There was cautious optimism about the ability of Canada’s medical laboratories to innovate in ways that advance patient care, while recognizing the ongoing challenge of adequate lab staffing and budget constraints
TORONTO, ONTARIO, CANADA—This week, more than 150 leaders representing clinical laboratories, anatomic pathology labs, in vitro diagnostics (IVD) companies, and provincial health officials gathered for the first “Canadian Diagnostic Executive Forum” (CDEF) since 2019. It would be apt to say that the speakers objectively addressed all the good, the bad, and the ugly of Canada’s healthcare system and its utilization of medical laboratory testing services.
Over the two days of the conference, speakers and attendees alike concurred that the two biggest issues confronting clinical laboratories in Canada were inadequate staffing and an unpredictable supply chain. There also was agreement that the steady increase in prices, fueled by inflation, is exacerbating continuing cost increases in both lab salaries and lab supplies.
Canada’s Health System Has Several Unique Attributes
Canada’s healthcare system has two unique attributes that differentiate it from those of other nations. First, healthcare is mandated by a federal law, but generally each of Canada’s 13 provinces and territories operates its own health plan. Thus, the health system in each province and territory may cover a different mix of clinical services, therapeutic drugs, and medical procedures. The federal government typically pays 40% of a province’s health costs and the province funds the balance.
Second, it is a fact that 90% of the Canadian population lives within 150 miles of the United States border. Yet there are provinces with large populations that have geography that ranges from the US border to north of the Arctic Circle. These provinces have a major challenge to ensure equal access to healthcare regardless of where their citizens live.
During day one of the conference, several presentations addressed innovations that supported those labs’ efforts to deliver value and timely insights during the COVID-19 pandemic. For example, a lab team in Alberta launched a research study involving SARS-CoV-2 virus surveillance from the earliest days of the outbreak. This study was presented by Mathew Diggle, PhD, FRCPath, Associate Professor and Program Lead for the Public Health Laboratory (ProvLab) Medical-Scientific Staff at Alberta Precision Laboratories in Edmonton, Alberta.
Study Designed to Identify Coinfections with COVID-19
While performing tens of thousands of COVID-19 tests from the onset of the pandemic, and identifying the emergence of variants, the ProvLab team also tracked co-infection involving other respiratory viruses.
“This is one of the largest eCoV [endemic coronavirus] studies performed during the COVID-19 pandemic,” Diggle said. “This broad testing approach helped to address a pivotal diagnostic gap amidst the emergence of a novel pathogen: cross-reactivity with other human coronaviruses that can cause similar clinical presentations. This broad surveillance enabled an investigation of cross-reactivity of a novel pathogen with other respiratory pathogens that can cause similar clinical presentations.
“Fewer than 0.01% of specimens tested positive for both SARS-CoV-2 and an eCoV,” he explained. “This suggested no significant cross-reactivity between SARS-CoV-2 and eCoVs on either test and provided a SARS-CoV-2 negative predictive value over 99% from an eCoV-positive specimen … The data we collected was highly compelling and the conclusion was that there was no coinfection.”
Chairing the two days of presentations at this weeks’ Canadian Diagnostic Executive Forum was Kevin D. Orr (above), Senior Director of Hospital Business at In-Common Laboratories. He also served on the program for this national conference serving clinical laboratories, anatomic pathology labs, and in vitro diagnostics (IVD) companies throughout Canada. This was the first gathering of this conference since 2019. Attendees were enthusiastic about the future of medical laboratory services in Canada, despite lab staffing shortages and rising costs due to inflation. (Photo copyright The Dark Report.)
Clinical Laboratory Regionalization in Quebec
One of Canada’s largest projects to regionalize and harmonize clinical laboratory services is proceeding in Quebec. Leading this effort is Ralph Dadoun, PhD, Project Director for OPTILAB Montreal, which is part of the Ministry of Health and Social Services in Quebec. The ambitious goal for this project is to move the 123 clinical laboratories within the province into 12 clusters. Initial planning was begun in 2013, so this project is in its ninth year of implementation.
During his presentation, Dadoun explained that the work underway in the 12 clusters involves creating common factors in these categories:
Implementation consistent with and respecting ISO-15189 criteria.
Another notable achievement in Quebec is the progress made to implement a common laboratory information system (LIS) within all 12 clusters. The first three laboratory clusters are undergoing their LIS conversions to the same platform during the next 180 days. The expectation is that use of a common LIS across all clinical laboratory sites in Quebec will unlock benefits in a wide spectrum of lab activities and work processes.
The 2022 CDEF featured speakers from most of the provinces. The common themes in these presentations were the shortage of lab personnel across all technical positions, disruptions in lab supplies, and the need to support the usual spectrum of lab testing services even as lab budgets are getting squeezed.
At the same time, there was plenty of optimism. Presentations involving adoption of digital pathology, advances in early disease detection made possible by new diagnostic technologies, and the expansion of precision medicine showed that clinical laboratories in Canada are gaining tools that will allow them to contribute to better patient care while helping reduce the downstream costs of care.
