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    Dr. Jane Dickerson

    Lab Stewardship: Where the health system, payer, and patient all benefit from success Interview with Dr. Jane Dickerson

    Global Impact: Rebecca Rock, RN and SABM CFO talks with HPI about two roles across two countries

    From Lab Trend Visionary to Dark Group CEO: HPI connects with the Founder and Editor of the Dark Report, Robert Michel

    Two Imaging Leaders, Two Systems, One Outcome: Communication

    From Communication Strength to Just in Time Reopening at MGH A conversation with Dr. James Brink, Chief of Radiology at Massachusetts General Hospital

    From Time Magazine to PBM Influencer: Sherri Ozawa's Mission to Define the Value of Blood

    Buried Blessings: Pandemic perspective from Tom Strauss, CEO at Sisters of Charity Health System

    Katie Castree, Career Healthcare Process Improvement Connoisseur

    Solving Lab Challenges through Recruiting Innovation: HPI connects with Lighthouse Lab Services President, Jon Harol

    Providing Value-Based Care in a Pandemic through Telehealth and Data Resources: An HPI exclusive with Dr. Darrel Weaver

    From Supply Chain Crisis to Innovation in a Pandemic

    From Navy Medic to running a Clinical Laboratory . . . during a pandemic

    Planning for Blood Shortages in a Pandemic with Dr. Claudia Cohn

    Blood Banking is more complex today than ever before. Rob Van Tuyle, President of Vitalant's Blood Division, tells us why.

    Profoundly Impacting Healthcare with Breakthrough Anemia Management

    Supporting Imaging Precisely Where You Need It

    Working Together Makes End of Life Conversations Easier to Have

    The Future of Imaging: Assessing the early impacts of COVID-19 and the path to innovation through Artificial Intelligence (AI) A conversation with Dr. Geoff Rubin

    Pivoting in a Pandemic: How a U.S. 3D printing manufacturer is helping healthcare in its time of need

    Mara G. Aspinall: Diagnostic evangelist educating the world on the power of diagnostics today

    How The Joint Commission is addressing the COVID-19 Pandemic

    CHI Nebraska’s Laboratory Director Connie Wilkins, describes How To Manage a Clinical Laboratory During the pandemic

    Former Commercial Lab Leader Highlights the Hospital Lab as the Solution to Community Sustainability in a Healthcare Crisis

    Three Phases Essential to Crisis Preparedness in Patient Blood Management with Anne Burkey of St. Luke's Health in Boise, ID

    The Importance of Agility in Your Lab

    Dr. Paul Biddinger Shares Three Ways to Prepare for COVID-19

    Bringing Clinical Skills to Operational Leadership During a Time of Crisis; Dr. Blanton, Chief Medical Officer at Peterson Health

    7 Team Attributes to Teams that Work in Challenging Times & Through Rapid Innovation

    From Finding Problems to Saving Lives: The Evolution of Interventional Radiology

    Identifying the Potential with AI in Radiology with Dr. Chung

    Communication in the C-Suite with Cliff Robertson of Catholic Health Initiatives

    Reviewing Your Patient Financial Journey with Melody W. Mulaik, President of Revenue Cycle Coding Strategies

    Ask An Accumen Expert: Carolyn Burns, MD, a Patient Blood Management Advocate

    Linda DeVee, Leads Radiology Services at Edward-Elmhurst Health

    Theresa Mouton, Market Chief Financial Officer with Steward Health

    PELITAS President and CEO Steven Huddleston Wants Patients to Have a Great Experience – Both Clinically and Financially

    How Do You Deal with 2 Billion Forms a Year? Ask Randy Campbell

    Medical Director of Telehealth for UAB Knocks Barriers Down to Treat Patients on Their Terms

    C-Suite Spotlight: Wayne Bohenek Chief Ancillary Services Officer, Bon Secours Mercy Health

    A Leader in the Laboratory Service Line : Pierre Mouawad

    Healthcare Partner: Autumn Farmer, Chief Laboratory Officer, Bon Secours Mercy Health

    How Imbio is using AI to close the gap of missed diagnosis with Mike Hostetler

    Spit Matters with Bill Phillips from Spectrum Solutions

    How COVID-19 inspired TeraRecon to accelerate their imaging solutions to the point of care with Jeff Sorensen

    There are multiple names for lab utilization programs today: test utilization, lab utilization, and lab stewardship to name a few. They all support the same goal, but each word communicates a slightly different message in a world and time where words matter. HPI connected with Dr. Jane Dickerson, Director of Chemistry, Director of Reference Lab Services, and the Medical Director at the North Clinic at Seattle Children’s Hospital, and Clinical Associate Professor, University of Washington, Department of Laboratory Medicine. She weighed in on the topic, sharing her affinity for the word stewardship as it communicates a feeling of being on a team, with a shared responsibility to manage a limited resource which she quickly notes has never been more true than right now.

