Career options for the medical technologist

1. Career options for the medical technologist Cheryl G. Davis, DHA, CLS(NCA) Associate Dean for Administration and Resource Development Tuskegee University AMT National Meeting July 10, 2013

2. Objectives • Discuss the body of knowledge for laboratory practitioners • Discuss clinical skills for laboratory practitioners • Discuss career options for laboratory personnel • Advanced training and skills required for selected career options • Clinical laboratory as it relates to meaningful use and transparency

3. Introduction • Medical laboratories represent an area of healthcare constantly undergoing changes due to technological advances and external pressures. • Forecasting future can be risky. • Prepare for the future.

4. Body of Knowledge • Normal and pathological physiology, biochemistry, and basic genetics • Disease processes and their etiology • Differential diagnosis • Pharmacokinetics • Diagnostic and therapeutic procedures and their biochemical consequences • Analytical theory, quality control, and quality assurance • Ethics in laboratory medicine • Diagnostic function of other pathology departments • Operations of clinical environment and the healthcare system • Mechanisms for quality assurance and improvement

5. Skills for Clinical Liaison • Problem solving • Critical appraisal • Creativity, initiative, observational and questioning skills • Communication, teamwork, and presentation skills • Information technology • Applied statistics • Application of knowledge

6. CAREER OPTIONS “The only way to predict the future, is to create it.”

7. Academia • Continuous supply of laboratory personnel • Curriculum development • Basic and advanced training • Masters • Doctorate

8. Administration • Hospitals • Clinic/Group Practices • Community-based organizations • Government

9. Public Health • Epidemiology • Infectious disease • Chronic diseases • Surveillance • Health promotion/prevention

10. Research and Development • Principal investigators • Collaborators • New products • Protocols • Medical advances

11. Consultants • Correlate laboratory data and patients status • Proposed changes in CLIA and HIPAA to allow patients direct access to results • Home lab tests

12. Bioterrorism • Identification of pathogens • Identification of chemical substances • Standards of practice • Relationship with state and federal agencies

13. Sales/Marketing/Technical • Promoting laboratory products • Technical services

14. Meaningful Use • As the healthcare landscape continues to modernize, recent legislation was passed to encourage the adoption of Electronic Healthcare Record (EHR) technology in documenting patient care. As a result of the American Recovery and Reinvestment Act (ARRA) eligible Medicaid providers, beginning in 2011, are offered financial incentives for the implementation and meaningful use of Health Information Technology (HIT) in the management of patient populations.

15. Meaningful Use: Consumers • The safe and secure exchange of health information is a great benefit to health care consumers. One Health Record will not only help to improve the quality of care patients receive, it can also lead to a reduction in health care costs.Integrity, privacy and security are essential components of One Health Record. Consumers can rest assured that their private health information will be protected under federal and state guidelines by industry leading practices and safeguards.

16. Transparency • The trend toward greater transparency in health care pricing continues to spread. • This trend is designed to require providers, including clinical laboratories and pathology groups to make laboratory test prices available to patients and consumers. • Transparency is expected to contain rising health care cost by creating consumer-driven competition between providers.

17. Continued • Oregon, Utah, Tennessee, New Hampshire, and Maine have legislation establishing statewide online database of costs for medical treatments. • Massachusetts launched MyHealthCareOptions (http://hcqcc.hcf.state.ma.us/ is an interactive, consumer-friendly web site that allows consumers and stakeholders to compare common healthcare procedures at hospitals in the state. Examples: hip replacement, angioplasty, mammogram, etc.

18. Advanced Practice Roles • Analyze and sign out without pathologist oversight all laboratory test requiring interpretation (i.e. bone marrow aspirates, etc.) • Define a list of test which an interpretation is approved for payment. Work with payers on test list for which interpretation is necessary and approved for payment, but does not require a medical doctor.

