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Compass on ‘consumerizing health care’ and more

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June 2022—What stood out among all that was seen and heard at the Executive War College? Compass Group members who were there answer CAP TODAY publisher Bob McGonnagle’s question in their early May virtual get-together, shortly after the War College took place. Here’s what they and other lab leaders said about retail lab testing, digital pathology and artificial intelligence, and their plans for the future.

The Compass Group is an organization of not-for-profit IDN system laboratory leaders who collaborate to identify and share best practices and strategies.

Many of you were at the Executive War College, as was I, and I want to share this perspective from the meeting. We have a lot of new lab participants and many of them were there to do deals or learn more about opportunities they could get or fit into. I saw an emphasis too on retail testing, point-of-care testing in pharmacies. Greg Sossaman, what struck you at the War College?
Gregory Sossaman, MD, system chairman and service line leader, pathology and laboratory medicine, Ochsner Health, New Orleans: There was a focus on the strategy for some of these new players. Truvian was one of the companies that presented its point-of-care device, which was interesting. I think in this post-Theranos world there will be a couple of players that come out with a device that works in a clinic-type setting.

There was also a focus on artificial intelligence as it pertains to digital pathology but also other areas, perhaps AI in conjunction with some of these new, smaller devices that could be put in a clinic. There was a newer focus on data and artificial intelligence or computational pathology than I have seen before. There were interesting discussions about anatomic pathology and as it evolves more toward automation and pairing of digital pathology and computational pathology. I’m going to see how those fit in our strategy.

Bull

Tony Bull, did anything at the meeting strike you?
Tony Bull, system administrative officer, Pathology and Laboratory Medicine Integrated Center of Clinical Excellence, Medical University of South Carolina: It looks like decentralized routine testing is starting to come to fruition, and I’m trying to understand what the impact will be and how it will affect our laboratories. I’ll be interested to see how it bears out and if the promises are met or if we find it has limitations.

Dwayne Breining?
Dwayne Breining, MD, executive director, Northwell Health Laboratories, New York: The era of digital pathology is upon us. We’re entering into it full steam ahead. COVID drove a lot of that with the demands for people to stay out of the office.

Dr. Breining

The other thing at the War College that struck me is the disruption and displacement by other players, and by that I mean chain drugstores like CVS, Walgreens, Rite Aid. There seems to be infrastructure going up, putting clinics next to retail pharmacies.

In New York we’ve been seeing a trend away from the classic primary care providers, your family doctor, and more into urgent care, episodic care, you don’t touch health care until you think you need it and you don’t have loyalty to anything. We have to keep a close eye on how that drives testing, and the big pharmacies will want their part of that, too.

Stan Schofield, do you think the momentum toward more point-of-care testing and testing distributed in a region is a pipe dream or is it becoming a reality where you operate in Maine?
Stan Schofield, president, NorDx, and senior VP, MaineHealth: It’s not a pipe dream. It’s happening in large, concentrated cities with high population densities and younger populations. Younger people tend to not have an affinity or an allegiance to a system, and they go when they want something. They want it now and they want it convenient.

Urgent care or walk-in clinics are here, but the drugstores are not taking over anything yet. Our population is still either government paid or you have insurance. There’s a lot of resistance to out-of-pocket payment for services. The younger generation probably doesn’t have that reluctance, but the older population and higher users of these services probably do. Drugstore testing is infrequent here, but I’ve seen it around the country and people I talk to say it’s growing and gaining traction. We’ll be one of the last ones. We have urgent care that took 10 years to get here—after everybody else had it. Drugstore testing will be five years after everybody has it, or at least in terms of it being used frequently and consistently.

The population is driving this because access to primary care is hard. You can’t get in to see a doctor quickly, and when people have something, they want to take care of it. To use urgent care centers with insurance, the deciding factor is the out-of-pocket expense, and that’s going to separate early adopters from later on in this cycle of evolution, at least in my region.

Pete Dysert, Dallas has a lot of socioeconomic diversity—is this a strategic consideration at Baylor Scott & White as you plan for the future?
Peter Dysert, MD, chief, Department of Pathology, Baylor Scott & White Health, Dallas: Our overarching strategy is defined around consumerizing health care. The success of our Epic app and people’s ability to communicate when everything was shut down has built a strong constituency who likes that platform. Anything our system decides is strategically related to supporting the consumer is something we will be asked to figure out.

