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A guru's hard look at the lab field's future.

Give Henry M. Weinert a podium and a little time, and watch the sparks fly. The president of Boston Biomedical Consultants recently let loose with sharp and often provocative comments on many lab-related issues in a talk on "Consequences of the Technological Revolution" at the annual meeting of the National Committee for Clinical Laboratory Standards in East Rutherford, N.J.

Rather than paraphrase and dilute his message, I will get out of the way and let Weinert speak for himself on as many topics as space permits.

* Chemistry and other lab testing. "I think clinical chemistry will become the home of a pretty broad and diverse cellular biochemistry. . . . Morphology is really a dated and ancient art and should get replaced by function testing [in the clinical chemistry laboratory]. . . .

"If you look at molecular biochemistry, it's likely that the clinical chemistry laboratory more than any other laboratory will be the recipient of this new technology. . . . We frankly don't have that much hope for hematology, cytology, and microbiology as stand-alone laboratories if you look all the way to the year 2000. The rate of change of those labs is just unacceptably slow."

*Bedside testing. "Patient bedside testing is economically attractive, and it has evolved for blood gas to the point where 70 to 80 per cent of all blood gas systems are not in the laboratory anymore. But it will be held back by significant constraints until the 1990s. What are the causes? Inept hospital administration (a terrible fear of somehow running out of control and that bedside testing will do awful things to the central laboratory); educational training needs among the nursing staff, which have been successfully ignored except by the manufacturers; and attending physician indifference , which shows you that the average physician in a hospital still doesn't have clue one or any empathy and understanding about cost-effective diagnostic testing."

*Diagnostic manufacturers. "One of the fundamental props for the more successful diagnostic manufacturers in keeping up with technology has been product improvement and renewal. It's basic now that as much as 50 to 60 per cent of your development budget is not spent on discovering new products but simply improving what you have. . . .

"A key issue has become when to build a really integrated system, and is there a way to escape rapidly launching first, second, third, and fourth-generation systems? By the time you get to the fourth generation, you have a system that meets customer expectations in terms of reliability, performance, and so on, but it has been very cost-punishing. "

* Acceptance of new tests. "The clinical practitioner will have to adapt more quickly to technology change. . . . Current, painful hospital-by-hospital trials and evaluations of a new analyte are inefficient. There ought to be a way, as in Europe, for a recognized peer leader group to make up its mind and announce that an analyte is relatively useful, and then have things move on."

* Defensive medicine. "Malpractice-based, for-the-record testing represents about 25 to 30 per cent of all testing in the U.S. Unless limitations are put on that, you're robbing dollars from acceptance of new analytes and more worthwhile diagnostic testing."

*Third-party payers. "Although the health care reimbursers have gotten a lot of abuse, their practices have been pretty enlightened. HCFA [the Health Care Financing Administration] allowed very early for complete reimbursement of whole-blood glucose testing at home. . . . The other fascinating thing is that we see new analytes turning up in unclassified schedules, which is really a way of allowing new analyte testing to be done without raising an issue with third-party reimbursers. . . . However, we have also seen some negative episodes."

* Regulating new technology. "I think the industry can play a role by setting early standards on a voluntary basis that bureaucrats can happily accept because it saves them the trouble of enforcement. Current quality control issues at the doctor's office and in home testing are excellent examples. Most of the answers there lie in product technology and not in having inspectors at great expense visit 60,000 to 100,000 physician office practices."
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Title Annotation:Henry M. Weinert
Author:FitzGibbon, Robert J.
Publication:Medical Laboratory Observer
Article Type:editorial
Date:May 1, 1988
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