Priming the Clinical Laboratory for Population Health

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Priming the Clinical Laboratory for Population Health

A Clinician’s Perspective: COVID-19 and the Lab’s Evolving Role

By Jeremy Orr

During the early part of the pandemic, laboratorians mobilized to provide timely, accurate testing for individual patients. In places where testing was limited, lab personnel sometimes enforced prioritization criteria. Fortunately, in many (though not all) parts of the world, tests are now available in greater quantities and rationing is no longer an issue. So it’s natural to ask: what lies ahead for the lab as the next stages of the pandemic unfold?

First, let’s acknowledge that none of us know for certain how the next few months will go. Different regions are at different points on their case growth curves – and the shapes of those curves are dependent on the circumstances. Will there be a rebound in places where an apparent peak has been reached? Will we see COVID-19 take on seasonal characteristics like influenza? Will containment efforts evolve or corrode? What role will herd immunity play? When will there be a viable vaccine? We just don’t know the answer to these questions.

Despite the uncertainty, the laboratory will continue to play a central role – but the nature of that role will evolve. Here are some of the potential future use cases – and how the lab may fit in:

  1. Patient triage and population health efforts. For patients who have already tested positive, laboratorians are in a strong position to provide risk stratification to guide disposition and follow-up protocols.
  2. Contact tracing – a best practice in epidemiology, but also a resource-intensive one. Not every COVID-19 positive patient will have complete contact tracing. Because clinicians operate 1:1, they often can’t see the connections between events. Labs can see all the data and map the temporal and geospatial relationships between events. There is a long history of labs reporting this data to public health agencies for surveillance purposes, but they can do more. Even tracing within a health system or locality can help prioritize contact tracing and mitigate disease spread.
  3. Antibody testing. It’s fraught with challenges, but has been used for other infectious diseases and will be used for COVID-19 to assay immunity at both the individual and population level. Given the interpretation pitfalls, lab expertise will be needed to guide policy and implementation.
  4. Vaccine prioritization. An effective COVID-19 vaccine will be critical to long-term containment. But, in the early days of any vaccine, access is often limited and we will have to decide who goes first. Essentially, it’s a risk/benefit ratio, and labs – the center of the care data flow – are in an excellent position to help.
  5. Return to routine. We all know that routine care, including cancer screening and chronic disease management, is being delayed and deprioritized for this phase of the pandemic. How do we get back to par? As routine care efforts rebound, the lab can again play a central role in helping providers understand who needs care most urgently. Who should be at the front of the cue for a colonoscopy or a diabetes check-up? Labs provide critical clues.

 

Central to all of these use cases is the careful and informed interpretation of data familiar to the lab. Of course, lab personnel cannot alone be responsible for surveying all data available to them for the purposes of powering these use cases – but they don’t need to. Newer technologies, including machine learning, are maturing just in time to help. Newer algorithms (full disclosure: including some developed by my company) can systematically analyze structured data and lab results to flag the patients at highest risk for COVID-19 complications, cancers, chronic disease complications, and more. The natural place for running these complications is in the lab – why? Because labs have both the data and the natural expertise to translate insights back to providers.

 

Jeremy Orr is a practicing, board-certified family physician and Chief Executive Officer and Chief Medical Officer of Medial EarlySign, Aurora, Colorado, USA.

 

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