Laboratories: Integrating Services

Laboratories: Integrating Services

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The laboratory is really a vital component of any integrated approach to service and health provision, maybe more so than many people realize. The laboratory is a foundation for diagnostic testing and providing results back to the health care provider in a timely way allows an integrated approach to healthcare provision to be a reality.

The diagnostic information that the laboratory provides back to the health care provider forms the foundation for all appropriate care to that patient, but at the same time that diagnostic information goes into programmatic efforts to link that patient into appropriate care, to counsel that patient appropriately, to possibly identify partners and other risk components of the person's lifestyle.

So the laboratory forms the foundation, not of just the health care provider's approach to the patient, it also provides all the other services that improves the outcome of health for that person. Right now the laboratory has an opportunity to educate the programmatic side and the health care providers in how best to coordinate diagnostic testing and what battery of tests would be appropriate given certain risk factors; educating health care providers about how to approach their patient care around the expectations of the diagnostic tests.

There are a number of logistical issues that laboratories need to think of in advance. An integrated approach to diagnostic and health care provision is going to increase the demand on a laboratory, rather than just having a single HIV test request, they now at least have an HIV test and an STD test on the same patient. And it's to their benefit (to) work through some aspects of their own workflow so that the expectations of the health care provider and a(n) integrated service program can be met.

Some of those logistical issues are in regard to their own workflow, how they receive samples, how they group them together in their testing algorithms and even what tests they run and in what sequence they run them in order for a logical flow of the results and the workflow to be implemented.

Laboratories have an important role to play in advancing the coordinated effort that will be required for program integration. We've been working with the Association of Public Health Laboratories, APHL, to educate their laboratory managers that program integration is a reality. They need to be involved in the conversation so that their workflow is brought into the consideration as program designs a(n) integrated approach to health care provision.

The laboratory has an important role to play in helping program take shape around the diagnostic services that are going to be necessary, what types of tests should be requested, what types of fluid should be taken, what the risk factors are that would allow a hierarchy of different tests to be requested. That conversation needs to happen between the laboratory manager and the health care programs.

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