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Running a laboratory in the information age.

Running a laboratory in the Information Age

How would we ever survive in the workplace without the tools of the Information Age? When I first entered the field of laboratory management, the most sophisticated instrument at my disposal was an electric calculator. Fifteen years later, I find it difficult to imagin life without my personal computer, fax machine, and high-speed photocopier. * Data overload. A decade ago soothsayers predicted technology would make our lives easier one day. The sluggish antiquated machinery to which we had become accustomed would be replaced by high-tech equipment. The new instrumentation would set intricate data at our fingertips and help us to render accurate test results expeditiously.

Unfortunately, the scenario that has evolved is entirely different from what was predicted. Instead of swimming through a streamlined day, managers and administrators find ourselves inundated by a sea of data and swamped with endless possibilities. Decision making is slowed not by having too little information but by having too much.

I'm not suggesting that we do away with the complex machinery of our times, but how much is too much? At what point should we stop campiling data and follow our instincts? * Too many tests. We face a similar dilemma in a more critical situation within the health care realm. Computerized analyzers churn out test results at an ever-increasing rate, enabling laboratories to offer expanded test menus to physicians. Lab tests are often correlated with more costly imaging studies for good measure.

I prescribe to the notion that if you do enough testing, you will discover abnormalities in the healthiest of individuals. Excessive testing can lead both physician and patient on a wild goose chase in an attempt to track down abnormal test results that turn out to be meaningless.

Even regarding tests that were appropriate to order, I often wonder how many results are actually reviewed. One of my favorite anecdotes comes to mind. A hematology laboratory was short-staffed due to inclement weather. Employees were told to hold off processing differential counts for specimens that had WBC counts within the normal range until physicians called for the results. Days went by; not a single doctor contacted the lab. I am sure many of us would have the same experience in our own laboratories.

The information explosion is the crux of the problem for controlling health care costs. Physicians insist they need as much patient data as possible to make a correct diagnosis and plan treatment. Other care givers counter that clinicians should spend less time mulling over endless test results and more time evaluating the patient's clinical condition.

An ongoing debate rages over when tests should be ordered. Some clinicians take the "rifle" approach, requesting an assay only when the patient's clinical condition warrants it. Others favor the "shotgun" approach, in which a battery of tests is run simultaneously in an effort to uncover any abnormalities quickly. Today's health care policies encourage the latter philosophy so that patients can be discharged from the hospital as early as possible. * Some control. While most laboratorians have little control over test requests, we can influence which assays are performed and when. By placing restrictions on test ordering patterns, we can help modify physicians' utilization of laboratory services--at least to some degree.

Education is the key to retaining control over laboratory information. Those of us who work within a teaching institution can often trace a large jump in the demand for some obscure test to a recent lecture on grand rounds. Perhaps a portion of medical rounds should be devoted to a review of unnecessary tests. If clinicians' behavior can be modified to encourage them to order more tests, couldn't they be urged to order fewer? * Staying afloat. The technologic wonders of our age provide superb tools for providing information that permits accurate and timely health care decisions to be made. We must learn to ride the crest of the information wave so that we don't end up drowning in a sea of data.

The author is administrator of clinical laboratories at Thomas Jefferson University Hospital, Philadelphia, Pa.
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Title Annotation:Viewpoint; laboratory management
Author:Maratea, James M.
Publication:Medical Laboratory Observer
Article Type:Column
Date:Oct 1, 1991
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