Public Health Laboratories and Health System Change . Creation of Integrated Knowledge Bases


Many laboratorians interviewed suggested that the future of the commercial reference laboratory industry centered on the development of sophisticated informatics products that will be able to integrate laboratory results data with outcomes data from other health system players. Some large clinical laboratory companies have reported making large investments in information technology. For example, Quest Informatics has reported investing $20 million in relational databases in recent years. A fundamental issue for these systems is the lack of coordination with other sources of patient data (e.g., hospital, physician, and prescription pharmaceutical observations).

Despite some limitations, major clinical reference laboratory providers are already actively marketing their ability to provide software that allows MCOs to aggregate and index laboratory data, which is useful for assessing overall health status among members and developing disease management programs for specific therapeutic areas. In addition to the software products, laboratory services vendors may offer consulting services designed to implement Aquality improvement opportunities identified by their software. While it is likely that clinical reference laboratories will continue to market informatics products, the effectiveness of their tools have yet to be widely tested in health markets.

The longer-term vision for PHLs in the context of the broader public health safety net is to develop a comprehensive and integrated LIS that would facilitate epidemiologic surveillance as well as public health case support.21  The vision includes development of common community health indicators that could be monitored on a real-time basis to improve public health. Such a system would clearly require cooperation from other offices within a Department of Health (e.g., Epidemiology), as well as other state organizations involved in health (e.g., Medicaid) that track patient information. Some states, such as Washington, Missouri, and South Carolina, have created working groups to support realization of this vision.

An example of current PHL involvement in information transfer technology is the internet effort of Iowa's University Hygienic Laboratory, which serves as the state's PHL. While Iowa's site is still in development, it currently includes a description of the laboratory's activities, as well as a state-wide disease reporting system for respiratory tract pathogens. The system allows physicians using the site to click on the county in which they practice in order to view an updated list of the number of cases of respiratory infections reported in the county, along with the pathogens that caused the infections.

Other state PHLs are developing a presence on the web through SHAs, including internet accessible systems to provide health status indicator information to medical providers and local health agencies. These efforts have been monitored by the NCVHS. An example of this type of activity can be found at the Massachusetts State Laboratory Institute website.22