Nov 25, 2009 | Laboratory Management and Operations, Laboratory Pathology
Highly-automated hospital labs are organized to serve inpatient testing and don’t compete for “outreach” lab business from office-based physicians in the community
DATELINE: AUCKLAND, NEW ZEALAND—In this nation’s single payer health system, clinical laboratory testing services are allotted to hospital laboratories and commercial laboratories in very specific ways. Consequently, hospital laboratories in New Zealand tend to provide testing primarily for inpatients and for outpatients seen by specialists who practice within the hospital’s facilities.
This is an interesting distinction which sets New Zealand hospital laboratories apart from hospital labs in such countries as the United Kingdom, the United States, Canada, and Australia. In each of these countries, it is common for hospital laboratories to provide some laboratory testing to the outpatient and outreach sector, particularly to primary care clinics and office-based specialist physicians.
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Oct 1, 2009 | Laboratory News, Laboratory Pathology, News From Dark Daily
Growing interest in Quality Management Systems (QMS) surfaces at Lab Quality Confab
DATELINE: ATLANTA, GA—From nine countries around the world, several hundred clinical laboratory and pathology quality experts gathered in Atlanta this week for the third annual Lab Quality Confab. Dominating the sessions are impressive success stories from laboratories using Lean, Six Sigma, and similar quality management approaches.
Today is the last day of this high-energy gathering. At least two valuable insights emerged from the collective comments of more than 40 speakers—all of who spoke about different ways that their clinical labs, pathology groups, and hospitals are using Lean, Six Sigma, ISO, and the like to advance the quality of care and the service performance of their organizations.
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Sep 11, 2009 | Laboratory Management and Operations, Laboratory Pathology, News From Dark Daily
Upcoming Lab Quality Confab features “world class” cost-cutting methods and experts
Belt-tightening by clinical labs and pathology groups continues as the current economic recession approaches the end of its second full year. To generate additional cash, a significant number of labs report aggressive belt-tightening on the operations side of the business.
This is particularly true of hospital and health system labs. Many have been asked by their administration to reduce spending below budgeted levels in order to allow the parent hospital to accumulate cash. Since baseline budgets for most hospital labs are already established at parsimonious levels, this compounds the difficulty of cutting costs to free up cash for the parent hospital.
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Jun 19, 2009 | Laboratory Management and Operations, Laboratory Pathology
Utica Hospital holds accreditation in ISO 9001 and 14001, may pursue 15189
When the federal Centers for Medicare and Medicaid Services (CMS) approved DNV Healthcare, Inc. , of Cincinnati, Ohio, to accredit hospitals in the United States last fall, it changed the accreditation landscape significantly. A division of Det Norske Veritas of Oslo, Norway, DNV Healthcare is the first new hospital accreditation competitor for The Joint Commission http://www.jointcommission.org in 40 years. The Joint Commission is the longtime leader in hospital accreditation in the United States.
Among the first hospitals to use this new Medicare accreditation program was St. Elizabeth Medical Center in Utica, New York. One compelling reason why St. Elizabeth used DNV to pursue Medicare accreditation was that it already held ISO 9001 accreditation and the DNV accreditation process enables hospitals to earn accreditation under both programs. Based in its successful experience with DNV and with ISO 9001, St. Elizabeth’s administrators and clinical laboratory managers expect to pursue ISO 15189:Medical Laboratories accreditation within the next two years.
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Sep 17, 2008 | Laboratory Management and Operations, Laboratory Pathology
In the United States and many countries around the world, primary goals for healthcare reform commonly center on better patient safety, improved health outcomes, and higher quality services. As clinicians in these countries actively work to achieve these goals, the clinical laboratories that serve them must respond to these efforts with appropriate lab tests and services.
