By Gary L. Milburn, PhD   

The clinical laboratory diagnostic field is undergoing major change. The available technologies are rapidly changing, improving, and becoming more complex, and there is increasing financial pressure on laboratories. In addition, the paradigm of patient management is shifting from diagnosis and treatment to risk assessment and predisposition, facilitating the hope that behavior changes and appropriate intervention will prevent the onset or advance of a disease or disorder. Furthermore, patients are now more informed about their own bodies and health and are more frequently demanding that their health management include the latest diagnostic and treatment options. Collectively, these changes put ever-increasing pressure on laboratorians and clinicians to remain current on advances in clinical laboratory medicine.

However, the reality of laboratory management requires management of sophisticated laboratory operations, which can include dealing with staffing shortages, failed runs, reagent back orders, and equipment failures, with many interruptions in between. These important issues rightfully take precedence over the need and desire to learn about new assays and how they impact patient care. Laboratorians often have to scramble to answer a clinician’s question about a new assay or test that has been brought to their attention by an informed patient or a recent journal article. So, how can laboratorians keep up to date while juggling so many crises and interruptions?

Enter the GETS Team
The Quest Diagnostics solution for laboratorians is to deploy an elite group of laboratory professionals called GETS (genomic and esoteric testing specialists). The GETS team provides information about alternative and improved testing methodologies, new technologies and other clinical diagnostic advancements. They provide an educational and consultative resource to Quest Diagnostics customers, including hospital laboratory personnel, physicians, and clinicians, helping them to understand the ever-changing differences in available technologies. The GETS team concept was launched early in 2003 and has been extremely successful thus far.

The Quest Diagnostics GETS team currently consists of 11 PhD/MD genomic and esoteric testing experts nationwide. The team works exclusively with hospitals to help lab directors, laboratory personnel, pathologists, and physicians understand the increasingly complex world of diagnostic testing. Their mission is to provide hospital laboratories with access to sophisticated clinical science expertise and to help hospital laboratory personnel better understand ongoing advances in genomic and esoteric testing.

When developing the GETS program, we recognized that the greatest need for the hospital testing segment was to have a top-tier team with clinical science backgrounds and expertise to help hospital labs understand and choose genomic and esoteric tests. Quest Diagnostics management therefore insisted on building a highly qualified team that was devoted exclusively to the hospital environment.

Anecdotes from the Field

GETS education initiatives include proactive and reactive scenarios

Education in Advance of a Problem
Last winter, as a GETS team member, I had a scheduled engagement to speak to a group of lab directors in Portland, Ore about HIV and hepatitis C testing. However, as it turned out, these lab directors were eager to obtain information about testing for West Nile virus, which they knew would be hitting the West Coast a few months later. They wanted to know what Quest Diagnostics offered for West Nile virus and what symptoms to look for in the emergency room or in a hospitalized encephalitis patient that would indicate the need to order a West Nile virus PCR test.

I spoke to this eager but anxious audience of lab directors on the unanticipated topic of West Nile virus testing, as well as on my prepared topic of HIV and hepatitis C testing. The lab directors left the conference feeling more educated and confident about being able to meet the expected inundation of West Nile virus cases.

Education Before and During a Problem
Until recently, the hepatitis C virus test result was reported in “copies per mL.” But monitoring the patient’s treatment progress was complicated by lack of an HCV viral load standard. As a result, numbers were frequently inconsistent depending on the diagnostic instrument, the technology used, and the laboratory running the test. So, the World Health Organization issued a statement calling for standardization utilizing a standard control quantitated in international units.

The result was concern and frustration among many doctors. They wanted to know why the change was made; what international units were; how they correlated to copies per mL; how to recalculate their reports; and how to follow their patients who had previously been measured by copies per mL.

For many large academic institutions, the GETS team responded to doctors’ frustrations with a straightforward message: this is the change that is coming; here is what it means; here is the conversion factor; and, importantly, we will support you through this. GETS team members visited labs to help them understand the new standard of care guidelines for hepatitis C patient management.

