The Year of “Us”

Every year, Time magazine selects its renowned “Person of the Year.” In this annual ritual, a panel at the magazine selects a person who represents, for better or for worse, the last 365 days of our recent past. In 2006, the Person of the Year was somewhat remarkable. The Person was someone to whom every Time subscriber could relate, someone everyone who picked up the magazine was familiar with, and someone you could say everyone knew inside and out. The 2006 Time magazine Person of the Year was, in fact, “You.” Time quoted widespread Web development, blogging, Facebook profiles, YouTube movies, Amazon reviews, MySpace, and the plethora of podcasts available on any subject as evidence that in 2006 each member of the American public truly had a chance to make the year about them, and they were quick to do so! Many media sources, as well as Time contributors themselves, then joked that 2007 would be the year of “Them.” While the magazine instead chose Vladimir Putin as its 2007 Person of the Year, the 2006 selection is one that remains fresh in the memory of the popular culture even today. Now, with more than half of 2008 already behind us, it is time to begin thinking of who the 2008 Person will be. It is my opinion that, at least in terms of clinical laboratories, 2008 should be the year of “Us.”

New technology, new applications, and new users have advanced clinical laboratories to a state in which people and facilities must work together to achieve success. This is evidenced by some of the recent advancements and changes in operating procedures, such as web-based order management systems and off-site patient service centers. There is a host of Internet-based order management systems that physicians, laboratory technicians, and staff members can utilize to increase the speed and efficiency of clinical lab reporting and ordering. These products allow more functionality than a physician’s remote access to a portal system, because now physicians are able not only to view results, but also to order tests. Allowing physicians access to the clinical laboratory order entry program from anywhere they are able to surf the Web allows them to more immediately meet their patients needs. Physicians now place the order themselves and no time is spent pushing the order through the appropriate channels to have it reach the lab. These order management systems also reduce the error margin on reading a physician’s handwriting on their order documentation or the lab’s error in order entry.

The Web-based products also allow physicians and their office staffs to customize the order screen for their specific practice. For example, a primary screening page can appear without prompting for each patient in the system. This screening page is customized for the specialty and is based on the individual practice patterns of the people that will be using it. Physicians will always have to order lab tests; it is just that they are now able to do so in a more efficient and personalized manner.

Another positive attribute of the order management system is that it allows physicians and their staffs to look up lab results of their own accord. This reduces the time that the lab must spend notifying physicians that results are available for viewing. In many of the systems, automatic callback features are available to notify a specific telephone number (a physician cell phone or the reception desk at the private practice, for example), that test results are available for their patients. Hence, the lag time in notification is eliminated, as physicians and staff can check for patient results as often as they like.

The order management systems help patients by ensuring that the tests they need to drive their clinical care are ordered and processed as quickly as possible. These systems also help physicians and staff by allowing them to order and read tests from nearly anywhere (provided there is internet access available), at any time of day or night. Further, they help lab staff by ensuring that orders are filled directly by a physician, and there is nothing “lost in translation” as it makes its way through the order entry process. These systems are a prime example of how the most significant advancements are made when done with multiple groups of people in mind. Suddenly, things are not being done to help just a patient, or just a physician, or just a lab staff member, but rather, to help all of those people. In 2008, things are being done to help “us.”

Another great example of the focus on “us” this year is the development of patient service centers. Many hospitals are realizing that there is not a need for all services to take place within the four walls of the main hospital building. The explosion of ambulatory surgery centers over the last decade gives credence to that fact. However, hospitals are now beginning to offer lab services at external locations. Patient service centers, located throughout a hospital’s primary and secondary service areas, are an alternative to traditional inpatient or physician practice lab locations. These centers, often located in professional or medical office buildings, give the patient a place to have specimens drawn without the inconveniences that can come along with a hospital or doctor’s office. These specimens are then picked up by courier and taken to an outreach lab where they will be processed with other routine lab specimens. This is no different than the pick-ups that would be made by couriers at doctors’ office throughout the city and the way those specimens would be processed.

Patient service centers are beneficial because they allow patients easier access to non-emergent medical care. Often, follow-up lab work for patients who have been discharged from the hospital does not need to be done on an emergent basis. However, these labs are important in allowing a physician to track a patient’s health status over time. For patients who do not live near a hospital, the patient service centers located throughout the greater community can serve as a more convenient location to have follow-up lab work completed. In addition, patient service centers, often housed in medical office buildings, may offer a less stressful environment than that of a hospital. Rather than having to make the long journey to the hospital, patients can make the shorter trip to a nearby office park and have their labs drawn there with equal success.

These service centers are also beneficial because they do not require the financial investment that a hospital or physician office might necessitate. When accessing services at a patient service center, the patient does not have to be re-admitted as an outpatient at the hospital, nor do they have to pay the co-pay associated with an office visit.

For a patient, there are several advantages these service centers offer over the hospital or the physician office. However, there are also benefits for those parties as well. These centers are an asset to a physician office because there may not be a nurse or other staff member that is available for a draw when a patient comes in for routine follow-up blood work. The nurse may be assisting the physician in other ways, such as putting a patient into a room, conducting a preliminary work-up, pulling charts, scheduling patients, or a host of other duties.

At the end of this year, Time may select You, Them, Us, or a singular person to stand as its nominee for Person of the Year. Regardless, 2008 has truly been the year of “us” for clinical laboratories.