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Panel weighs in on practices, pressures in heme labs

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October 2021—Rules, slide reviews, test ordering, and provider education were part of the conversation when CAP TODAY publisher Bob McGonnagle convened a hematology-focused virtual roundtable in late August. Workforce problems too: “We have a bigger exodus now and our pipeline is smaller,” said Eric D. Hsi, MD, of Wake Forest University.

With McGonnagle and Dr. Hsi were Natasha Savage, MD, Medical College of Georgia at Augusta University; Susan Behnke, MT(ASCP), MBA, Horiba Medical; Rachel Burnside, PhD, MBA, Beckman Coulter; Ken Childs, MBA, Cella­Vision; Ann Ludwig, MT(ASCP), Sysmex America; and Eeva Slattery, Abbott. Here’s what they had to say.

View CAP TODAY’s guide to hematology analyzers.

The last CAP TODAY hematology roundtable was two years ago, and those who took part talked about reducing the rate of the manual differential, new tests in hematology, new parameters within the differential, test ordering, and labor issues. Natasha Savage, can you tell us what your laboratory’s manual differential rate is and how much of that division is slides versus screens?
Natasha M. Savage, MD, medical director of hematology and hematopathology laboratories, Augusta University Health, and associate professor of pathology, Medical College of Georgia at Augusta University: We’re at 28 percent in our core laboratory. As far as technology-assisted manual differential versus nonassisted, I wouldn’t say we’re at 100 percent assisted, but we’re getting close to 100 percent because we use CellaVision in our core lab. This of course has reduced the tech time for a manual differential substantially—from approximately eight minutes to two minutes.

Ken Childs, tell us, generally, in the Americas at CellaVision, what is the range of images on the computer versus glass, in your experience?
Ken Childs, MBA, director, Americas, CellaVision: Laboratories, especially larger laboratories, typically do use CellaVision technology in order to digitize the slide and automate the entire hematology process to provide critical information more readily and quickly to the clinicians.

Knowing the diagnostic industry as I do, I’m somewhat surprised that CellaVision remains an independent company. Is that a coincidence or a desire of the Swedish owners?
Ken Childs (CellaVision): We are a small Swedish company and we have a unique market at this point. We are the leader and one of the only companies that does digital morphology for hematology. This is a small niche in our market, and there have been opportunities for other companies to come along and they have over the years, but CellaVision continues to be the favorite. It’s distributed through most hematology partners so it gives the customer the opportunity to consider automated morphology when they purchase their hematology systems. That’s the way we’ve operated for the past 15 years and the way we continue to do things today.

Slattery

Eeva Slattery, can you comment on some of the market factors you’re observing? What are you seeing that’s top of mind at Abbott in hematology?
Eeva Slattery, marketing director, global product and portfolio management for hematology, Abbott: We’re hearing from our customers similar dynamics to those discussed in the roundtable two years ago, especially workforce challenges. This includes technologists who have the skill set but are getting close to retirement as well as fewer individuals choosing to enter the laboratory profession and completing their training. That’s a big challenge for our customers, particularly in the less densely populated areas. We’re focusing on how we can meet that need in the workflow of our laboratories and how we can make it as easy as possible for labs with their current staffing level to provide an optimized workflow and get results out on time.

Susan Behnke, what’s top of mind for you at Horiba Medical?
Susan Behnke, MT(ASCP), MBA, senior marketing manager, Horiba Medical: Horiba Medical is a bit different than the other hematology companies. We go through distribution for all of our sales, and our focus is on the physician lab, secondary reference labs, and then, for the hospital market, on the critical access and rural hospitals. Their challenges are a little different than those of the city and other high-volume hospitals. There’s more near-patient testing. We work with a lot of individuals who may not have a four-year medical technology degree, so training is always top of mind to ensure the best specimen is run through the analyzer.

Ann Ludwig, two years ago, we talked about a barbell-type spread of testing, one side being near-patient testing in the clinics, whether independent or clinics that are part of large health care systems, and the other side being automated testing in core labs. How have we advanced in that line in the past two years? Would you say that dichotomy is becoming greater or lesser?
Ann Ludwig, MT(ASCP), assistant director of automation solutions, Sysmex America: We’ve experienced an even greater adoption of our broad portfolio of products, especially with the XN-L series. While we have great success in the reference lab and hospital market, it has taken off in the past two to three years in filling a gap in the smaller clinics, ERs, and satellite labs, where laboratory staff can enjoy the same reagents, technology, and software. Rotating their staff and training become a nonissue. Ease of use and flexibility and familiarity are driving that adoption.

