In healthcare across the globe there is an explosion of knowledge from genetic information that is now opening the door for improved diagnostic capabilities.

Pathology labs are getting new technologies that allow for earlier and more accurate diagnosis, improved patient care and better outcomes.

All this means less cost per episode of care as earlier diagnosis can speed up recovery.

The case has clearly been made for ‘precision’ or ‘personalized’ medicine. There are an increasing number of genetic markers that allow doctors to tailor treatments, knowing whether a treatment is likely to be effective.

The cost saving here is obvious, for instance, cancer drugs can often cost tens of thousands of dollars so they should be used only when there is likely to be a benefit. Avoiding the side effects and wasted time is clearly preferable for patient wellbeing too.

However, it is not only genetic tests or new technologies that can be used strategically to save money.

A US analysis* of a change in the use of creatinine testing in hospital inpatients showed that when this simple test was used more diligently by doctors, acute kidney injury was diagnosed earlier. This meant quicker treatment and faster discharge from hospital, freeing up beds and saving hospital funds.

Evidence suggests that there is a case for an increase in HbA1c testing, for monitoring patients who have a diagnosis of diabetes and also for catching the many undiagnosed cases out there.

The expense of treating the complications of diabetes such as organ damage, foot and eye problems, is far higher than the cost of providing regular testing to diabetic patients and testing potential diabetes cases.

Diligent test ordering for these patients is an important first step, but follow up is also vital to encourage patients to attend for testing, retrieve their results and take the necessary action on them.

Patients missing tests or results is all too common and happens for a range of reasons. However, Pathologists have little direct interaction with their patients and lack the opportunity to communicate the importance of following through with tests. Awareness raising initiatives such as Know Pathology Know Healthcare aim to highlight pathology’s essential role in healthcare, and to encourage better health literacy among Australians.

With the current trends in health, for example increasing obesity, higher rates of diabetes, an ageing population, it is important that pathology is utilised to its fullest extent. To be clear – I am not advocating for simply more testing, but for physicians to be strict about following testing guidelines for all patients.

Getting the most from pathology requires strategic funding but there is also a need for effective knowledge sharing. Pathology professionals and physicians need to communicate better.

It is difficult for doctors to stay ahead of advances in pathology and testing guidelines for every possible ailment and disease state they may encounter. Technology and knowledge are moving quickly in pathology, making the expertise of Pathologists a vital resource for treating doctors.

Doctors should be encouraged to use the expertise in the lab, to ask questions and discuss results. Medical labs should also be taking a lead on communicating with clinicians on test updates and ensuring reports are clear and contain the appropriate detail.

In short, working together to provide the right test, for the right patient at the right time is the best way to serve the population, as patients and taxpayers.

*This article is an opinion piece by Robert Michel and was originally published in Medical Observer on 21st November

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THE Australian health system is under pressure to deliver more for less with an ageing population and growing burden of chronic disease.

The role of efficient and effective medicine has never been more important, but in the case of pathology, value is difficult to articulate.

Pathology is a vital part of medicine. However, it is mostly hidden behind laboratory doors and typically struggles to demonstrate its worth, because it is often considered in purely cost terms.

This is why Pathology Awareness Australia launched the Know Pathology Know Healthcare initiative, which aims to raise awareness of pathology’s value and integral role throughout healthcare. It is an approach which other countries should also embrace.

In my own work, I look at ways in which a change in approach can help pathology realise its full potential and show its value to the health system, both in terms of cost savings and improved patient outcomes.

Although there may be areas within pathology that can be improved to reduce spend, the idea that massive savings are available via automation is misguided. It is difficult to imagine improving health expenditures meaningfully when all of pathology costs a mere 3% of the healthcare budget.

Pathology’s appearance in the interim results of the MBS review is focused on over-testing.  Although some over-testing clearly exists, data suggests that under-testing is more than twice as prevalent (20.6% vs 44.8%¹) and the absence of necessary diagnostic information is likely to harm patients and cost more than any savings from over-testing. Yet under-testing is rarely considered an area of concern.

There are also some excellent examples of how pathology labs have become more actively involved in patient care with fantastic benefits for patients and financial savings.

One of these is a U.S lab that identified a pharmacogenomic test that could help patients needing anti-clotting medication (Clopidogrel). The drug may not be effective for all patients, meaning some could be at risk of adverse events (stroke) with the associated financial cost to the health system.

The lab showed that using this test for these patients would prevent 60 adverse events and save $1.5m annually.

A further example is a lab that reviewed high creatinine results where patients had not had follow-up testing. Working with care providers they pursued a number of patients resulting in the identification of 1,000 cases of undiagnosed kidney disease.

Although pathology teams know their worth, the demonstration of this value and the realisation of the full benefit labs can provide to patients requires a shift in thinking, both from within pathology and from the wider medical profession.

A lab’s mission should not just be to provide accurate, timely, low-cost test results. The clinical lab’s mission should be to efficiently enable the accurate diagnosis of conditions, the selection of appropriate treatments and the effective monitoring of health status.

Fostering more input from pathology professionals into patient care would better address all these issues, demonstrating that collaboration and appropriate pathology use is better (and cheaper) than driving down pathology costs in isolation of patient needs.

^{1 Zhi M, Ding EL, Theisen-Toupal J, Whelan J, Arnaout R (2013) The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis. PLoS ONE 8(11): e78962. oi:10.1371/journal.pone.0078962}

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