There are several important trends within the general healthcare environment that have impacted the diagnostic laboratory. As the median age of the population has increased, there has also been an increase in those chronic conditions which are more prevalent and closely correlated with advanced age. This increasingly elderly population will generally require more health services, including those services provided by the diagnostic laboratory.
Another strong theme which has driven the movement toward automation has been the continual pressure to reduce costs. There have been several regulatory changes that have impacted reimbursement rates, such as the reduction in spending through Medicare and Medicaid by $116 billion through the Balanced Budget Act of 1997. Ultimately, the survival of many laboratories may hinge on their ability to operate in a more cost effective manner, since more testing will have to be performed with less reimbursement revenue.
Coupled with the need for cost containment while absorbing increasing test volumes, has been a focus on outcomes which optimize patient care. This is really just another angle on the efficiency focus, but its emphasis is on the patient perspective, rather than merely operational efficiency. The goal of patient-centered optimization is to provide optimal management of a course of patient treatment, which is necessary to achieve the best clinical outcome, while controlling the costs to provide that treatment. As laboratory results become increasingly incorporated into patient outcome optimization schemes, the laboratory will take on a larger role in the management of patient care. Testing methodology is becoming more individualized and pharmacodiagnostic. These changes demand rapid and accurate diagnosis that is treatment predictive. Personalized medicine trends are expected to place the laboratory at a key point of focus in managed care, health maintenance, and disease management within the next five years.
Overall, the idea of high quality tied to efficiency is a consistent theme throughout the current healthcare environment. Like all areas of the laboratory, histology is turning to automation and technology in order to meet these increasing demands.