Last week involved a full slate of pathology meetings and medical laboratory site visits on both islands of New Zealand during Dark Daily’s visit to this Pacific nation
DATELINE: CHRISTCHURCH, NEW ZEALAND—There’s a good case to be made that the health system in this South Pacific nation is farther down the path of medical laboratory regionalization and consolidation than most other developed nations.
That’s one insight to be gleaned from a week’s worth of meetings with pathologists, clinical laboratory professionals, and health system administrators in the cities of Auckland on the North Island and Christchurch on the east coast of New Zealand’s South Island. Your Dark Daily Editor, Robert Michel, had the opportunity to speak at several conferences and workshops, along with visits to medical laboratories.
A note of explanation about nomenclature will be helpful to Dark Daily’s international readers. In Australia and New Zealand, “pathology laboratory” is the common term for the medical laboratories that typically test blood, urine, saliva, and similar specimens. (In the United States and Canada, “clinical laboratory” is used interchangeably with medical laboratory.) “Histopathology” (or anatomic pathology) is the common term for labs that handle tissue specimens in New Zealand and Australia. (In North America, anatomic pathology, or surgical pathology laboratory is used more frequently than histopathology.)
Common Trends Reshaping Healthcare Systems
Last week started off with a two-day conference at LabPLUS, an IANZ accredited medical laboratory located at Auckland General Hospital in Auckland. The conference was organized by Ross Hewett, Laboratory Manager of Auckland District Health Board (DHB) at LabPLUS. In attendance were pathology laboratory administrators and directors from different health districts located on New Zealand’s North and South Islands.
In a keynote presentation, Michel explained the common trends now reshaping the healthcare systems of most developed countries. Topics discussed included:
• Efforts to integrate the delivery of healthcare;
• Encouraging providers to offer precision medicine; and
• The need for pathology labs in New Zealand and other countries to offer the types of diagnostic tests these physicians need to provide precision medicine services to their patients.
Diagnostic Genetics and Precision Medicine
Of course, molecular diagnostics and genetic testing are the foundation of precision medicine. That topic was addressed by Don Love, PhD, Director of Diagnostic Genetics for LabPLUS and Auckland General Hospital. He described the capabilities of the current generation of molecular and gene sequencing technologies, emphasizing the challenges in obtaining accurate, reproducible, clinically-actionable results. One technology in use by his lab is array-based molecular karyotyping in tandem with the development of an analysis strategy to interrogate the array data. His lab team is also moving forward with next-generation sequencing strategies to replace conventional capillary-based Sanger-type sequencing.
Then it was off to Christchurch, the largest city on South Island. Dark Daily readers with good memories will recall that Michel last visited Christchurch in July 2012. This was about 18 months after two powerful earthquakes destroyed the city’s central business district, as well as more than 20,000 residences. The city is energetically rebuilding and evidence of new construction and innovative urban services can be seen everywhere. (See Dark Daily, “Earthquakes and New Lab Test Contracts Shake Up Christchurch’s Pathology Marketplace,” July 16, 2012.)
Pathology Consolidation and Integration
The first of two different pathology laboratory conferences there was organized by Canterbury SCL, an IANZ accredited medical diagnostic laboratory that is a division of Healthscope International Pathology (Healthscope). This private pathology lab company has a contract with multiple district health boards (DHBs) and is an example of how DHBs are using the strategies of pathology consolidation and integration to better manage pathology costs while supporting a robust pathology testing service.
This conference was titled “Pathology 2030.” In attendance was an interesting mix of healthcare professionals and administrators. It was pointed out that DHBs are working with 10-year contracts involving pathology testing. So, looking at the likely path of pathology testing through the year 2030 was consistent with how healthcare in New Zealand has been transforming.
This was a “big picture” conference and the futurist of the day was Gabe Rijpma, Senior Director Health and Social Services, Microsoft Asia. He offered examples of new healthcare delivery models that are using technology in innovative ways so that physicians, nurses, and other caregivers can be more productive while delivering a high level of clinical care. Some examples he discussed are:
• At the 3,000-bed Severance Hospital of the Yonsei University Health System in Seoul, Korea, physicians at the outpatient clinic are using advanced cloud-based informatics tools, including an electronic patient health record (EHR) that enables them to see 170 patients daily.
• Headquartered in Singapore, Fullerton Health currently operates 180 medical clinics in Singapore, Indonesia, Malaysia, Hong Kong, China, and Australia. It has moved informatics to the Cloud and its caregivers provide services to eight million people in the region. Working with Microsoft, Fullerton Health is gaining the capability to allow any caregiver to access shared documents and care plans from any device, regardless of its location.
Increasing Collaboration between Radiology and Pathology
Two days later, Canterbury Laboratories and West Coast DHB Laboratory (WCDHB), the public pathology laboratories serving the Christchurch region, hosted a strategic meeting to explore the newest developments in integrated diagnostics with an emphasis on increased collaboration between radiology and pathology. The program was organized by Kirsten Beynon, General Manager, and her team at Canterbury and WCDHB. Key sessions addressed included:
• Pathology’s shift from volume to value—speaker: Robert Michel;
• Radiology’s use of new technologies and the need for increased collaboration with pathology—speakers: Dr. Sharyn MacDonald, Chief of Radiology at Canterbury DHB and a cardiothoracic radiologist, and, Kirsten Beynon, General Manager, Canterbury Health Laboratories and West Coast Laboratory, Canterbury DHB;
• Pathology laboratory advances—speaker: Dr. Peter Gootjes, CEO, Canterbury SCL.
• Unstructured data and progress on accessing more information from radiology and pathology images—speaker: Dr. Mike Hurrell, a radiologist and Clinical Senior Lecturer for the University of Otago, Christchurch. Hurrell is working on projects to use information technology to solve the challenges of unstructured data.
This conference was conducted at The Design Lab, a unique facility developed by the Canterbury District Health Board. The Design Lab is designed to open “the doors to patient-centered healthcare. It’s a space where clinicians, engineers, architects, and user groups are rethinking how health services are provided.”
In a tour of The Design Lab, your Dark Daily Editor saw the latest design concepts for two types of patient-centered hospital rooms:
• One layout for single-patient occupancy;
• The other layout for a multi-patient room arrangement.
The design work is world-class and may cause other healthcare systems to rethink the current standard of single-occupancy patient rooms, once these designs are built out and the experience of real patients is evaluated.
As the summary of events and activities demonstrates, it was a full week of learning in New Zealand. With almost 20 years of ongoing pathology laboratory consolidation, regionalization, and integration behind it, the New Zealand health system has maintained a reliable pathology testing service.
Of course, like all developed nations, the big challenges in New Zealand are adequate pathology lab workforce, meeting the steady increase in demand for pathology testing, and tight budgets for funding new diagnostic instruments and technologies.
In closing, I would like to thank all the pathology professionals who organized these meetings, extended the invitations for me to speak, and arranged the laboratory site visits. It was a rich learning experience and this Dark Daily e-briefing is an attempt to capture the high points of the conferences.
Your Dark Daily Editor,
Robert L. Michel
Canterbury District Health Board Design Lab
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