Laboratory IT systems grapple with genetic testing surge
BOSTON – Precision medicine holds big promise, but it's also posing big challenges for hospital labs trying to manage a huge increase in requests for genetic tests.
At the HIMSS Precision Medicine Summit on Tuesday, Patrick Mathias, associate director of laboratory medicine informatics at University of Washington, spotlighted just how complex the genetic testing boom has become for clinical technology.
Hospital laboratories are "feeling the first wave of precision medicine," said Mathias, as they're "on the front lines of coordinating high-complexity testing."
Many hospitals rely on having to send out tests to reference laboratory when testing is unavailable at primary lab. But that leads to IT challenges for hospitals. Most distinct tests aren't integrated into EHRs and there's a big potential for order entry errors from tests not defined in clinical information systems.
As genetic testing has evolved in complexity beyond the single-gene paradigm, the genetic testing market has become similarly complex and dynamic, he said – with more than 69,100 genetic testing products on the market and as many as 10 new ones every day.
To improve the management of tests and better integrate their genetic information into workflow, Seattle Children’s Hospital – which spends more than $1,000,000 annually on genetic sendout testing – helped launched the Pediatric Laboratory Utilization Guidance Services, or PLUGS, a nationwide network with more 60 other hospitals and health systems, with the aim of improving ordering, retrieval, interpretation and reimbursement for genetic tests.
Along the way, within its own walls, coordination between clinical and IT staff was key, said Mathias, and demanded a nuanced approach to process improvement from both sides of the equation.
The initiative required staff at Seattle Children's to embrace workflow standardization improve the efficiency of manual sendout processes through. The hospital had to bolster lab staff expertise to improve ordering process, streamlining test comparison and get better test result management.
It also made used lab genetic counselors to improve quality and reduce costs – they help spot and correct errors that could impacting patient safety, said Mathias, leading to cost savings that in turn justify the addition of more resources.
Having achieved those successes, "the challenge was how can we do that so we can scale across all health systems," said Mathias.
PLUGS enables hospital labs across to decrease testing costs and errors. Seattle Children's says network members that have implemented smart utilization management have achieved savings of 10 percent or more on their sendout testing.
Within his hospital, Mathias said clinicians and IT staff are still grappling with certain aspects of precision medicine – especially making better use of testing results in clinical workflow.
"There's this foundational question of, if you want data in the workflow, there has to be some EHR integration," he said. "I don't think we've really solved that question yet.
HL7 and FHIR standards are helping, he said, but "this is the tip of the iceberg – we need to lower the barrier to move usable genetic data."
But while integrating genomic data remains "an ongoing challenge," said Mathias, "we are creating actionable results today."