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Value of Clinical Laboratories and Clinical Pathologists

The clinical laboratory plays a vital role across the entire continuum of health care. Clinical laboratory testing heavily impacts clinical decision making by providing physicians, nurses and other health care providers with important information needed for the prevention, diagnosis, treatment and management of disease. Virtually every practicing physician depends upon the clinical laboratory for the care of his or her patient. Laboratory testing represents less than 5% of total health care expenditures, but it significantly impacts the remaining 95% of total costs.

Well run clinical laboratories are often perceived as commodities because they provide seamless service and keep problems under control. The perception that clinical laboratory technologists just push buttons is incorrect; in reality the clinical laboratory has evolved into a highly specialized medical service.

Good laboratories do much more than just run a specimen through an analyzer to get a result. They determine which tests should be offered to support the medical staff, how they should be built electronically so that the proper test is ordered and how they are reported so that results are interpreted correctly. Laboratories make certain that appropriate tests are included in clinical order sets and unnecessary tests are deleted. Hospital laboratories perform testing as quickly as possible so that diagnosis and therapeutic decisions are not delayed. They carefully monitor laboratory quality to ensure accurate and reliable test results.

More than 4000 different laboratory tests are available today for clinical use, of which approximately 500 are ordered on a daily basis. Today physicians, other health care workers and patients are finding it increasingly difficult to keep up with the tremendous amount of information being generated by clinical laboratories. This trend is expected to continue with the implementation of genomic testing and personalized medicine. Esoteric lab tests are projected to increase at an annual rate of 12%. Clinical pathologists are specialists who consult with physicians 24/7 to recommend the correct tests for their differential diagnosis, interpret the clinical significance of esoteric tests and answer physicians’ questions when a test result differs from their clinical impression.

Hospital and physician practice models are moving to fully integrated services. Inpatient, outpatient and outreach test results need to be fully integrated within these new practice models. An integrated health system laboratory will play an increasingly important role in decreasing unnecessary testing and its associated downstream medical costs. Local clinical pathologists who work closely with the medical staff will have the most success at influencing physician ordering behavior.

At the end of the day, physicians turn to the clinical laboratory for most of the information about their patients. Optimal turnaround times for laboratory tests and accessible clinical pathologist consultations are essential components of a successful, fully integrated clinical practice.

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