    Laboratory stewardship has two main stakeholders – the most important being the patient. When someone goes to get a lab test collected, they know that the lab result is going to impact the clinical decision making of their care team. They expect everything to go well from the beginning to the end. Unfortunately, we know that errors happen – not just in the lab. It is very hard sometimes to select the right test, to interpret a complicated test result or to even get the result back in a timely fashion. The communication of these reasons – test selection, interpretation, retrieval of lab results – are often the biggest causes of lab related litigation and ultimately patient harm. Laboratory stewardship programs put a bubble around this process, helping providers select the right tests, make sure that the interpretations are clear and visible, and facilitate timely retrieval of those results back to the care team and the patient for the second stakeholder, the healthcare system. Health plans are also invested in this process. They want to optimize the value of lab tests as well, paying specific attention to quality and cost. Stewardship programs can qualify the over/under and miss utilization of lab tests as well as the bottom line, including how much money the patient will be responsible for versus how much money the system is going to absorb. This information and analysis are becoming more important as healthcare institutions continue to find themselves balancing crisis alongside the need to provide care. We asked Dr. Dickerson to share the key drivers, even in pandemic times, of starting and maintaining a thriving lab stewardship program.

    Limited Resources
    Labs have struggled to have the right supplies to perform lab tests, long before COVID-19. Shortages for everything from tubes to reagents, on top of limited staffing to keep up with demand. Clearly not prepared for a pandemic, many hospitals have had to redeploy staff specifically for COVID testing, which comes at the continued expense of other lab testing. While we scramble to meet the critical testing needs across the country, the already limited budget is being compounded with furloughs, capital equipment or hiring freezes, and medical or executive leaders taking on a larger role in managing lab testing because of COVID-19. The lab has never been more prominent than it is today, providing a stewardship program a unique opportunity for visibility. If you need something, now is the time to ask for it. At a minimum, get an informatics resource to create a COVID-19 dashboard. You can then apply that resource to other tests as we slowly gain a capacity to think about other things.

    Success starts with culture
    Success has a lot to do with the culture of your institution and culture is no doubt shaped by leadership. Dr. Dickerson suggests engaging a few high-level stakeholders in the beginning of your program to create a few hospital wide policies. If those members can’t attend regularly, having them peripherally involved is still helpful because they remain an effective champion in driving change. This might be a person in the lab, a physician leader or executive from the hospital administrative side. The key is their support early on in providing data to the program, to identify, monitor and maintain the interventions put in place. Then, on an as needed basis, begin inviting service line leadership. For example, if you’re talking about genetic specific testing or gastroenterology, not everyone needs to be there. Dr. Dickerson is firm in pointing out that a program does not automatically need to have 30 people at the table – you can do a lot with a small group who’s committed.

    Success continues with clear goals . . . and expectations
    Dr. Dickerson continues, recognizing that success will look different depending on the institution and program goals. I think it’s key to have realistic expectations going in and celebrate small wins. These may be as simple as getting a few key policies through the system that didn’t exist before or finding an intervention that’s measurable that doesn’t take years to get consensus on. Basically, something that’s not controversial that everyone can agree on and doesn’t require a ton of resources from the outset. Then, over time, you use those small wins to gain traction, get known within your institution, and subsequently be able to ask for more resources.

    Success persists when you engage external resources
    There are external resources available as well for hospitals or health systems starting a stewardship program. Dr. Dickerson emotes gratefulness as she describes the lab community as “sharers”. There are really no shortages of resources that you can find. I think one of the more publicly facing resources is of course Choosing Wisely (www.choosingwisely.org). They have a lab section with guideline templates and clinical lab standards for laboratory stewardship and utilization. Then of course, there’s PLUGS: Patient-centered Lab Utilization Guidance Services. PLUGS has its own national lab stewardship committee that has put together guidelines and resources you need, including the people you need at the table and a checklist to easily identify areas that are lacking or need more support.

    PLUGS is a nonprofit within a nonprofit within Seattle Children’s Hospital Department of Laboratory. The organization was formed in 2012, when genetic testing was taking on a life of its own. The initial mission was to provide guidelines for these new tests to ensure they were the right tests to best diagnose or inform a patient’s care. A few years into their work, they realized that all institutions shared the same questions, applied to all laboratory testing. Today, with an expanded mission, PLUGS is a network of over a hundred like-minded organizations that share experiences, interventions, policies, and tools. These are collected and shared frequently on their website (www.schplugs.org).

    Profoundly Impacting Healthcare
    When asked how PLUGS is making an impact on healthcare, Dr. Dickerson doesn’t hesitate. I think the biggest way PLUGS is making an impact today is through our partnerships with health plans. This is not considered the friendliest place to drive change, but it often feels like there’s these big silos in healthcare: the hospital, the patient, and the insurance plan. We really wanted to bring those together to find where we have common goals. PLUGS has clearly done so, consistently updating and writing policies for previously uncovered esoteric tests that have now been adopted by many payers and cover millions of lives. Connecting the payer and the patient, they have developed kits to guide families through the preauthorization process, so they’re not burdened with large bills at the conclusion of testing or treatment and continue to submit applications for new codes to help apply national coverage policies to lab tests. Each year we make incremental progress. We’ve got great friends across the health plans, institutions, and commercial labs. I’m proud of the community we’ve created and the impact we’re making.

     

    It’s time to PLUG in. Or PLUGS. Success starts with one step forward. Take it.

     
    Dr. Jane Dickerson

    Dr. Jane Dickerson

    Director of Chemistry, Director of Reference Lab Services, and the Medical Director at the North Clinic at Seattle Children’s Hospital, and Clinical Associate Professor, University of Washington, Department of Laboratory Medicine