The Pursuit of Value in Laboratory Medicine - Progress and Challenges

Abstract

The pressure on healthcare budgets including laboratory medicine is relentless and the focus on activities and costs remains the dominant funding model of laboratory medicine everywhere. The limitations of this model are well documented and for a decade or more laboratory professions worldwide have started looking at alternative models where the value of laboratory medicine and its impact on patient outcomes are the predominant driving force. There are multiple ways to determine the value of a medical test, particularly if one takes into consideration its impact upon the complete clinical pathway. Thus various approaches to value determination are being explored by a number of international organisations. These organisations will be reviewed below, including one which uses the concept of a value proposition that describes in detail how a test should be implemented by measuring its clinical, operational and economic impact. All approaches for determination of value require professional leadership. There is a need for research of varying types including that related to translating global evidence into local practice, a key challenge facing laboratory medicine and healthcare generally. Another challenge is to think and act beyond the silo of the laboratory to achieve greater collaboration with those colleagues more directly involved in patient care.

Figure 1

Complete process from biomarker discovery through test evaluation to adoption and implementation of routine testing.

Figure 2

Vitamin D test requests at an Australian pathology practice by month from 2014–2017.

Figure 3

Process of development of Clinical Decision Support (CDS) software for test requesters. (Supplied courtesy of Ken Sikaris, Sonic Healthcare, Melbourne, Australia.)