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September 2024—The ADLM meeting in Chicago had just wrapped up when Compass Group members met online Aug. 6 with CAP TODAY publisher Bob McGonnagle. Stan Schofield, Compass Group VP and managing principal, noted Allina Health had announced in late June its definitive agreement with Quest Diagnostics for select assets of Allina’s laboratory services business, and Schofield reported plenty of M&A talk at the ADLM meeting. The group’s August discussion began there and moved to laboratory-developed tests and cybersecurity.
The Compass Group is an organization of not-for-profit IDN system laboratory leaders who collaborate to identify and share best practices and strategies.
The ADLM meeting seemed to have more vibrancy and energy than any meeting since the pandemic ended and had a great number of people interested in M&A activity, certainly in terms of technology.
Geisinger was Risant Health’s first acquisition. Diana Kremitske of Geisinger, what can you tell us about Cone Health and Risant Health having recently signed an agreement under which Cone will become part of Risant?
Diana Kremitske, MS, MHA, MT(ASCP), VP, Diagnostic Medicine Institute, Geisinger, Danville, Pa.: It is going through the regulatory process. Cone Health signed a definitive agreement with Risant on June 21 to become the next participating health system. Cone Health is smaller than our organization. It has more than 13,000 employees, four [acute-care] hospitals; we have 23,000-plus employees, eight hospitals. It’s my understanding that its health plan focuses on Medicare Advantage.
Sterling Bennett, what do you think of the Cone Health announcement? I realize it’s early innings but it underscores the seriousness of what Kaiser Permanente is about.
Sterling Bennett, MD, MS, senior medical director, pathology and laboratory medicine, Intermountain Healthcare, Salt Lake City: I agree with that assessment and I’m sure Cone Health is one of several, if not many, to come.
Prime Healthcare in California announced at the end of July that it’s acquiring Ascension’s nine hospitals in Illinois. Guillermo Martinez-Torres, Ascension, after having built an empire, continues to be giving the empire back to other owners, isn’t it?
Guillermo Martinez-Torres, MD, president and chief physician executive, NorDx, Scarborough, Me.: Some in the pathology laboratory space within Ascension seem to welcome this move. We saw something similar in Michigan where they took half of the ministry and passed it on to Henry Ford.
Dwayne Breining, Abbott had a good session at its ADLM booth with Jim Crawford [former pathology chair at Northwell] talking about hanging on to your laboratory. Any comments about the meeting?
Dwayne Breining, MD, executive director, Northwell Health Laboratories, New York: I participated in a session in which we talked about the hidden value of having an integrated laboratory in your health system. One of our Northwell executives shared a few things we went through that we wouldn’t have been able to handle had we not had our own lab. Of course COVID was one example, but also one of our hospital labs flooded a few years ago and we kept the lab running and relocated it ourselves—things you could never do if you outsourced it. It was nice having a hospital executive speak and answer questions from their perspective.
Everyone is still talking about the FDA lab-developed tests final rule and what it will ultimately be. I had many conversations about AI and ideas for AI implementation, but not many implementations as of yet. Everyone is thinking about it and it’s cooking.
Moira Larsen at MedStar Health, what’s top of mind for you?
Moira Larsen, MD, MBA, physician executive director, MedStar Medical Group Pathology, MedStar Health, Columbia, Md.: Top of mind continues to be LDTs. We seem to be in a holding pattern but it’s not stopping us from making lists of our LDTs and making sure we have procedures in place so we can fulfill the documentation requirements on the required schedule, just in case.
We are exploring the world of digital pathology and AI and trying to move forward into being a single practice with nine locations. We’re trying to leverage our subspecialty expertise and be able to deal with consolidation of anatomic pathology laboratories. We’ve already done that in Baltimore; we have one lab for four hospitals. Digital pathology is important there. Right now we’re driving glass all over the city. We’re undertaking further consolidation or growing our outpatient business. We need to find something that is less manual, so digital pathology is something we’d like to start soon.
Cone is one of the great health systems in the country but obviously needed support. Dan Mumm, tell us your thoughts on the news.
Dan Mumm, president/GVP, ACL Laboratories, Advocate Health, Charlotte, NC: The financial bottom lines of many health care organizations are not doing well, which lends itself to mergers and acquisitions.
We’re branded Atrium in the Charlotte, North Carolina, region, where there’s extensive growth. Novant is a player in that market, but Atrium is dominant in that region in terms of inpatient admissions and ambulatory visits.
Harbin Clinic in Georgia recently became part of Atrium Health Floyd. It’s not large as far as mergers go, but it is for Floyd and the city of Rome, Georgia. We’re going to see this more and more and maybe in five, 10 years, there won’t be so many health care organizations and it’ll be down to five or seven national organizations. So, buckle in.
I’ve watched Ascension struggle in the Wisconsin and Illinois regions, and the malware attack did not help them.
You’ve raised an important issue with cybersecurity. Laboratories seem to be vulnerable—if your laboratory system and EHR shut down, you’re reduced to some terrible things. Are you devoting ever more resources and time to cybersecurity?
Dan Mumm (Advocate): Yes. Our LIS is completely dependent on our two instances/versions of Epic; one serves the Midwest and the other the Southeast. We dedicate significant resources and time to business continuity if our primary systems are shut down. Our IT is a corporate department and our CIO is always worried about cybersecurity. Lurie, Ascension, and OneBlood were all recent targets of ransomware attacks, and the effects are devastating.
