A simple change in lifestyle can make a world of a difference. A September 2017 World Health Organization (WHO) report said that heart diseases, respiratory diseases, cancer, and diabetes, broadly referred to as non-communicable diseases (NCDs), are responsible for 7 of every 10 deaths globally. NCDs kill 15 million people between the ages of 30 and 70 annually and the number is increasing. In India, NCDs like respiratory infections, tuberculosis, gut infections, dengue, and malaria are a major cause of death, and make up as much as 61 percent of deaths in the country.
But these diseases can be prevented or managed through simple changes in behavior. Bad habits like tobacco use, unhealthy diet, lack of physical activity, and excessive consumption of alcohol can easily be corrected and NCDs altogether avoided. Awareness also goes a long way in helping to prevent these diseases. Regular diagnostic screenings that bring about a preventive mind-set do not just reduce the cost burden of a disease but make it easier to manage or avoid the problem altogether.
A mere 9.6 percent of overall healthcare expenditure in India is spent in preventive healthcare. In other words, a whopping 90 percent of overall healthcare expenses go into treating diseases and their complications amounting to more than Rs. 3.6 lakh crore a year. Further, around half the expense goes for in-patient beds for lifestyle diseases, especially in urban and semi-urban pockets. The fact is that India’s ratio of 0.7 doctors and 1.5 nurses per 1000 people is far lower than the WHO recommended average of 2.5 doctors and nurses per 1000 people.
The government has also taken cognizance of the need for preventive healthcare. The 2012 Union Budget introduced tax benefits under section 80D (IT Act) on preventive health check-up up to Rs. 5000. While the incentive is minimal, the intent is clear.
Unfortunately, healthcare is still mainly patient-driven. People visit a doctor when they feel unwell and then a diagnostic lab for tests based on the doctor’s recommendation. But there is some change happening. Increasingly, we are seeing the demand for regular health check-ups rising. In the near future, more and more individuals will seek a clinical laboratory’s services before they need to visit a physician. This is how diagnostic laboratories will drive the concept of preventive health screens. And that is where value creation in healthcare is poised to happen.
The preanalytical specimen processing domain of the clinical laboratory operation is typically prone to multiple errors in specimen handling and aliquoting, and represents 70 percent of a laboratory’s total errors. As the market expands owing to rising health awareness and increasing demand for preventive healthcare packages, it will be imperative that clinical laboratories employ strategies to contain pre-analytical errors. Of late, a wide variety of specimen containers have become available to the laboratory for the collection and transport of human fluid specimens. This has increased the complexity of processing specimens before analysis. Owing to substantial advances in technology, laboratory automation, and analytical quality, there is mounting evidence that further quality improvements should be targeted at extra-analytical activities of the total testing process. I foresee laboratories pushing for optimization of services through technological upgrades and focusing more on pre-analytical automation.
The central laboratory concept was first implemented in the mid 1980s in the United States of America, driven by the need for a more rigorous way to collect, combine, and report clinical trial data from different clinical sites. The concept was later expanded for offering retail laboratory services to a vast geographic area from a central laboratory, thus achieving significant economies of scale. In the mid-1990s, creation of the European Union simplified cross-border transportation in Western Europe and triggered the setting up of central laboratories in Europe. SRL started its central clinical reference laboratory in 1995 in Mumbai with a state-of-the-art laboratory and an efficient logistics network. One of the primary goals of a central laboratory or a chain of laboratories is to achieve a 24-hour or less turnaround on the shipment of any laboratory specimen from any market it operates in.
The key technology that will drive logistics applications of the future is one that lets a laboratory understand the logistics effects on the quality of biological material by cellular enabled real-time temperature tracing combined with cloud-based IT systems for data collection. These data-loggers will not only record and transmit the temperature inside the sample container, but also a wide range of logistics and transportation factors that affect the quality of the biological material. Logistics for collecting samples at customer’s doorstep will usher in the era when services will move to a customer’s house rather the customer coming to a laboratory. I foresee a steep growth in requirement for quality logistics services and tracking mechanism for delivering accurate reports within the least possible turnaround time.
Speaking about IT application in healthcare, artificial intelligence (AI) is making big waves. Artificial neural networks and natural language processing capabilities of super computers may not revolutionize clinical diagnostics in 2018 but will surely make inroads into the way big data on lab servers is analyzed and service is delivered. AI can use algorithms to learn patterns from a large volume of healthcare data, and then use the obtained insights to assist reporting of diagnostic tests for use in clinical practice.
For example, even a normal report made on a panel of tests can be personalized based on an individual’s demographics and clinical history, and a health score can be attributed to that individual. AI can also be equipped with machine learning and self-correcting abilities to improve its accuracy based on an expert’s feedback. AI is already being applied in analyzing next-generation sequencing data from the human genome and for tailoring therapy for individuals as per their genetic makeup, especially in cancer treatment. AI is poised to make precision medicine far more accurate and intuitive.
Another significant trend, which I feel will change the clinical diagnostics field for the better is focus on quality standards through accreditation and proficiency testing. Empowered by information available in mass media, more number of customers will like to see stamps of standards of quality on the laboratory reports. The national laboratory accreditation board NABL has seen a steady growth in the request for its accreditation over the last few years. The number of NABL accredited laboratories increased to 1766 from 1165 in 3 years. Even the number of College of American Pathologists (CAP, a US based global laboratory accreditation agency) accredited laboratories crossed 50 in 2017 in India.
For diagnostic laboratories the main drivers will be the focus on preventive healthcare, shorter turnaround time through automation, next-generation logistics network, value added services like application of AI for qualifying lab reports, home collection of samples, and establishing connect with customers through handheld devices. Even as health awareness spreads, as with any other healthcare services, the focus for laboratories will shift from a physician-centric approach to a customer-centric one. Although this shift is already palpable, it will gather momentum in 2018 onwards as laboratories move away from a simple pathology test provider’s role to an integrated healthcare solution provider’s one.