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Pathologists and population health—first steps

December 2018—Pathologists who want to become involved in population health initiatives can take five main steps, say pathologists and laboratory leaders interviewed for an article published online last month in Archives of Pathology & Laboratory Medicine (doi: 10.5858/arpa.​2018-​0223-CP).

In “The role of the pathologist in population health,” the authors report on the interviews they conducted and their review of the literature to answer several questions, among them whether pathologists in both large settings and smaller community-based settings can engage in population health (yes), and whether pathologists are in a position to analyze data for population health (“The data are there,” they say, “but getting to the data—and providing meaning out of it—is the hard part”).

One of the first steps to becoming involved in any type of population health management activities, the authors write, is to understand the philosophy of the institution’s CEO and senior management. How do they define population health and strategize its implementation, and do they view laboratory data as essential to their population health management goals?

In addition, understand your health care system’s landscape and the role of laboratory data within that landscape. If the health care system is part of an accountable care organization or regional health information organization, how are laboratory data sent and stored? Who can retrieve cloud-based data? If the system isn’t part of an ACO or RHIO, “how are data collected and stored across your institution and other institutions” within the system?

Also important: “[W]hat laboratory data inform the metrics for the value-based payment performance?” and what EHR systems does the institution use?

“Whatever the circumstance,” the authors say, “it is important to understand whether data are accessible across the hospitals of an enterprise or are limited to single institutions. It is also important to understand what information in your LIS is also in the EHR and what information remains only in the LIS.”

Second, ensure the integrity of the laboratory data by standardizing the data within the network, particularly if there are multiple EHR and/or LIS platforms in the organization. “Creating and maintaining a data dictionary that standardizes test names, units of measure, terminology, and associated coding systems across the enterprise will greatly simplify analysis when analytics are used to compare outcomes,” the authors write.

Third, make it clear to leadership that laboratory data are actionable and have analytic and predictive value. Focus on “the pre-preanalytics—the decision-making of ordering the right test at the right time—as well as the post-postanalytics—defining and deriving maximum value from analysis using laboratory data.”

Fourth, be proactive, even “intrusive” and “persistent,” according to the experts interviewed for the article. “Few administrators may initially reach out to pathologists unless pathologists have inserted themselves into the decision-making process,” the authors write, “not only of the data analysis but also of the overall population health program design and execution.”

Last, once an intervention is in place, demonstrate the success of that intervention and the role the laboratory data had in it.