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The winds of change are blowing in the lab.

Like it or not, major changes in the delivery of lab services are coming. When they will arrive is debatable, but one thing is certain: They will have an impact of hurricane force on laboratorians at all levels. These changes fall into three categories: economic, technological, and organizational.

* Economic changes. Congress continues to study the lab, focusing on Medicare and Medicaid reimbursement rates and capital equipment issues. With the Supreme Court having acknowledged the NLRB's right to accept eight separate bargaining units for health care institutions, unions will mount a massive campaign.

If professional and monetary concerns are not met by labs--the largest group in the professional unit--they will be filled with underpaid, unhappy technologists. Union organizers will capitalize on their dissatisfaction with sophisticated PR campaigns.

* Technological changes. Equipment and procedures in labs are advancing at a breathtaking pace.

Robotics. Once an instrument that can interface with other equipment and computers is created, the use of robots in the lab will make strong headway. Three or four technologists can screen no more than 4,000 colonies a week. A robotic system with artificial intelligence can screen 75 bacterial colonies a minute. Using this system, one lab was able to screen millions of colonies a day. As a result, several microbiology laboratories closed.

Imaging. Sometimes called a window into the human body, positron-emission tomography enables physicians to determine the degree of heart muscle breakdown by measuring glucose levels. Small amounts of naturally occurring human compounds labeled with radioactive markers are sent into the bloodstream through an IV line. Using PET, physicians may one day be able to detect other organ deficiencies and early stages of cancer.

Disposable system. In the world of microsensors, researchers predict extraordinary advances within a decade. A single chip containing an entire fluid-testing system will soon take the place of expensive diagnostic equipment. The chip will be dropped into a specimen, a reading obtained, and the whole system discarded.

In vivo techniques. Biosensory and fiberoptic technologies have made tremendous strides. Prepare to begin replacing traditional in virto procedures with in vivo testing.

* Organizational changes. Two hospital-generated programs that assess the cost benefits of patient care service delivery are gaining in popularity. If proved successful, they will move throughout the country rapidly.

Total Quality Management, an offshoot of the JCAHO's quality assurance approach, relies on out-come-oriented service teams rather than on QA process evaluation in individual departments (or lab sections). TQM will force laboratorians out of the lab and into interaction with other health care professionals.

The most dramatic of the new programs involves cross-training of caregivers and decentralzation of ancillary services. Teams train for 12 weeks to learn the basics of nursing, laboratory, and radiology and test the provision of major services in a prescribed bed unit system. This program is being tested in Florida, Georgia, Indiana, Nebraska, Tennessee, and Virginia. In states that allow only licensed labs to do testing, technologists perform other services, such as routine nursing functions. So far the impact on cost and turnaround time has been impressive.

* Prepare. While we can't know precisely how these changes will affect us, we must follow their progress and be ready for them. Laboratorians must be willing to move out of the lab, if needed, to learn new techniques. If not, other professions will move in where laboratorians fear to tread.

Educators should substitute courses on new techniques and developments for traditional studies that are becoming obsolete. Professional organizations must move aggressively to promote expanded roles and responsibilities for laboratorians. Rather than rehashing current testing approaches, scientific programs and meetings must focus on the future.

How we ride out the hurricane of change will determine the success or failure of our profession.

Annamarie Barros is a management consultant and educator; director of Health Management Analysts, Woodland, Calif.; and laboratory operations adviser, Ernst & Young, Great Lakes Region, Cleveland.
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Author:Barros, Annamarie
Publication:Medical Laboratory Observer
Article Type:column
Date:Aug 1, 1991
Words:641
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