analytics will continue paving the way for innovation. New players, working until now in other sectors, will continue entering the healthcare sector.

4. Consumerism, patients and users expect on-demand healthcare services, and will be more empowered than ever, thanks to their access to information and technology.

Let´s review now the status of diagnostics. Physicians struggle with increasing complexity of diagnostic testing and this represents an opportunity for laboratories to collaborate with physicians. Our study [1] showed that 2/3 of German doctors and 1/3 of Brazilian doctors said that they received less than 1.5 days of laboratory training in the last year (and this was probably overstated).

And it’s no secret that physicians are extremely busy, in many cases seeing 100 or 200 patients per week, even more in the case of a general practitioner or in the emergency department. Based on discussions with physicians, most of the times they order tests for nearly everyone, and they don’t always know what to order and how to interpret the results.

Despite these uncertainties, they rarely consult with the laboratory. Instead, they often choose the most expensive option or refer the patient to the specialist. However, when they do consult with the laboratory, they find it very helpful. So, there’s a need for more support and willingness to receive that support.

Effective communication between laboratories and physicians increase the satisfaction of healthcare professionals, reduce healthcare utilization and costs (such as in specialist referrals) and may improve patient outcomes – all appealing aspects to payers.

These reasoning drives to the conclusion that it is not delivered enough training and support; whilst raising the question.

Where do we want to be?

The fact is that laboratories have the data to become decision engines, but to do so, they need to take advantage of the opportunities for digital health, extract insights from this data, and facilitate appropriate action.

Digital innovation will transform the healthcare landscape with new value pools and shifting existing functionalities. These are the main opportunities for digital health: (1) Connectivity enables virtual interaction: which is key for telehealth, health searches and scheduling. (2) Digital innovation allows remote monitoring, real-time self-help and proactive care, for example through wearables and portable data. (3) Big data enables real-time analytics, clinical decision support systems and clinical research with enhanced patient data. (4) Automation improves the patient experience, clinical outcomes and efficiencies, which involves less manual workload, as well as better communication and coordination among healthcare professionals.

When reflecting on ‘where do we want to be?’, one element is clear: in the healthcare of the future, the patient is at the center of the system. This can be understood from different perspectives, in terms of access, healthcare stakeholders like us want to achieve optimized patient access to treatments, with appropriate treatments at the right time, at the right place and for the right patient. Furthermore, we want to achieve improved prevention and patient involvement, providing them increasing autonomy. There is a shift from reactive care to prevention and proactive plans. Patients indeed want to be proactively involved in their treatments. From a quality perspective, diagnostic parties could be a key contributor to improve quality of care. Clinicians could use technology to accurately diagnose, treat illness and deliver care. Diagnostic teams contribute to integrated pathways, improving hospital and health system key performance indicators. Quality of care also involves, improved and supported clinician adherence to guidelines, shaping ordering behavior, reducing unwarranted variation and retaining expertise. From a data perspective, patient data needs to be in one, accessible place. All care delivery stakeholders across the system should communicate and share information effectively. From a process’s perspective, innovation goes beyond technology, it also involves processes and structures, so clinical decision-making can be supported by accurate and timely healthcare information. New cost-effective care delivery models, should include processes and care delivery outside the hospital. Ideally, these processes should be driven by the correct staff doing the correct work (e.g. pathologists handling complex cases, instead of administrative tasks).

To finalize this reflection about what success looks like and ‘where do we want to be’, it is included an inspirational message for healthcare leaders [2]:

Health care leaders should consider building technology ecosystems that embrace non-traditional players and sources of knowledge outside their own four walls. They also should consider building pilots before investing in scale; embracing change; and evaluating new technology-aided revenue sources. Additionally, organizations should strive to be agile in anticipating and adjusting their strategies as innovations continue to evolve.

After covering the questions ‘Where are we?’ and ‘Where do we want to be?’, next let´s reflect on:

What do we need to do?

Let’s start explaining what Abbott and Digital Health Solutions (DHS) are doing in this regard. Abbott’s fundamental purpose is to help people live fuller, healthier lives, maximizing their potential at all ages and stages of life. Our organization does this through four major businesses that span the spectrum of human health.

DHS and its family of AlinIQ solutions, support the transformation of clients, through an offering positioned at the center of opportunities for digital health mentioned before.

The DHS Value Proposition includes providing personalized solutions, consisting of resourceful advocates, harmonized systems and intelligent insights to achieve better healthcare outcomes.

DHS is helping across the Diagnosis Cycle by providing visibility and optimizing every step of the diagnosis cycle. As Peter Drucker said: ‘If you can’t measure it, you can’t improve it.’ Abbott has its own methodology and tools to work with clients on their roadmap to materialize their vision. It is called Abbott Transformation System Methodology (ATS).

Together through a series of workshops, engagements, and discussions, DHS teams address with clients their clinical, operational, and financial concerns around the organization’s goals. The process allows them to take a step back from day-to-day concerns and proactively address long term strategic priorities. The process involves six phases and it might be helpful for any organization.

1. Discover: Analyze the business health of the organization, including market forces, competitors, customers, Key Performance Indicators (KPIs), profit and growth opportunities, and clinical value to spark a conversation about goals, priorities, and key stakeholders.

2. Envision: Align stakeholders in the organization to the key goals and challenges that emerged in the Discover phase.

3. Design: our teams create the requirements and plans to lock in the success factors to engage stakeholders, build the infrastructure, and implement the right level of performance.

4. Decide: In this phase, evaluate with clients the proposals and options in order to make the best selection.

5. Execute: This involves delivery and addressing implementation barriers to create a smooth process and achieve successful outcomes.

6. Amplify: Create an ongoing review and improvement cycle to build success beyond the original strategy. More than a post-deployment review, this is an opportunity to assess, measure, and refine performance, as well as identify and initiate new opportunities to amplify the department´s importance, growth, and core capabilities.

The next section describes some tangible examples of client pain points, solutions and real outcomes achieved. In order to do so, it is used the Diagnosis Cycle framework and its different steps:

Test ordering step: Some clinicians struggle in the ‘ordering step’ of the diagnosis cycle; actually, 77% of physicians would value additional interpretation [3]. DHS can help tackle underuse and overuse with AlinIQ Clinical Decision Support (CDS) and AlinIQ Integrated Platform. Recommendations and guidance through AlinIQ CDS help shape the ordering behavior of the physicians. As examples of the outcome, the team worked with a French client to reduce underuse of laboratory testing, identifying that 1.020 patients were falling into a care gap (patients in G3a-G5 stages of chronic kidney disease, with no annual testing on parathyroid hormone, calcium, peripheral blood lymphocytes and phosphate, as per protocol). In a similar way, we worked with an Italian client to reduce the overuse of head computed tomography (CT) scans requested in the emergency department, identifying that 9.8% of CT scans on neurally-mediated syncope and 16,3% of CT scans on minor head injury, were not required.