Last week, Dark Daily Editor Robert Michel traveled to New Jersey to participate in a lab management meeting specifically organized to look at healthcare globalization and identify how this globalization trend is influencing clinical laboratory services. It was the annual meeting of the Customer Advisory Board (CAB) for the Pre-Analytical Services division of Becton, Dickinson and Company (BD) (NYSE:BDX) of Franklin Lakes, New Jersey. To foster productive discussion about globalization in healthcare and laboratory testing, BD arranged for presentations via teleconference from laboratory experts in India, South Africa, Belgium, and Mexico. Here are noteworthy points from each presentation:
INDIA: Healthcare services in this country are provided through government programs and the private sector. Annual spending on health is about US$37 billion. Government health services are delivered at the state level and India has 22 states. Experts identify the need for 896,000 more hospital beds in this nation and the private sector is responding to meet this goal. Because of the lack of healthcare resources in rural areas, telemedicine services are being pushed because it extends the reach of physicians and greatly increases their productivity. In the laboratory sector, there may be as many as 40,000 independent labs. Consolidation and acquisitions have created at least five major laboratory companies. There is a shortage of laboratory technologists. Phlebotomy is performed by medical technologists, each of who must have a four-year degree. Laboratory accreditation often involves an ISO standard and ISO 15189 is gaining favor.
SOUTH AFRICA: This government provides a minimum health insurance program to individuals who fall below a certain level of income. Above that income, private health insurance is the major source of healthcare. One challenge for the country is that it has at least 13 different races which are genetically unique. As genetic medicine advances, personalized services appropriate to these patients must be developed. HIV is a major factor in South Africa. Up to 90% of government health spending goes to HIV positive patients who undergo treatment for other health conditions. There is a shortage of pathologists in the public hospital sector of South Africa. Phlebotomy is done by trained nurses who attended college. Because it can take two or three days to move a specimen from some areas of the country, there is strong interest in point of care testing. (POCT). ISO 17025 is often used by private sector hospitals and laboratories for accreditation.
BELGIUM: As a developed nation with aging demographics, healthcare in this country faces many of the same challenges as the United States. Hospitals have their own laboratories and independent lab companies serve physician offices. There has been some consolidation of the independent lab sector. There is a shortage of both pathologists and technical laboratory staff in Belgium. Laboratories must be accredited with a quality management system (QMS) and ISO 17025 has been used. However, up to 20% of the nation’s laboratories are using ISO 15189 for their accreditation. Lean and Six Sigma is gaining wide acceptance and integrates well with accreditation under ISO standards.
Phlebotomy must be done only by physicians, nurses, and medical technologists.
MEXICO: Healthcare in this country reflects the extremes of wealth and poverty among the population. The government’s social security system provides minimum health benefits to everyone with a job. However, self pay and private health insurance play significant roles in the Mexican healthcare system. A national health priority is extending health services to remote areas of the country. There are still deaths from diseases such as cholera simply because individuals in these areas have no access to healthcare. Phlebotomy is done by nurses and medical technologists. Physicians do not draw blood in their offices, but refer patients to the collection sites operated by independent laboratories. Laboratory accreditation is mandatory in Mexico and ISO 9000 has been used. ISO 15189 is an option to meet accreditation requirements and growing numbers of laboratories are using ISO 15189.
Not surprisingly, everyone participating at the BD meeting on healthcare globalization was fascinated by the similarities and differences in healthcare and laboratory services in each of these four international presentations. Observation number one: Across these four countries, it was obvious that standards of care are tightening. Accreditation of laboratories is one example. In this regard, the quiet inroads being made by ISO 15189 in all four countries caught the attention of the American lab managers participating at this meeting. They recognized that other countries are moving rather rapidly to bring their laboratory services up to the level seen in developed countries.
Observation number two is that the adage “all healthcare is local” remains true. That was illustrated by the different national objectives. In India, use of telemedicine to support rural needs is different than in Mexico, where there are major efforts to create healthcare infrastructure in regions totally lacking any health services whatsoever. Similarly, In South Africa, meeting the health needs of so many HIV positive patients is the primary objective, whereas Belgium’s healthcare system is preparing to serve the many aging, but reasonably well-off individuals soon to reach their retirement years.
Further, it was pointed out that the demand for reliable and cheap point of care (POC) diagnostic tests by countries such as India, South Africa, and Mexico as a way to support rural care, would make these attractive and sizable markets for the IVD industry. Thus, more innovation in POC testing innovation is likely to occur first in those countries, rather than in the United States or Europe.
Your Dark Daily Editor,
Robert Michel
