LabMind

Most healthcare professionals are frustrated by the lagging progress of health IT. In an era when Google and Facebook seem to know every detail of our lives, why can’t health IT do a better job of predicting the information needs of patients and clinicians? Or even modify their data displays based on clinical context? One reason is the nonstandardized nature of most healthcare data. Pam Banning has spent her career making health data more usable through standardized terminologies such as LOINC and SNOMED. In this conversation she describes how far we’ve come using semantic interoperability over the past 25 years, and why we still have a very long way to go.

Thrombosis has turned out to be one of the major subplots of the COVID-19 clinical story. In this conversation, two experts in hemostasis and thrombosis explain how academic physicians and scientists have been studying the coagulation defects seen in patients with COVID-19 in order to more effectively monitor patients and prevent complications.

The SARS-CoV-2 virus was first identified and sequenced using a technique known as “unbiased sequencing.” During this conversation, Robert Schlaberg, MD, Dr Med, MPH, takes us inside this technology, helps us understand how it works, and describes how it can significantly improve infectious disease diagnosis. He also explores how scaling up this technology will catalyze a quicker diagnostic response to future pandemics.

Dr. Marc Couturier has experienced a number of pandemics during his career as a microbiologist, from West Nile virus to Zika virus to SARS-CoV-2 (COVID-19). And he knows what it’s like to work in both a commercial clinical lab and a public health lab. In this conversation, he describes how lab professionals from both these settings have been working in recent years to improve pandemic preparedness and response.

How do clinical laboratories report data to public health agencies, and what do those agencies do with the data? In this conversation Sam Marsden describes his experiences working in both the public health and clinical diagnostic arenas. He also dives into the critical role of public health agencies in gathering, analyzing, and applying data to improve the health of communities.

To manage and ultimately conquer COVID-19, the public is placing its hopes on rapid scientific discovery. What does it take to make this happen? Dr. Tracy George, executive director of clinical trials and PharmaDx at ARUP Laboratories, describes how her group is coordinating efforts across multiple outside research groups to facilitate faster and larger trials to answer important questions about COVID-19 therapy.

Antibody testing (serology) for COVID-19 has been eagerly awaited by the medical community and more broadly by our country's political and business leaders as we chart a path forward to ease physical distancing and the strain on our economy. Drs. Slev and Rychert have validated assays and platforms here at ARUP Laboratories. In this interview, they explain what clinicians need to know about COVID-19 serology, the inherent limitations of these tests, and the research data that's still to come.

Dr. Hardeep Singh is a general internist and authority on the various causes of diagnostic error. He argues that most diagnostic errors aren’t due to failures of complex reasoning, but rather failures of the routine processes we take for granted such as communication and followup of test results. His research focuses on improving organizational systems and processes, including those involving health information technology.

In this second segment, Dr. Mark Graber focuses on post-analytic errors and the need for more pathologist-clinician and pathologist-patient communications. He also emphasizes the importance of inviting patients to participate in medical societies and conferences. Finally, Graber delves into the 2015 Institute of Medicine (now National Academy of Medicine) Report, “Diagnostic Error in Health Care,” and its key messages for the laboratory community.

During Mark Graber's academic nephrology career, he became interested in bringing diagnostic error out of the healthcare shadows. Diagnostic errors occur more frequently than either surgical errors or medication errors, but they've received less attention from the patient safety community. In this initial interview, he shares personal experiences encountering diagnostic errors in clinical practice. We also discuss the central role of laboratories in addressing these problems, including where labs struggle and where the opportunities lie.