Disruptive Innovation of the Hospital Transfusion Service
Hospital transfusion services will continue to emphasize blood conservation in order to enhance patient safety and decrease costs. Blood management programs will expand across the entire continuum of care. Patients will be actively screened for anemia. Noninvasive devices, such as the Massimo continuous hemoglobin biosensor, will upload patient data wirelessly to an individual’s smart phone and also to the blood management team. Anemic patients will be proactively treated to avoid the need for transfusion.
Accountable care organizations will gradually shift care to the outpatient setting including transfusion. This transition will put more financial pressure on hospitals because most blood center processing fees are higher than Medicare reimbursement for outpatient transfusion blood components.
Transfusion services will begin to solicit competitive bids for blood components instead of relying on their local blood center. Blood centers and transfusion services will adopt an Amazon-like model of supply chain management. Transfusion services will order blood components on-line from whichever mega-blood center has the most favorable pricing and suitable inventory. Blood collection agencies may offer Groupon-like incentives to sell short-dated products and decrease wastage. A cloud based blood product inventory will include donor unit genotypes and allow transfusion services to seamlessly order antigen-matched blood for patients with sickle cell disease, autoimmune hemolytic anemia or myelodysplasia. Blood will be delivered the same day or next day, possibly by driverless car or drone.
The current reliance on antigen antibody reactions to ensure compatibility between donor and recipient will gradually be replaced by genomics and proteomics. As the cost of genotyping decreases, it will become economically feasible to genotype donors and recipients to provide blood components that are extensively antigen matched. Eventually, positive antibody screens and hemolytic transfusion reactions will become rare events.
As whole genome sequencing enters mainstream medicine, it may become unnecessary for transfusion services to genotype patients. A patient’s genetic sequence may already be stored in their electronic medical record. With informed consent, transfusion services will be able to query a patient’s electronic medical record and determine their blood group genotype from their genetic sequence. Future transfusion service information systems will include a module that can read the whole genome sequence and display a patient’s blood group genotype.
Microbiology is being revolutionized by the introduction of MALDI-TOF for rapid bacterial identification. The same technology will eventually be adopted by blood centers and transfusion services to determine both donor and patient’s blood group phenotype. This technology should be much less expensive and easier to perform than genotyping.
Health care reform and advances in technology will disrupt the practice of transfusion medicine in the very near future.
