Prospecting for gold in the data mine.

As a transaction based industry, health care is data rich. A new generation of business-supporting information technology is emerging that can transform such data into knowledge critical to sustain value in health care. In order to adopt successfully this new information technology, physicians and other health care leaders must come to understand the value of complete, accurate and consistent coding of clinical activities. The clinical laboratory has a pervasive role in health care. With its recent federally assigned responsibility to assure clinically relevant testing through ICD-9-CM and CPT coding, and its experience with computerized information systems, the clinical laboratory is in an ideal position to become a champion of the new information technology.

Projecting corporate health plan utilization and charges from annual ICD-9-CM diagnostic rates: a value-added opportunity for pathologists.

OBJECTIVE: To develop an allocation method for corporate health plan resources and expenditures based on annual International Classification of Disease, 9th revision, Clinical Modification (ICD-9-CM) diagnostic rate stratification as a surrogate for disease incidence. DESIGN: A data-mining process was applied to a self-insured corporate health plan database. Annual membership rates of Current Procedural Terminology (CPT) procedure utilization and charges between 1990 and 1994 for a cohort of 7216 continuously employed plan members were stratified according to the annual rates of the 19 major ICD-9-CM diagnostic classifications. The stratified annual CPT utilization and charge rates were analyzed by correlation analysis and one-tailed t test. RESULTS: Laboratory and pathology procedure utilization and charge rates were highly correlated with specific rankings of ICD-9-CM diagnostic classifications. The health plan diagnostic rate, laboratory utilization rate, and all charge rates increased significantly during the 5 study years. CONCLUSION: Although all procedure utilization and charge rates in this health plan increased each year, their proportionality consistently was maintained among diagnostically related groups of patients. By restraining global expenditures, managed health plans conflict with historical utilization and charge patterns. Treating ICD-9-CM diagnostic groups as disease management services within a managed care plan allows procedures and expenses to be allocated according to medical necessity in the context of total membership benefits. For pathologists, who recently were mandated by the Health Care Financing Administration and the Office of Inspector General of the Department of Health and Human Services to become stewards of ICD-9-CM coding, this is a unique opportunity to lead an initiative to perfect managed care. The process will require permanent patient numbers, computerized longitudinal patient records, and standardized coded medical terminology.

A pathologist is as a pathologist does. Changing roles in a changing time.

Managed care challenges pathologists to a paradoxical cultural transition requiring clinical participation in the community while refining competitive managerial skills to maintain a livelihood. This presentation explores several role changes that a pathologist may undertake to acquire perceived clinical and economic value in a managed care system.

Practicing pathology as a health care contractor. Business planning for managed care.

Managed care requires a pathology practice to take on the role of a health care contractor whose existence depends on obtaining, managing, and renewing competitively bid contracts for the group's services. This presentation is a primer on how to write a formal business plan for a pathology practice using a model case study to illustrate, among several business issues, the differences between and the key elements for success in operating a pathology practice in both fee-for-service and capitated managed care environments.

Multimedia communications networks. Patient care through interactive point-of-care testing.

This decade will see a historical convergence of technologic and socioeconomic events that will merge interactive multimedia communications with longitudinal participatory health care systems. Diagnostic testing will extend from the home to the most sophisticated acute care settings. Point-of-care testing networks will resemble modern electrical utility power grids with workload distributed to optimize test turnaround time and economic effectiveness. Throughout the network, clinical and managerial information will be accessible as needed at all points of use. The networks will become "physician extenders" by allowing broad interactive geographic and mobile accessibility to clinical information in a context that maintains patient confidentiality and data security.

The fourth dimension. Management of the postmodern clinical laboratory.

The clinical laboratory has undergone historic changes over the past decade. The Clinical Laboratory Improvement Amendments of 1988 are the regulatory acknowledgement of the technological revolution that has occurred. Challenged to meet increasingly diverse medical needs while facing cost restraints, managerial leadership will replace technical leadership in the clinical laboratory. Ignored for half a century by most American industries, total quality management has been invoked as the embodiment of systems engineering and group decision making in the postmodern clinical laboratory. The matrix organization, workload recording, and productivity measuring are cost-effective applications of total quality management in the clinical laboratory.

Negotiating a laboratory information system contract.

The key to successfully negotiating a laboratory information system (LIS) contract is consensus. Before sitting down at the negotiating table, the LIS selection team must reach consensus on a variety of issues--ranging from financial concerns to political considerations. Once a vendor is selected, consensus must be reached regarding the laboratory's needs and the vendor's capabilities. This article discusses the entire LIS negotiating process--from selecting a vendor to writing the final contract. By looking beyond costs and working out problems in advance, the laboratory will have a better chance of negotiating a successful LIS contract.

Transfer data. A proposed international standard for interlaboratory information exchange.

Clinical laboratory information is composed of descriptive terms and corresponding codes that define patients, specimens, and tests. These basic units of information, or data elements, assume literal character content and sequences in clinical laboratory computer files and messages. The growing international use of computers for scientific data transfer highlights the need for standardized coding conventions that eliminate the ambiguities of language and scientific terminology. An international symposium of the Commission on World Standards of the World Association of Societies of Pathology recommends that international consensus standards be developed to insure the accurate transfer of scientific data between clinical laboratory computers while maintaining strict subject confidentiality. It is anticipated that such standards would be widely applicable to the storage and retrieval of medical information in computers throughout the world.

A method for the collection of pure pulmonary lymph in the canine.

An original method for the collection of pure or nearly pure pulmonary lymph in the canine is desirable for the study of pulmonary water, protein dynamics and cells. Right lymphatic duct lymph has been used extensively but it known to contain lymph from a number of extrapulmonary sources and has been altered by passage through lymph nodes. Pulmonary lymph was collected from 13 dogs through an open chest. The mean flow of lymph was 1.5 milliliters per hour +/- 0.08. This flow is compared with 3.7 milliliters per hour from the right lymphatic duct and 22.5 milliliters per hour from the thoracic duct in a group of dogs with a closed chest. The levels of lactate dehydrogenase--634 units per liter--and glutamic-oxalacetic transaminase--416 units per liter--in pure pulmonary lymph were much higher than in right lymphatic duct lymph--lactate dehydrogenase 125 units per liter; glutamic-oxalacetic transaminase 94.0 units per liter, in thoracic duct lymph--lactate dehydrogenase 47 units per liter; glutamic-oxalacetic transaminase 80.5 units per liter--and in blood plasma--lactate dehydrogenase 299 units per liter; glutamic-oxalacetic transaminase 95 units per liter. Low levels were noted in Na+, 107, and Cl-, 85, in pure pulmonary lymph versus plasma--Na+ 145; Cl- 112, right lymphatic duct lymph--Na+ 146; Cl- 115, and thoracic duct lymph--Na+ 146; Cl- 114. The method can be adapted for prolonged drainage in conscious dogs, which would enhance its usefulness.

Canine cardiac lymph potassium, pH and flow after experimental myocardial infarction.

Canine cardiac lymph was studied after acute experimental myocardial infarction. The lymph potassium concentration remained the same, the lymph potassium content increased, the lymph pH decreased, and the lymph flow increased while the serum potassium and pH remained the same. It is suggested that localized hypoxia may result in cellular changes that release substances, e.g., potassium, to the interstitial space where they mobilize fluid and enhance lymph flow.