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Monday, February 15, 2016
The Laboratory Exoskeleton
One of the advantages of attending conferences is all that empty time that occurs while sitting on the airplane on the way home. I know that many people would not see that as a plus, but this is one of the few moments in time when your mind is set into motion having absorbed all sorts of information – some new, novel and excellent, some maybe not so much. There have been conversations, again some routine, but others very intriguing and stimulating. And now you find yourself on the airplane, usually alone, contemplating and reviewing and contextualizing.
That opportunity rarely comes along, except in the situation as described.
On this occasion I was returning home after attending the Labquality Conference in Helsinki for two days, and was now spending what was feeling almost as long sitting in airports and airplanes waiting to get home.
The conference was excellent; interesting people, interesting topics, interesting ideas. Much more on this later.
The two themes of the conference were Pre-Analytics and Point of Care Testing. (Personally, I think the term Pre-analytics is incorrect; the correct term would be Pre-Examination. That being said, I agree that pre-analytics is easier to say and easier to write.) This was not particularly surprising because these have become very hot topics in the medical laboratory arena over the last few years, with Quality folk interested in both, each in its own distinctive way. The two topics were presented on sequential days to pretty much the same audience. As much as they are very different topics, they felt they were kinda-sorta related.
So I came up with a way to formally put them together.
During the “Pre-analytics” portion of the conference, every presenter, including myself came up with a slide that showed a version the Total Testing Cycle or the Laboratory Testing Cycle. You know what I am talking about: It goes from the Patient to the Pre-Pre-Examination Phase to the Pre-Examination Phase to the Examination Phase and on to the Post-Examination and Post-Post Examination phases and then back to the Patient. I think of this as a linear horizontal pathway.
It works, but focuses on one aspect of the laboratory activity, specifically the testing process. But it leaves out a lot of other stuff that is equally important; laboratory Quality, laboratory Safety, laboratory Communications.
So I have put together another schema, this based on a core, a layer of activities that holds the core together and intact, and related activities that occur outside and separate from the laboratory. I think of the layers as:
The laboratory core: the central activity of laboratory testing. It is the laboratory analysis activity area. This is the testing activity that occurs within the four walls, the ceiling and the floor of the laboratory space.
Exo-Analytic Layer: The layer of activities that sits outside the testing core and serves as providing support and binding. The prefix "exo" means “outside but an extrinsic part”. Think of this as the exoskeleton of laboratory activity. This is the layer that includes Quality, Safety, Communication and Education, plus others.
The Extra-Laboratory Layer: The layer beyond out side the Exoanalytic. The prefix “extra” means outside and separate, but may be related. This would include activities that includes transport and legislation issues as well as home and residential considerations.
These days this schema gives a way to indicate that Point of Care Testing crosses into all aspects of the laboratory with a very small component being part of laboratory testing, a larger amount being part of the exo-analytics, and an even larger part in the extra-laboratory.
The advantage of this layered view is that it makes clear that some exo-analytic activities have important associations with laboratory testing, others have associations with the outside community, and others have both. Each has to addressed in its own way.
Over time I will refine the model. Today I think it works; I will see if it continues.
Important message to self: the long sit on the airplane can be filled with moments other than Sudoku.