Our lab-initiated strategy is to be an observer as the forces in the community work these issues out and as the role of the primary care network versus an app-based approach to accessing care works its way through our system.

If you were to learn that a Quest or a Labcorp or a Sonic were planning to put a large network in pharmacies or groceries in the Dallas area, do you think it would be a precipitating event for Baylor to be more active to counteract that competition?
Dr. Dysert (Baylor Scott & White): Yes, we’d take notice of that. The pressure would arise from our primary care doctors as their patients start to demand the convenience of accessing those services over having to come to the doctor’s office. We recently offered in-home immunizations, as one example, through the app, to save people time and play on the convenience of our services.

Wong

Dhobie Wong, how is Sutter viewing this?
Dhobie Wong, MBA, MLS(ASCP), CLS, VP of laboratory services, Sutter Health, Sacramento, Calif.: We have full-service labs within our foundation setting, and we are exploring that model. There is heightened demand for more access to test results, receiving results more rapidly, especially in oncology. We’re determining the cost-benefit analysis. Does it make sense to decentralize our testing? What testing is absolutely needed in the outpatient physician setting?

Have you thought about adding rapid testing capability in your patient draw centers?
Dhobie Wong (Sutter Health): We have some testing available in our outpatient setting, including full-service lab tests. Several are co-adjacent with urgent cares, so we can provide some level of rapid testing for our patients and physicians. We are evaluating that model—the cost, decentralization, equipment, redundancy.

Wally Henricks, talk about digital pathology in AI or this question of should we do more distributed testing, and perhaps we need to because we can’t afford to lose patients from the system.
Walter Henricks, MD, vice chair, Pathology and Laboratory Medicine Institute, and laboratory director, Cleveland Clinic: We’ve implemented self-swabbing capability and are looking to expand it. We’re pursuing more rapid testing at acute care centers so it can be done in one place. We expanded and enhanced point of care at those outlying centers. In the future we’ll look at more frequent courier service and improvements in logistics.

Regarding AI, there’s justified excitement and at the same time there’s much hype. Hooman Rashidi, MD, recently joined us and is directing and developing a new Center for Artificial Intelligence and Data Science in Pathology and Laboratory Medicine. Dr. Rashidi had done a lot of innovative AI work at UC Davis and developed an AI platform. He’s going to champion our program regarding applications of machine learning and artificial intelligence in pathology. We think there are opportunities to drive outcomes.

There are a lot of unknowns for laboratories regarding AI and machine learning. What regulations or guidance will apply to labs using these tools? The FDA is actively looking at these. Laboratories might contribute to the rigor of validation of AI/ML tools. We are used to doing that and are tuned in to how to analyze test validation, test performance, and other data. Pathologists and laboratories are well suited to ask good questions about the foundations on which these algorithms are built. Another question is the extent of lab and pathologist responsibility. If the result or interpretation ends up in a CLIA-type test report, then that’s one level of responsibility. When lab values already reported by a lab are used in some other AI algorithm that incorporates clinical or other data that are outside the purview of the lab to generate an output, it’s a different level of oversight responsibility.

We see great opportunity. But what the value is for the investment needs to be looked at rigorously, just like digital pathology in its early days.

There’s discussion about the use of AI in infectious disease and some therapeutic drug monitoring. It’s not restricted to surgical pathology.
Dr. Henricks (Cleveland Clinic): We have active efforts in both anatomic pathology and laboratory medicine. AI is not only about digital imaging, and it will be applied to non-image data sets familiar in clinical pathology.

Sterling Bennett, one of the conversations at the War College in a session on AI in surgical pathology was how many institutions are being advised to credential their pathologists in many states or are doing it on their own, almost as if they were a national AP laboratory. Is that happening at Intermountain?
Sterling Bennett, MD, MS, senior medical director, pathology and laboratory medicine, Intermountain Healthcare, Salt Lake City: As the Intermountain footprint grows in seven states and looks at a fully integrated pathology service, it’s important for our pathologists to be credentialed or licensed in many states. One of the advantages in digital pathology is we can more readily use the subspecialty expertise among our pathologists. To use it fully requires they be credentialed in multiple institutions and licensed in multiple states, and that will open the door to more use of AI.

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