As organizations embrace the mandates of the Affordable Care Act and move into the Accountable Care Organization format, most facilities are adopting an integrated health model, also commonly referred to as coordinated care.
In the integrated health system, all facets of healthcare are coordinated, from mental health, substance abuse, primary care and of course, the laboratory, to focus on patient-centered care from all departments.
"Laboratories are an important part of the treatment team," Irina Lutinger, MPH, MASCP, H(ASCP)DLM, FACHE, member of the American Society for Clinical Pathology's board of directors and a senior administrative director of clinical labs at NYU Langone Medical Center said. "We are central to decision making, play a critical role in patient healthcare records and have a skill set that is integral to the success of coordinated care."
Currently non-integrated systems produce huge variations in care, Glen McDaniel, MS, MBA, MT, MLS, DLM, healthcare executive, clinical lab scientist, speaker and freelance writer, told ADVANCE. "Information related to a single patient is very fragmented, stored in several places, not easily available and very difficult to trend. This fragmentation results in duplication, increased utilization of services, increased cost and for hospitalized patients, increased length of stay."
The coordinated care facility, by integrating all hospital services and adopting patient-centered care, can avoid those issues. The laboratory will play an essential role to integrated care success.
Lending Laboratory Skills
In the integrated health model, laboratory professionals are in a prime position to take leadership roles. They "have the ideal skill set for coordinated care, as we are data driven and have keen analytical minds," Lutinger said. "For facilities focusing on workflow and efficiency, laboratories have the most appropriate algorithms for data flow, quality processes and examination."
McDaniel said that the lab staff can play a leadership role in integrated health by actively educating clinicians on the importance of the laboratory. "It is going to take much more aggressive education of physicians and administrators," McDaniel noted. "Laboratories should take a look at how stakeholders such as pharmacists have inserted themselves into patient care. They are not shy about offering their expertise and even creating protocols for proper use of their services. Clinical laboratorians should take the same approach."
When speaking with clinicians and preparing for integration, McDaniel recommended laboratory professionals focus on their role in patient care. "Many clinicians are overwhelmed by data, institutional regulations and a large patient load," he said. "They will readily admit they need all the help they can get. The laboratory can and should fill that gaping void."
Laboratorians play an essential role in selecting the right test at the right time, providing accurate results in a timely manner and converting complex data into useful information by providing interpretive reports, McDaniel said. "We make it possible to ensure results are available and retrievable to physicians across many platforms, whether the doctor is in the hospital, the golf course or the office."
When seeking a leadership role in your facility's coordinated care system, Lutinger said the ideal positions would be in hospital committees and forums, where laboratory quality indicators can be shared with various facility personnel. "Integrated health creates a single team to treat each patient," Lutinger said. "With our knowledge and ability to diagnose multiple conditions, whether in infection, inpatient care or the emergency room, the lab is at the core of care."
McDaniel said that no matter the discussion, laboratorians would be valuable leaders in integrated health. "Whether the focus is on a new service, a changed protocol or a care map, the laboratory must insist on being part of the decision making," he said. "No longer can decisions be made with the lab in absentia."
McDaniel suggests co-opting the laboratory pathologist to speak with physician peers as equals to advocate for the laboratory. "Very often, it will take the non-physician laboratorian to educate clinicians about current medical lab science practice and capabilities. Step into the educator role gladly and acknowledge your unique role." There is not a single administrator or clinician leader, McDaniel said, who will not listen if a laboratorian approaches him or her using the correct language and offering the help of the laboratory to solve facility dilemmas.
For those in laboratory management positions, Lutinger said it is important to give staff the chance to excel outside of the department. "By giving staff opportunities to be involved in projects outside the lab, you are providing momentum for professional growth," she said. "Ask staff to present educational lectures to others or become a member of a committee. It will be a chance for other departments to learn about the lab and for laboratory professionals to succeed."
When approaching integrated health in your facility, remember: You already have the skills needed to succeed in a coordinated care environment. "You have multi-faceted talents in electronic data, being part of a team plan, analyzing data and processes in detail, creating new systems, and standardizing quality control," Lutinger said. "You have the power to bring the laboratory's role in integrated health forward."
Kelly Wolfgang is on staff at ADVANCE. She can be reached at firstname.lastname@example.org.