Education to Dispel Uncertainty
A new transplant drug has been rapidly adopted by the transplant world. When transplant patients are treated with such drugs, they need to be monitored because too much of the drug can lead to immunosuppression and infection, but too little can lead to rejection of the transplant. One form of monitoring is done with a new assay performed on an LC-MSMS instrument, an expensive cutting-edge instrument that requires a significant investment in both dollars and operational expertise. Quest Diagnostics performs this test, but labs and doctors still want to know what the reference range is, what the turnaround time is, and how to match the test result with other clinical test results to best manage their transplant patients. They find it reassuring that their GETS expert is able to help answer their questions, provide consultation, and help replace their initial uncertainty with knowledge and confidence. The assay is set up twice per day, seven days per week at the Nichols Institute.

Crisis Management
GETS specialists have also become the conduit when and if issues arise with sample collection. Complications, such as the wrong specimen type is provided or a sample is frozen instead of kept at room temperature, occur all the time. GETS specialists help to address these problems every day. They can advise, for instance, that for flow cytometry an ambient room temperature is needed for blood sample, and that if the sample is frozen, there is no way to recover, and you must redraw the patient. Different problems have different solutions, and the GETS team can sometimes help the lab or doctor salvage a specimen and obtain a clinically valid result.

GETS: A New Concept for the Hospital Lab
The GETS team provides educational services to labs and physicians. Team members offer multiple, overlapping, and clinically relevant science and business strengths, and many complement their PhD/MD degrees in such areas as molecular diagnostics, histopathology, and molecular genetics with MBA degrees. All members bring strong problem-solving, interpersonal, and presentation skills to hospital clients. This blend of technical know-how and customer service has been most welcome.

Equipped with a thorough understanding of clinical genomic and esoteric testing, GETS experts assist lab directors and pathologists (and physicians, when requested by lab directors) in understanding a test and when it is appropriate to order. Information needed about a new or upgraded test can include what the clinical utility of a test means to the lab’s physician clients and patients; a test’s sensitivity and specificity advantages and disadvantages; factors a lab should consider when determining whether to switch to a new testing technology; which specific esoteric test is the correct one to order; how to interpret a laboratory report for a complex esoteric test; and the cost-effectiveness of bringing an esoteric send-out test in-house.

How GETS Serves Education Needs
The GETS team’s education function spans a spectrum that includes, but is not limited to:

• Providing support and consultation on the clinical aspects of testing services
• Addressing national and local professional society meetings
• Delivering formal presentations at grand rounds in major academic teaching hospitals
• Presenting informal clinical presentations to laboratorians in a “lunch-and-learn” format
• Providing CEU and CME lectures

For information on these and other educational opportunities, contact Gary L. Milburn, PhD, via email: [email protected].

Relationship Is Key
The hospital-targeted GETS concept is only a year old, yet lab directors, pathologists, and doctors have already reported that their relationship with their GETS specialist is personal and collaborative. The patient’s best interest is their collective goal. They have told us that having a peer specialist to call on adds a meaningful clinical, educational, and consultative boost to the customer service they receive from Quest Diagnostics. GETS specialists work most often through the local hospital lab director, unless instructed or invited by them to interface directly with the lab’s client doctors.

The relationship between a GETS specialist and a lab director often begins at the sales stage, when the GETS specialist accompanies a Quest Diagnostics account executive. What could have been a routine sales call becomes a valuable information exchange session for explaining a new test. Often, lab clients say that the sales call was a win-win situation—and the relationship with their GETS consultant was forged at that time.

Looking Ahead
The laboratory testing environment is characterized by rapid change, uncertainty, and the relentless need for new information. In such an environment, our clients have quickly recognized the value of the GETS program. Based on the increasing number of requests for GETS specialists to serve as speakers and educators, Quest Diagnostics has recognized that the need for expert genomic and esoteric testing knowledge in the field is enormous. In response, we will add more members to the GETS team in the near future.

Gary L. Milburn, PhD, is the national director of Genomic and Esoteric Testing Services for the Hospital Business Unit at Quest Diagnostics–Nichols Institute. Prior to becoming the director of the Hospital GETS program, he served as the scientific director of the Molecular Diagnostics Laboratory at Quest Diagnostics–Nichols Institute, Chantilly, Va.