The Canadian Diagnostics Executive Forum is organized by a team from In-Common Laboratories in North York, Toronto, Ontario. Founded in 1967, it is a private, not-for-profit company that works with public hospitals and laboratory medicine providers. Information about CDEF can be found at its website, where several of this year’s presentations will be available for viewing.
As demand rises, Canadian clinical laboratories must learn to juggle test systems automation, funding challenges, and staffing shortages
Canada’s clinical laboratories are deeply affected by many of the trends impacting the Canadian healthcare system overall. Deployment of new technologies, such as test automation and artificial intelligence (AI) for example, are forcing Canadian labs to adapt during times of changing demographics and funding pressures.
The development of disruptive new technologies is becoming the norm and the laboratory’s role in healthcare delivery is growing. That’s why change management has become a focus of clinical laboratory leaders.
Sheila Woodcock, Convenor, WG 1 Quality and Competence in the Medical Laboratory at ISO/TC 212, and President and Principal Consultant at QSE Consulting Inc., Nova Scotia, Canada, says “allocation of resources” is a challenge for senior diagnostic executives juggling financial, technology, and staffing decisions.
In an exclusive interview with Dark Daily, Woodcock
said, “The number one lab challenge today is not having enough money; second is
not having enough people. Because if you don’t have enough money, even if there
are people out there, you can’t hire them. Money, people, and trying to keep up
with all the technological innovations bombarding us nowadays are the main
reasons to make changes.”
From deployment of digital pathology services and point-of-care (POC) testing to the introduction of automation and AI, innovation is happening at a rapid pace. It may or may not increase medical laboratory efficiency or support precision medicine, but it definitely alters laboratory infrastructure.
“Change is nearly constant in the clinical laboratory and
the healthcare network worlds, and there are many complexities that go with
that,” Woodcock said. “With the implementation of new technologies, and the
rapidly advancing world of automation in clinical laboratories that have never before
been automated, how do we ensure that when we automate new technology it
doesn’t negatively impact the quality of the testing process?”
Disruptive Changes are Redefining Clinical Laboratories
As Clinical Lab Products (CLP) points out, medical laboratories have become a reservoir of data that can “guide fact-based decisions to improve operational, financial, and clinical performance throughout their institutions.” As a result, clinical laboratories are increasingly shedding their “traditional and narrowly defined roles” in which “physicians order tests and labs report results.”
Emerging technologies also are ushering change outside of the medical laboratory. Drones soon may routinely transport patient specimens across healthcare networks. Dark Daily has reported on several new drone transport systems under development around the globe. One such system in the US involves UPS, the FAA, and WakeMed. Such high-tech specimen tracking and delivery systems could lead to fewer spoiled samples and possibly save lives, and clinical laboratories are at the heart of these innovations.
Kevin D. Orr, Senior Director, Hospital Business at In-Common Laboratories, believes technology may help laboratories overcome one major issue—a growing demand for testing services at a time when the laboratory workforce is shrinking, and provincial and territorial global funding is not keeping pace with diagnostic utilization rates. Orr points to digital pathology as an example of a technology that may enable labs to “do more with less” in terms of both funding and staffing.
“As people get older, there’s more demand for healthcare
services and because of that more clinical laboratory testing has to be done,”
Orr told Dark Daily. “The peak of the Baby Boomers is starting to get
sick now. We need to focus on innovations and technologies clinical
laboratories are employing to address the overarching issue of doing more with
How Clinical Laboratories Should Demonstrate Value
Woodcock, however, maintains that clinical laboratories also
need to do a better job of lobbying for funding, so they have the money needed
to implement new technologies.
“Traditionally, when labs are told they have cutbacks, they
do their utmost to work within what they have been assigned. But other
departments might be jumping up and down, getting more attention, and getting
more funding,” she said. “One of the things lab people have to learn—and are
getting better at as time goes on—is giving the lab a voice and making known
the contributions the lab makes to diagnosis and treatment of patients in a
The Canadian Diagnostic Executive Forum on October 24-25 at
the Westin Harbour Castle Hotel in Toronto provides such an opportunity for
laboratory leaders to learn how to leverage technology to create positive
change in lab operations.
“We want to inspire people,” Orr told Dark Daily. “We
want people to leave this conference excited about what diagnostics is doing
and where it’s headed and what other people are doing. We want to show them the
bright light at the end of the tunnel, because sometimes when you’re dealing
with the negative aspects of no money or no staff or no this or that, it gets
pretty awful. We want to breathe some life and show them the rainbow and that the
light at the end of the tunnel could be just around the corner.”
The CDEF conference will be hosted by In-Common Laboratories, in conjunction with The Dark Report, Dark Daily’s sister publication. This two-day event will be packed with thought-provoking sessions on digital pathology, next-generation technology, precision medicine, blockchain, sample tracking, and artificial intelligence, as well as updates from across Canada on the latest innovations and technologies being implemented in medical laboratories.