With the aim of promoting the integration of Laboratory Medicine into the healthcare process, highlighting its impact on patients, healthcare professionals, health systems, and society in general
• The clinical laboratory faces new challenges, such as increased demand and costs, the development of 4P medicine, technological innovation, and growing patient empowerment
• Technological innovation, molecular diagnosis, and information systems and big data (which influence connectivity and the interpretation of results), are factors that are leading the change in Laboratory Medicine
• Cooperation is necessary to improve the appropriateness of laboratory tests, given the high number of unnecessary tests requested that generate over-diagnoses and over-treatment
It is estimated that 1.3 requests for clinical laboratory tests per inhabitant are requested every year, tests that represent 4% of hospital costs. In 2015 alone, according to data from the Ministry of Health, more than 60 million requests and more than 604 million tests were carried out in Spain.
Various published studies indicate that more than 70% of the clinical decisions made every day are based on Laboratory results, which is why it is the largest generator of information on healthcare activity.
Nevertheless, and despite the transversal nature of Laboratory Medicine, its contribution to health care is undervalued. For this reason, it is necessary to redefine the role of Laboratory Medicine specialists as expert consulting work and collaboration with clinicians, since these professionals are dedicated to generating information and knowledge that help in clinical decision-making.
Therefore, with the aim of assuming the leadership that falls to it as a scientific society to situate Laboratory Medicine in a wider context that benefits everyone, especially the public, the Spanish Society of Laboratory Medicine (SEQCML) has created The Committee on the Value of the Clinical Laboratory, which it has introduced to representatives of different medical-scientific societies in a conference.
Specifically, the meeting included the presence - together with representatives of the SEQCML - of Javier García (AEDP, Spanish Association of Prenatal Diagnosis), Leticia Moreira (AEGASTRO, Spanish Association of Gastroenterology), Angel Cequier (SEC, Spanish Society of Cardiology), Anna Rodríguez (SEDISA, Spanish Society of Health Managers), Irene Bretón (SEEN, Spanish Society of Endocrinology and Nutrition), M. Luisa López-Teijón (SEGO, Spanish Society of Gynaecology and Obstetrics), Gilberto Alonso (SEMES, Spanish Society of Urgent and Emergency Medicine), Manuel Jiménez de la Cruz (SEMERGEN, Spanish Society of Primary Care Physicians), Alberto Hernández (SEMYCIUC, Spanish Society of Intensive Medicine and Coronary Units), Héctor Boix (SENEO, Spanish Society of Neonatology), Miguel Ángel Seguí (SEOM, Spanish Society of Medical Oncology), Paula Peleteiro (SEOR, Spanish Society of Radiation Oncology) and Carolina Malagelada (SEPD, Spanish Society of Digestive Pathology).
Integration of Laboratory Medicine in the care process
"The Committee on the Value of the Clinical Laboratory has been created with the objective of enhancing the integration of Laboratory Medicine into the care process, emphasizing its impact on patients, healthcare professionals, health systems, and society in general," says Ana Quinteiro, Chair of the Committee.
"In this sense," she adds, "both the creation of the Committee and the organization of the conference respond to a profound process of reflection within our Society at a time of change: we have laboratories of the highest quality; laboratory professionals have invested a lot of effort in the optimization of internal processes, in quality assurance systems and in the improvement of efficiency, all with the aim of providing quality results at reasonable costs".
For Fernando Cava, member of the Committee on the Value of the Clinical Laboratory of the SEQCML, the laboratory specialties have been pioneers in qualitative changes, in the introduction of quality systems, and management involvement. "However, the real engine of change is a cultural change, a vision of what our role is -- in short, of who we are," he says.
For this expert, a medical laboratory creates value when it acts as a strategic core concept within the decision-making processes. In this context, it affects the production of clinical information far beyond the report (for example, detection of admitted patients with critical values and candidates for a potential admission to the ICU, etc.) as an example of generating value from the laboratory.
On the other hand, there are several factors that are leading, to a greater extent, the change in Laboratory Medicine, points out Ana Quinteiro, among which are technological innovation, molecular diagnosis (which affects practically all laboratory disciplines and is modifying the focus of clinical decisions: personalized and predictive medicine), and information systems and big data (which influence connectivity and interpretation of results).
Importance of the clinical laboratory in the current healthcare model
The clinical laboratory faces new challenges, such as increasing demand and costs, the development of 4P medicine, technological innovation, and growing patient empowerment.
Because of this, Isabel Llompart, member of the Committee of the SEQCML, puts the focus on the need to work together for a better appropriateness of tests. "There is an increase in demand for laboratory tests that is not commensurate with the increase in medical activity. A high number of the determinations requested are unnecessary and not only do they not add value to the patient but they generate over-diagnosis and over-treatment. Five of the main causes that lead to diagnostic errors are related to not asking for the correct laboratory tests or asking for inadequate tests, for which initiatives such as 'Not to do' or 'DianaSalud' [Target Health] are very important. Making the test requests appropriate is not aimed at trying to reduce tests, but to ensure that what is requested is correct".
"For all this, it is important that we work together at the level of scientific societies," she notes.
"There is a change in the laboratory model, from a model focussed on samples and technology to a model focussed on the patient and on participation in clinical decision-making. We want to be the engine of change so that by guaranteeing quality of results and the sustainability of the system we can provide the value that the patient and society need," he concluded.
Strengthen lines of collaboration
The SEQCML, as explained at the opening of the Conference by its president, Dr. Imma Caballé, has a total of 2,709 members (15% of whom are medical residents) and has various committees: Committee on the Value of the Clinical Laboratory, Committee on Congresses, Committee on Education, Committee on Communication, Committee on External Quality Programs, and the Scientific Committee, comprising 25 Commissions and 3 Working Groups. Likewise, the Society has 40 international representatives in international organizations: IFCC, EFLM, FESTEM, ICSH and CLSI.
Among the services it offers are Continuing Training Courses, online courses and training webinars, and External Quality Assurance Programs certified according to ISO 9001: 2015, with the participation of 700 centres. In addition, it has the JL Castaño-SEQC Foundation, and grants various scholarships, prizes, and travel funds (assistance for Congresses in Latin America).
Likewise, the Society works on activities and consensus documents with other scientific societies. Specifically, strengthening the lines of collaboration between societies has been one of the priority objectives of the Conference, as outlined by Dr. Antonio Buño, member of the board of directors of the SEQCML, who emphasized the different activities that could be carried out jointly, such as joint consensus documents, specific monographs, "cross" participation in congresses, creation of specific work groups within a society, organization of joint scientific conferences, multi-centre projects, endorsement of international guides in areas of interest, common strategies for communication and disclosure to the patient, etc.
"The Spanish Society of Laboratory Medicine is committed to working together with other scientific societies, so we hope that this first day will start a path of collaboration and contribute towards a greater interconnection between these societies in order to move towards better quality of healthcare ", concludes the president of the SEQCML.