Enhancing the patient experience through a patient-centered approach to care is a growing priority for healthcare organizations. The primary objective of patient-centered care is to ensure a continuing relationship between the patient and his or her healthcare team with a focus on prevention and detection, diagnostic accuracy, and team-based, multi-disciplinary information sharing and collaboration.
Improving health outcomes by providing “the right test for the right patient at the right time” is a popular credo in laboratory medicine that is becoming more achievable every day due to advances in genetic testing and pharmacogenetics, and the systems that support their implementation. A personalized approach to medicine based on a patient’s genetic profile not only accelerates patient diagnosis, but also helps determine response to medications to help guide the best possible treatment and health outcomes.
Toward this end, the laboratory is a critical link and information source across the entire diagnostic process, from the initial lab order through guided clinical decision support to help ensure targeted patient therapies for the best clinical outcomes.
Progressive labs are able to expand their role in support of patient-centered care in three distinct ways:
I. Developing evidence-based testing algorithms
While lab professionals routinely consult with clinicians on laboratory test selection, labs need to expand evidence-based best practices to help both patients and their physicians better understand lab testing options and their impact on personalized, cost-effective medicine.
To promote patient-centered care and help physicians and patients engage in discussions about choosing care that is truly necessary, supported by evidence, and not duplicative of other tests or procedures already received, in April 2012 the American Board of Internal Medicine Foundation, Consumer Reports, and nine medical specialty societies launched the Choosing Wisely campaign. Participating medical specialty organizations each developed lists of five recommendations for preventing overuse of a treatment in their field whose necessity physicians and patients should question (1).
To date, more than 50 specialty societies have joined the campaign and developed more than 250 evidence-based recommendations to help make the most appropriate care-based decisions at the patient level and provide information on when tests and procedures may be appropriate, as well as the methodology used in their development. The program has begun to spread internationally to Canada, the United Kingdom, Australia, and other countries.
Seven multi-stakeholder alliances were recently formed to focus on the local implementation of Choosing Wisely at health systems, hospitals, and medical groups across the United States to achieve measurable reductions of at least three Choosing Wisely recommendations.
Motivated by the campaign, and to advance both patient-centered and value-based care initiatives, healthcare organizations are developing their own evidence-based best practices for laboratory testing and clinical procedures as a resource to help clinicians better understand and improve their ordering practices to better serve patients.
As laboratory test recommendations are developed and implemented through these types of emerging evidence-based best practices, laboratory professionals will play an important role in educating clinicians and patients and consulting with them on how to improve the diagnostic value of laboratory tests while preventing the overutilization of laboratory resources.
II. Implementing clinical decision support to guide genetic testing
The growth of genetic testing is transforming the standard of care for some diseases, and clinicians will increasingly be able to pursue targeted, patient-specific therapies in the future based on the presence of specific biomarkers and molecular mechanisms causing a disease (2).
According to the National Center for Biotechnology Information’s Genetic Testing Registry, there are currently more than 32,000 genetic tests for 5,800 medical conditions and 3,900 genes. This vast volume of available genetic diagnostic tests makes it virtually impossible for physicians to keep current and know when to order a specific genetic test, or which one to order based on the patient’s medical history and other factors.
To help clinicians order appropriate genetic tests, interpret test results, and make the best treatment decisions for patient-centered care, labs should take a proactive role in supporting the development and integration of clinical decision support tools and genetic-based knowledge bases into clinical workflow. These tools evaluate and interpret the patient’s personal history, medication list, and genetic profile to analyze and guide clinical decisions about which tests and drugs are most relevant for the patient. Clinicians can review treatment implications and weigh trade-offs among medication alternatives based on known gene-drug interactions.
III. Supporting multi-disciplinary team collaboration
The multi-disciplinary care team is now widely recognized as an essential mechanism to achieve a more patient-centered, coordinated, and effective healthcare delivery system. Healthcare providers collaborate with patients and their families and share information within and across healthcare settings to deliver higher-quality and lower-cost care.
Technology is driving the ability of care teams to coordinate care and communicate through use of web-based healthcare portals, collaborative networking tools, electronic health records, or other hospital-based information and cloud-based systems, many of which can be accessed by the patient as well.
Laboratories and other diagnostic service providers are also leveraging technology to enable specialists such as radiologists, pathologists, and oncologists to access information and expertise from remote locations to facilitate consultation and collaboration on difficult or challenging cases. By having the ability to discuss a patient’s case in real time and share case information and digital images with the patient care team regardless of geographic location, labs support more efficient coordination of care and maximize the interpretation of diagnostics.
Integrated diagnostic reporting between pathology and radiology also provides an opportunity for the multi-disciplinary team to collaborate and bridge the information and diagnostic gap. Technology advancements and platforms are now making it possible to integrate diagnostic findings, results, digital images, and other relevant data into a combined diagnostic report to help determine a more accurate diagnosis and treatment plan.
Labs that are proactive in developing and communicating evidence-based testing algorithms, supporting tools for effective clinical decision making, and ensuring a collaborative care team environment with specialists from both inside and outside the existing network will be better positioned to elevate and cement their role in the patient-centered care model.
- Cassel CK, Guest JA. Choosing Wisely: helping physicians and patients make smart decisions about their care. JAMA. 2012;307(17):1801-1802.
- Tufel G, Multiplexing at the molecular level. CLP. December 21, 2015. http://www.clpmag.com/2015/12/multiplexing-molecular-level/. Accessed February 25, 2015.