We’ve learned that these bad actors don’t care about patients. They’re going to go for the money and hold the systems and data hostage until the systems pay up. Typically the companies will pay the bad actors and it’s still 30 to 40 days later before they come back online. It’s a big concern. Nowadays one has to have the mentality of when it’s going to happen to you, not if it will happen. It’s difficult to keep large systems safe.
Greg Sossaman, what is your take on cybersecurity? Will we be in an endless spend with cybersecurity? Epic is well regarded for its offering here, but they don’t have a blood system. Was this brought up when you were a part of the Clinical Laboratory Improvement Advisory Committee or in other groups?
Gregory Sossaman, MD, system chairman and service line leader, pathology and laboratory medicine, Ochsner Health, New Orleans: Not in CLIAC but we’ve recently had a work group focused on cybersecurity that involved the lab early on, along with radiology, Epic, and others. They’re still dependent on our systems, integral to all the functions of the system. They brought us in early to look at cybersecurity and said just what Dan said—it’s not a matter of if you’re going to have a cybersecurity breach that affects the system but when.
We’re going through workflows and looking at how we can go to more manual workflows. Where are the biggest points of vulnerability? It’s an extensive preparation, very different than preparations we’ve done around natural disasters.
Having central IT in the systems, as opposed to IT that’s dedicated to the lab, cuts against more awareness in the lab. But once it hits it’s devastating, isn’t it?
Dr. Sossaman (Ochsner): That’s right. Then you’re dusting off all the more manual downtime procedures and hoping people still have fax machines and other ways of getting your lab results. If you’re not prepared ahead of time, there’s no way to do it once the emergency strikes.
Wally Henricks, how are you doing with cybersecurity at the Cleveland Clinic?
Walter Henricks, MD, vice chair, Department of Pathology and Laboratory Medicine, and laboratory director, Cleveland Clinic: We’re doing well overall. We have a vigorous cybersecurity presence. We’ve worked aggressively with our cybersecurity team and know what the expectations are, and we build that in. Our pathology informatics team has been more integrated into the enterprise central IT team since we integrated Beaker into our systems. My successor as medical director of pathology informatics has developed strong partnerships with IT leadership, including the cybersecurity team leadership. The lab is much more on their radar.
All departments across our organization are asked to prepare for business continuity, including for the effect of a cybersecurity attack. We review that every year. The most seemingly mundane things are the biggest deals—fax machines, printers, paper, and labels. How are you going to get specimens from the ED to the laboratory, and what if you have to run results back? Trying to do seemingly simple tasks at scale is not easy, so how do you prioritize? How do you get at least your basic equipment?
Tony Bull, do you have a comment about cybersecurity?
Tony Bull, system administrative officer, pathology and laboratory medicine, Medical University of South Carolina: When we bring in new equipment, new systems, we have to put it through a security review with IT. That’s standard. It slows things down a lot.
We’ve asked for a review of our point-of-care wireless system to make sure there aren’t vulnerabilities. I’m almost afraid to say too much about feeling good about where we are because many people felt they were in good shape and then got hit with ransomware. I never feel comfortable about it.
As you think about dealing with vendors across the spectrum—instruments, IT, connectivity—are you thinking about increasing the understanding about indemnification or guarantees from those vendors? Or are we not there in terms of how we deal with vendors?
Tony Bull (MUSC): We’re not there yet. It opens a can of worms. It’s part of the reason for the security review—to make sure minimal security guards are included.
Give us your take on LDTs as of today.
Tony Bull (MUSC): I want to see the lawsuit be successful. We’d like to see this rolled back. We are preparing, though, to be ready for these rules. We’ve almost completed an inventory of our LDTs. We’re checking on whether our incident reporting software will meet FDA requirements. It would be fantastic if that were the case and less disruptive for us. If not, we’ll have to find another system.
Joe Baker, what’s top of mind for you in Dallas?
Joseph Baker, VP of diagnostic services, Baylor Scott & White Health, Dallas: We’re going live in mid-September with the largest single-day Epic implementation of Beaker ever done.
The CrowdStrike outage impacted us on many fronts. We look at it as a gift in that it highlighted where we have gaps, and we’re taking the opportunity to reassess and develop resolutions.
Where are you now with your LDTs? I know you have quite a few in your system.
Joe Baker (Baylor Scott & White): We do. We have taken inventory of them and are also hoping the lawsuit is successful because we know the challenges it will bring operationally. We have plans in place and are hoping for the best.
Ericka Olgaard, what’s going on at the University of Florida?
Ericka Olgaard, DO, MBA, clinical associate professor and vice chair for system integration, Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine: We’re working hard on utilization with blood cultures now because of the shortage of bottles. We have great partners with our infectious disease group, which has been working hard to make sure we’re utilizing them properly. We have not run out yet.
Tony Bull, how is your blood culture bottle supply?
Tony Bull (MUSC): The blood culture bottles are a serious issue for us. We’ve implemented strict guidelines for providers who order testing. We’re trying to mitigate it as best we can. It looks like straightening out the shortage will take a while.
This has become a nationwide problem, hasn’t it? Stan Schofield, can you comment on blood culture bottles?
Stan Schofield, VP and managing principal of the Compass Group: Reports are the shortages are caused by supply chain issues with the components and materials used to manufacture the bottles. I have heard additional comments in the industry that the FDA has concerns and is investigating the shortages and manufacturing processes.