19. Continued • Perform and interpret molecular testing at the clinical, research, biotechnology, and forensic levels. • Work on team with genetic counselor, physician on all genetic testing; serve as a genetic counselor. • Replace nurses as the intake/collection/etc. personnel in all blood donor centers.

20. Continued • Automation engineer • Biomedical engineer • Information technology • Pathology Assistant • Physician Assistant

21. Advanced Technical Practice • Perform bone marrow aspirates and biopsies • Work with payers to modify/define reimbursement rules to include services/procedures performed by non-physicians • Perform cerebrospinal fluid aspirations and other non-routine specimen collections • Collect routine specimens for microbiological investigation (from throat swabs to cornea scraping)

22. Should the masters degree be the entry level for MLS/CLS/MT? • Leadership • Quality assurance • Laboratory management • Education • Patient advocate • Consumer education

23. Doctorate in CLS • Advanced knowledge in scientific areas that impact on patient care and/or may not have been included in the previous CLS/MT curriculum (i.e., epidemiology, pharmacology, and pathophysiology) • Health care knowledge necessary to provide and coordinate patient care as impacted upon by laboratory testing. Development and application of clinical decision making, development and application of critical paths/test algorithms, utilization review, patient and provider safety, quality systems, and medical error prevention.

24. Continued • Patient assessment and participation in clinical experiences to include clinical rounds. • Collecting, managing, securing and applying information from patient records. • Interpersonal and communication skills necessary to function in direct patient care with diverse communities of patients and family members and with other health care practitioners (physicians, nurse practitioners, physician assistants, etc.) as an independent provider of health care.

25. Continued • Capstone experience, applied research, or translational research as required by the college. Integral components will include research design, statistics, grant writing, protection of human subjects, and research ethics. • Knowledge in development, interpretation and application of health care policy and legislation to include reimbursement policies, medical liability exposure, licensure, ethics, tort, patients privacy protection, etc.

26. Continued • Knowledge in health care services delivery and access through skills developed in resources management, outcomes analysis, analysis of costs relative to benefits, etc.

27. Integrating CLS Doctorate into the health organization • Educationally and experientially prepared to recommend support and enhance appropriate testing • Translate and transform complex laboratory data into an understandable product necessary for clinicians to be able to assess the validity of current and new assays to ensure better patient care • Assist in reducing questionable test usage, thus reducing costs

28. Stakeholders

29. Creating the Future • Proactive • Advanced Training • Advocate (public and legislative) • Professional Organizations

30. Ready for the future • Opportunities • Change is inevitable • Visibility • Use our knowledge-base • Leave the lab and/or allow others in • New skills sets • Different thought process

31. LET’S CREATE OUR FUTURE!!!!!!!!!!!!!!!!!!!!

33. References • Bossuyt. B., et.al. (2007). Clinical Chemistry. 53. No. 10, p1730-1733 • Clinical pathology labs should plan on greater transparency in test prices and patient outcomes. Retrieved from http://www.darkdaily.com/clinical-pathology-labs-should-plan-on-greater-transparency-in-test-prices-and-patient-outcomes-813#axzz1mfcAhT9e • Montoya, I., Kimball, O. (2009). Integration of the CLS doctorate into the health care organization. Clin Lab Sci; 22(3) pp136-140. • NAACLS Doctorate in Clinical Laboratory Science Guide to Accreditation • One Health Record, www.onehealth.alabama.gov • Panteghini, M. (2004). The Future of Laboratory Medicine: Understanding the New Pressures. ClinBiochem Rev. Vol 25. November. p207-215. • Plebani, M. (2002). Charting the course of medical laboratories in a changing environment. ClinicaChimicaActa. 391, p87-100 • Preparing to Implement HITECH: A Date Guide for Electronic Health Information Exchange. http://onehealthrecord.alabama.gov/Documents/1.5_Reference_Documents_and_Links/1.5.2_National/1.5.2_NGA_HIE_Report.pdf • Yu, M.(2012). Proposed Changes in CLIA and HIPAA. Advance. Posted on: January 23, 2012