Henry Ford Health System worked with clinical and information technology leaders to eliminate standing orders for daily laboratory tests in the EHR.
Across Henry Ford’s five hospitals, C-suite executives understand the value that their laboratories provide, says J. Mark Tuthill, MD, division head of pathology informatics at Henry Ford Health System, Detroit. However, “many organizations tend to see the lab as more of a cost center and don’t understand the strategic opportunities they have in the laboratory,” Tuthill says. “Because so many clinical decisions are based on laboratory data, organizations have a huge opportunity.”
Tapping the Lab for Value-Based Care
Tuthill believes laboratories can support overall objectives to improve patient outcomes and reduce costs. For example, Henry Ford maintains a task force focused on resource utilization and optimization. The task force includes leaders from all clinical departments, spearheaded by pathology and laboratory medicine.
One of the task force’s early initiatives has been working with clinical and IT leaders to eliminate physicians’ ability to create a standing order for daily laboratory tests in the electronic health record (EHR). Tuthill says this strategy to reduce unnecessary testing will save Henry Ford more than a million dollars annually.
To curb other types of wasteful testing, leaders at Henry Ford use tools to track utilization trends. Specifically, they can identify clinicians who may order unnecessary tests. Such technology also helps support pay-for-performance initiatives, which have been in place at Henry Ford for more than a decade. Under these arrangements, physicians are incentivized to follow evidence-based protocols associated with the best clinical and financial outcomes. Technology provides clinician warnings and allows leaders to monitor ordering down to the provider level. “We want payers to recognize the value that we bring,” Tuthill says.
In addition, leaders at Henry Ford are exploring precision diagnostics technology that helps physicians match patients to therapies based on their genetics. By identifying which patients are most likely to benefit from specific treatments, leaders hope to improve outcomes, reduce complications, and lower costs, Tuthill says.
Using the Lab for Clinical Integration
Leaders at Henry Ford also have been focused on laboratory outreach initiatives to provide for-profit laboratory services to physician groups that are not aligned with Henry Ford. Such outreach helps drive physician alignment and, ultimately, clinical integration efforts, Tuthill says.
“As physicians start to use laboratory services, they become familiar with the health system and become interested in using other aspects of it,” he says. For example, they might be more inclined to refer their patients for imaging tests or to use the surgical suites for patient procedures.
Today, Henry Ford is using an IT tool in conjunction with its laboratory information system to improve integration with physician offices. For example, the tool helps offices vet patient insurance and print transport information, such as individual site shipping manifests, to make sending samples to the laboratory more efficient.
John Spinosa, MD, PhD, a pathologist at Scripps Memorial Hospital, La Jolla, Calif., agrees that laboratories can help align physicians and set the stage for clinical integration efforts. “Of all the services that a health system provides, laboratory services are probably the one service that is in most physician offices,” says Spinosa, formerly chief of staff at the 357-bed hospital, which is part of Scripps Health, San Diego. “So the touch point of a laboratory is expansive for employed and independent physicians.”
Focusing on Laboratory Technology
Leaders at Scripps Health spent more than two years moving their hospitals’ laboratories to the same technology platform.
“We went through a fairly arduous process to get to an integrated laboratory network,” Spinosa says. “At the time, we had five hospital labs but two different parallel laboratory information systems and two different surgical pathology information systems. Most of the initial effort was to get us on a single platform and develop a core laboratory that could take control of low-volume [infrequent] testing and develop outreach laboratory capabilities.”
Integrating different systems required leadership buy in from the start. “We had to understand what we wanted to accomplish and why, including the financial reasons for integrating systems,” Spinosa says.
At Henry Ford, leaders leverage one laboratory information system to store and manage data for clinical laboratory services across all hospital laboratories. They also use one anatomic pathology software platform to analyze and share data on patient specimens and manage departmental staffing and billing issues.
One of Henry Ford’s current projects is building out its analytics capabilities to help support the health system’s population health management strategies and allow physicians to target at-risk patients. “We are just starting to look at this in a more sophisticated way,” Tuthill says.
For example, laboratory leaders have extracted data from their laboratory information systems to create a data warehouse that will allow them to use analytics to identify patients that may be at risk for chronic diseases like diabetes. “Right now, we are using a lot of ‘elbow grease analytics’ to look at outcomes,” Tuthill says. “This has driven us to fund more automated analytic solutions because we already see the value.”
Learning from Experience
Spinosa and Tuthill offer the following advice to organizations looking to tap their laboratories to meet strategic goals.
Create a governance structure to lead laboratory initiatives. Henry Ford’s task force has created a formulary of accepted lab tests, which reduces unnecessary utilization.
Find physician champions in each department. Physicians in surgery, family practice, and other areas can help pilot projects that provide early wins, Tuthill says.
Reach out to lab leaders. “Pathologists tend to believe they are underappreciated assets in a hospital,” Spinosa says. By demonstrating a willingness to partner with them, finance executives may find new allies.
View the lab as a partner in managing at-risk patients. “Lab testing can find undiagnosed patients who are at risk of becoming expensive patients,” Spinosa says. He points to patients with diabetes and liver and kidney disease. “This can help prevent people from falling through the cracks and prevent progression to more advanced disease.”
Sharing a Vision
“Laboratory leaders should work with executives to bring solutions to light,” Tuthill says. “Working across silos can help us improve outcomes and avoid developing parallel programs that can lead to competition or other challenges.” He recalls his laboratory’s effort to build its precision diagnostics capabilities at the same time the health system’s cancer center was developing its precision medicine center. “Executives were thinking about using diagnostic capabilities from outside the organization before they realized our laboratory could provide these services in-house,” he says. “It just took some communication to get everyone in the same boat and realize we were working on the same goal.”
Interviewed for this article:
J. Mark Tuthill, MD, is division head of pathology informatics at Henry Ford Health System, Detroit.
John Spinosa, MD, PhD, is a pathologist at Scripps Memorial Hospital, La Jolla, Calif.