LabMind

Clinical laboratories were hit hard when COVID-19 erupted in the United States last spring. Labs scrambled to develop and ramp up COVID-19 testing while facing PPE shortages, the need to keep staff infection free, and sharp drops in revenue due to patients delaying routine care and elective procedures. In this interview, Dr. Jon Genzen, COO of ARUP Laboratories, describes a few of the many ways ARUP quickly and successfully adapted to this unfamiliar and challenging environment.

Despite what the general public seems to think, laboratory tests don’t just run themselves. They require an educated workforce of clinical laboratory scientists. Maintaining this highly skilled workforce is challenging, especially since few young people are even aware of the laboratory science career path. In this interview, Diana Wilkins and Takara Blamires share their experiences recruiting young people into the medical laboratory science program at the University of Utah, and Misty Smith explains the intricacies of recruiting for a national reference laboratory.

Antibody therapy, which encompasses convalescent plasma, hyperimmune globulin, and monoclonal antibodies, is an intriguing and potentially important component of COVID-19 therapeutics. In this conversation with Dr. Ryan Metcalf, director of the University of Utah’s transfusion services, we discuss the current thinking around convalescent plasma therapy and why we need more formal clinical trials of therapies for emerging diseases.

COVID-19 presented ARUP’s Family Health Clinic with two major challenges: First, find ways to safely continue delivering the full range of primary care medical and wellness services. And second, set up a comprehensive infection control and contact tracing program for ARUP’s approximately 2,500 on-site workforce members. In this discussion, Dr. Kathryn Gibson, medical director for the clinic, describes how she collaborated with staff from the clinic, Wellness Center, Safety department, and others to succeed on both fronts.

Primary care in the United States is in crisis. Fee-for-service payment models cause clinics to maximize the volume of visits, leaving doctors feeling like hamsters running on a wheel, and patients feeling rushed and ignored. Medical and preventive health needs are shortchanged, resulting in poor health outcomes and enormous downstream costs. A decade ago, Dr. Peter Weir decided to solve this problem for ARUP’s employees and their dependents. He took ARUP’s employee health clinic and transformed it into a full-service medical home, untethered from fee-for-service reimbursement. Not only is the clinic enormously popular with ARUP’s workforce and their families, but it also reduces ARUP’s overall healthcare costs.

Supply shortages, from collection kits to reagents to personal protective equipment, have been a major bottleneck for COVID-19 testing. Join the ARUP supply chain management team and me as we take you behind the scenes of clinical laboratory supply sourcing. Michael Bevan and his team describe how purchasing processes and vendor-supplier relationships have dramatically changed in the era of COVID-19, and tell you why those processes and relationships may never be the same again.

A lot of misinformation has been propagated about the FDA’s role in regulating laboratory tests. Some have advocated for FDA regulation of all lab-developed tests as “medical devices,” which could be a death knell for many of these tests and put a stranglehold on the laboratory's ability to respond to certain patient care needs. In this conversation with Dr. David Grenache, chief scientific officer for TriCore Reference Laboratories, he discusses why laboratory-developed tests play an important clinical role, how they’re currently regulated, and how to best modernize those regulations.

Crises such as COVID-19 have a way of compressing a lifetime of leadership preparation into a single intense performance. Dr. Julio Delgado has worked as a primary care physician, immunology researcher, laboratory director, and chief medical officer of ARUP Laboratories. In this discussion he explains how his philosophy of leadership, which is based on valuing and connecting with individuals, has been tested in the context of the COVID-19 pandemic.

Patients with autoimmune disease have faced some distinct challenges during the COVID-19 pandemic. These challenges include tough decisions about whether to stop their immunosuppressant therapy and difficulties refilling their regular prescriptions for hydroxychloroquine. Dr. Tracy Frech, director of the Systemic Sclerosis clinic at the University of Utah, describes how she's supporting her patients during this difficult time. She also describes her research collaboration with clinical laboratorians and other academic colleagues to find answers to key questions that are important for this patient population.

How much do we really know about the sensitivity of COVID-19 molecular tests? And how much sensitivity can be safely sacrificed in favor of assay speed or the ease of collecting a particular specimen type? David Hillyard has decades of experience developing and studying molecular tests for viruses, including HIV, hepatitis B, and hepatitis C. His lab was one of the first in the U.S. to develop and validate a high-throughput assay for SARS-CoV-2. In our conversation he explains the key factors that impact the accuracy of these tests, what we know so far, and what we still have to learn.