Laboratory medicine: Create value for community health

ABSTRACT

Clinical laboratories are at a cross-roads. The focus on automation, distorted economics which subordinated medical objectives to economic ones turning the laboratory into a mega-factory, has resulted in the devaluation of laboratory medicine which is considered a support service rather than a true clinical department. However, in addition to a series of papers and visionary opinions, the SARS-CoV-2 pandemia has highlighted the central role of clinical laboratories as a vital part of the continuum of patient care and disease prevention. In fact, in the case of COVID-19, as in many other diseases and medical conditions, the diagnosis is performed by a laboratory test (rRT-PCR), many biomarkers and "conventional" laboratory tests play a relevant role in disease monitoring and prognostication, and serological assays are used for epidemiological surveillance. Clinicians, patients, citizens and politicians have finally realized the importance of laboratory medicine and the need for implementing a more value-based patient centric model for delivering laboratory services, Moving from the traditional to a value-based model of organizing medical laboratory practices requires a) a patient centric view;b) integration with other clinical services e.g.imaging);c) optimized test request and utilization;d) focus on all phases of testing cycle, not only on the intra-analytical;e) aggregation of "big data";f) use of artificial intelligence to improve the value of laboratory information;and g) the promotion of precision and personalized medicine. To improve outcomes for populations and individual patients requires laboratory professionals to increase their scope of practices influence outside the traditional laboratory model to diagnostic management throughout clinical care pathways, interdisciplinary collaborations to break down traditional practice silos, and outcomes research. Diagnostic stewardship, teleconsultations, integration in diagnostic management teams, efforts in improving patient safety using appropriate quality indicators are valuable tools in order to create value and improve the visibility of laboratory professionals.