Dr. Burnside

Rachel Burnside, I would imagine that your comments might lie very much in parallel with those of your colleague from Sysmex.
Rachel Burnside, PhD, MBA, senior manager, hematology product management, Beckman Coulter: They do, and I would mirror also what Eeva Slattery said about staffing challenges. With COVID, the focus has changed to more molecular-based testing, and technologists wear many hats. We’ve seen burnout among nurses and physicians, and I’m sure we’re seeing it in the laboratories as well. Some who are close to retirement are retiring, and other staff are earlier in their careers and don’t have the same skill set that the more senior staff have. So we as vendors want to make customers’ lives easier by providing them with workflow improvements and improvements on the automated differential to support that.

Eric Hsi, can you comment on the labor issue you’re facing as a laboratory director, and then generally as well?
Eric D. Hsi, MD, professor and chair, Department of Pathology, Wake Forest Baptist Health, and pathology enterprise service leader and academic chair, Atrium Health: Like everyone else, we are facing real pressure in terms of finding the right employees and talent because of the aging of the technologists. There’s definitely an element of COVID burnout. Some technologists are deciding that as they’re able to retire, now is not a bad time to do so. It’s only making some of the problems worse. Also exacerbating the problem are the many medical technology schools that have closed over the years. We have a bigger exodus now and our pipeline is smaller.

So we, like other places, are making a more concerted effort to partner with training institutions in our region to bring those technologist students into the laboratory for their internship so we can get a crack at hiring them. And we’re coming up with innovative ways to try to attract them into the program, including tuition forgiveness. And even earlier—generating programs that let students in high schools know there’s a career path in laboratories that they never knew existed. And then providing pipelines for phlebotomists—getting them in the pipeline and having them be able to progress along a career path. We’re starting to be much more intentional about developing programs.

Automation can only go so far. We still need experienced technologists and technicians to make the decisions and perform the higher-level functions. So we need as a community to publicize that there’s a viable career path for laboratorians.

Susan Behnke, with your particular market focus, are you also seeing these serious labor problems and the concern about having adequate staffing?
Susan Behnke (Horiba Medical): Absolutely. Everyone is wearing more than one hat and it’s always been a challenge but it continues. And after the past 18 months of COVID, some people are getting out of health care. They’re finding other career paths that better fit their family’s needs.

The HIV and hepatitis epidemics cut back on willingness to work in laboratories. Eeva Slattery, are you seeing any echo of that now in the COVID era?
Eeva Slattery (Abbott): Yes and no. We do see some concerns, but what’s also interesting is that we’re seeing more visibility about the career outside of the laboratory population. The importance of the role of the laboratory technologist was less apparent before COVID. So there’s a potential flipside that might be able to reignite the interest in this profession.

Natasha Savage, what are your thoughts about this labor problem?
Dr. Savage (Augusta University Health): I completely agree. We have been working on a significant number of openings for years, and it’s only been exacerbated by COVID. For a time we were working a platooning system in the fear that one group would become sick and pass it to the other lab staff members, which exacerbated the short staffing.

Like others during the pandemic, we had to validate numerous new tests and bring in new instruments to allow for COVID testing, so the already short staff got spread even thinner. We’ve been looking at ways to recruit more medical technologists. We’re thankful we have a medical technology program associated with our school, but it’s small and doesn’t fill all of our or statewide needs.

Another issue that’s a concern for everyone is cybersecurity. Rachel Burnside, does that concern reach into the hematology labs and the directors you know?
Dr. Burnside (Beckman Coulter): It absolutely does. Every time you’re going to contract with a customer, the sales team has to interface with IT. People are concerned not just about the security of their network but also the firewalls built into their systems, against ransomware or hacking, to maintain the security of PHI.

I have spoken to several people about laboratory budgets for next year, and it seems IT cybersecurity and labor are going to take an ever bigger share of whatever dollars we have to spend. Eric Hsi, would you agree with that?
Dr. Hsi (Wake Forest): Yes, I would. It’s unfortunate we have to spend a lot of resources on this when, in my view, it’s better spent on the testing and the technology. But it’s the world we live in. I’ve talked to colleagues whose institutions have been ransomware victims. It’s so disruptive, it harms patients, and it affects the whole health care system. And everybody is now taking it much more seriously and developing contingency plans.

Childs

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