Regional laboratory network wants to standardize lab test menus, methods, and LIS

In Canada’s Ontario Province, an ambitious effort to create a single, multi-site regional clinical pathology laboratory system is moving forward. Called the Eastern Ontario Regional Laboratory Association, Inc., (EORLA), it involves the clinical laboratories of 19 hospitals.

EORLA’s current clinical goals and business objectives reflect the experience of almost 25 years of laboratory cost-cutting and consolidation in Ontario. It was the mid-1980s when the Ontario Ministry of Health and Long Term Care began enacting measures to control the cost of clinical laboratory and pathology testing.

Often, these measures involved the creation of consolidated laboratory organizations in various cities, including Toronto. Some of these consolidated lab organizations included a mix of private commercial laboratory companies, academic center hospital labs, and community hospital laboratories.

Regional Medical Laboratory Networks in Ontario

EORLA’s story starts in the late 1990s, when first steps to organize regional laboratory networks in Eastern Ontario were taken. Around 2003, incorporation papers were filed to create the Eastern Ontario Regional Laboratory Association, Inc. By 2006, a formal clinical and operational plan was approved with the specific goal of standardizing laboratory testing operations across all of EORLA’s participating hospital laboratory sites.

Recently, at a meeting of the Champlain Local Health Integration Network (CLHIN) in Ottawa, Ontario, EORLA CEO Fred Swaine, M.D., discussed the goals of EORLA. “This is laboratory reorganization,” he stated. “It’s not about downsizing, it’s about managing growth” through automation and consolidation.

As described by Swaine and reported in The Ottawa Citizen, EORLA was created in response to a number of primary trends in pathology and laboratory medicine. Healthcare policymakers at the Ontario Ministry of Health report that the volume of laboratory tests is growing at the rate of 4.5% per year. At the same time, because of retirement and other factors, in coming years the province will have an inadequate number of medical technologists, clinical laboratory scientists, pathologists, and other laboratory professionals to support the ever-increasing volume of laboratory specimens.

Swaine explained how EORLA was organized to address these trends. One objective of the regional medical laboratory network is to standardize test menus and test methodologies across all the participating hospital laboratories. In parallel with this initiative, steps will be taken to introduce a common laboratory information system (LIS) to allow patient laboratory test data to be accessed by all the physicians served by EORLA.

Clinical Laboratory Test Menu Standardization

Expectations are that lab test standardization and a common LIS platform will produce two long-term benefits to Ontario’s healthcare system. First, there will be a reduction in the number of unnecessary tests that are ordered by physicians. Second, because physicians have access to a full record of a patient’s laboratory test results, the number of duplicate tests that are ordered will also decline.

However, the more strategic goal is for EORLA to support the ongoing integration of patient care across the entire healthcare continuum within Ontario. Standardization of EORLA’s participating medical laboratories will contribute to that goal.

Over the past decade, The Dark Report and Dark Daily have repeatedly observed that several of Canada’s provincial health systems have been early and aggressive at using consolidation, regionalization, and standardization as tools to cut the cost of clinical laboratory testing. Thus, as a second and third generation effort to further regionalize laboratory testing in Eastern Ontario, there will be many useful laboratory management lessons to be learned for EORLA’s successes and setbacks.

This may prove particularly useful for the nations of Ireland and the United Kingdom. In both countries, during the 1990s and 2000s, regionalization of hospital laboratory services was not pursued with the same vigor as in Canada, the United States, and Australia. Now, as both countries are declaring intentions to radically restructure pathology testing, their health ministries have the opportunity to study the successes and failures of the laboratory regionalization and standardization projects in other countries, including Canada.

As a lab regionalization/standardization “work in progress” for more than a decade, the Eastern Ontario Regional Laboratory Association certainly offers the opportunity to study what worked and what didn’t on its path to full standardization.

Related Information:

Lab specialists, pathologists to work under one system; Move to reduce delays for patients

Third Party Review of the Eastern Ontario Regional Laboratory Association’s Business Case: Final Report, prepared for the Ministry of Health and Long Term Care by www.QSEconsulting.com.

Third Party Review of the Eastern Ontario Regional Laboratory Association Inc. “February 2006 Business Case” prepared for the Ministry of Health and Long Term Care by www.QSEconsulting.com

“Lab Cuts?” by CUPE Ontario and Ontario Council of Hospital Unions, March 2008