Clin Biochem. 2010 Aug;43(12):939-41. doi: 10.1016/j.clinbiochem.2010.05.015. Epub 2010 May 31.
Technological developments and economic drivers have led to major changes in clinical laboratories worldwide, principally represented by an increase in testing productivity and efficiency. Currently, major expectations are entrusted on the introduction of diagnostically more effective tests as well as on translating the "omics" techniques into the clinical practice. However, the increased automation and standardization have far outpaced the laboratory professional involvement in assuring optimal test utilization and interpretation. While productivity of 'commodity' testing increases, the value of laboratory services seems to decrease contextually. This development represents a serious threat for laboratory medicine as an academic discipline not only because the laboratory professionals may lose the direct control of the commodity testing production activities but also because the present evolution exposes a failure of our core clinical activities, that is and remains the translation of laboratory data into valuable information for improving patient's outcomes. At a time when a revolution in healthcare organization is virtually unavoidable in the years ahead, clinical laboratories must proceed from a merely reactive strategy to a more proactive role in patient care. As patient-centered care is increasingly recognized as a primary focus in reorganizing the delivery of healthcare services, integrated practice units organized around the patients' needs and medical conditions are needed. An effective strategy to overcome the current inefficiencies in the delivery of laboratory services should encompass translation into integrated, multidisciplinary care, in which appropriateness in test request and interpretation both play a central role in assuring efficiency and effectiveness.
技术发展和经济驱动因素导致全球临床实验室发生重大变化，主要表现为检测生产率和效率的提高。目前，人们主要期望引入更具诊断效果的检测方法，并将“组学”技术转化为临床实践。然而，自动化和标准化的程度已经远远超过了实验室专业人员在确保最佳测试利用和解释方面的参与度。虽然“商品”检测的生产率在提高，但实验室服务的价值似乎在相应地下降。这种发展对作为一门学科的检验医学构成了严重威胁，不仅因为实验室专业人员可能失去对商品检测生产活动的直接控制，而且还因为目前的发展暴露了我们核心临床活动的失败，即仍然是将实验室数据转化为改善患者预后的有价值信息。在未来几年，医疗保健组织的革命几乎不可避免，临床实验室必须从仅仅的被动策略转变为在患者护理中发挥更积极的作用。随着以患者为中心的护理越来越被认为是重组医疗服务提供的主要焦点，需要围绕患者需求和医疗条件组织综合实践单元。克服当前实验室服务提供效率低下的有效策略应包括转化为综合的多学科护理，其中测试请求和解释的适当性在确保效率和效果方面都起着核心作用。
