Health Equity Starts in the Lab: Here's How

Empowering labs to bridge health equity gaps by enhancing patient access

Pursuing a career dedicated to improving patients’ lives is done with the belief that everyone should have a fair opportunity to achieve their highest level of health. 

Despite this belief, health equity remains a major challenge. Rather than merely being frustrated by healthcare disparities, we should use them as fuel to motivate us to continue building on the progress being made. The clinical laboratory is an area where medicine is making strides toward addressing healthcare equity and access issues.

The lab has more patient touchpoints than any other outpatient service line. It also has the potential to make the greatest impact on their lives. After all, diagnostic testing is the link that connects patients to the appropriate therapies and interventions. With advances like at-home tests creating new ways to reduce access barriers, the lab presents a key opportunity to address longstanding inequities by making needed changes.

GAINS MADE 

Health systems have made progress in recent years to bring down the barriers between patients and the testing that can help them identify their health issues and get them on the path to wellness.

Mobile clinics, for example, have helped bring laboratory testing and other care to communities with socioeconomic challenges and healthcare disparities. Programs providing free at-home tests to underserved communities have helped medical centers build relationships with those communities while also helping to screen for diseases that they are at higher risk of dying from.

In the clinical laboratory, artificial intelligence (AI) is already being used to improve efficiency, providing faster and more accurate testing. These tools promise to help address accessibility. Yet there are concerns that the lack of diversity in the data used to create them has the potential for AI to skew or bias data, negatively impacting care equity. New technologies address this problem by identifying bias, specificity, and sensitivity in AI models. This can help ensure models developed for the lab and the entire care spectrum are accurate and unbiased to reduce racial, gender, and socioeconomic inequities.

Health systems have also realized that ending healthcare disparities is too big of a job for any organization to do independently. Improving access to care for all and ending inequities are better addressed through collaboration. For instance, a county-owned medical center in rural Missouri expanded its operations recently by opening several new laboratory draw sites and clinics. Previously, the organization had only one draw site. The new draw sites allowed the medical center to better reach all patients—including those in underserved communities—in its service area, which spans several counties and thousands of square miles. 

To help manage the increased outpatient lab volumes, the medical center turned to an outside medical reference laboratory. Through the partnership, the medical center has done more than get timely results for patients; it has found greater value in its lab. Working with the outside lab helped the medical center determine which tests made financial sense to keep locally versus outsource. Now, the medical center is working with other smaller hospitals in its service area to bring them into this lab network.

Amid this progress, however, more work must be done to make clinical diagnostics an agent for change. We collectively need to think about how to make tests more accessible by meeting people where they are, in ways that are affordable, understandable, and actionable. 

The pandemic drove a massive increase in the global manufacturing base for low-cost, self-administered diagnostics. To understand how to harness this to drive meaningful change in healthcare, we must go beyond thinking about the business case for home testing kits. Instead, to be invested in our primary calling to serve the health and well-being of society, we should collectively think about how to use this capability to broaden access to high-quality diagnostics across high- and low-resource settings. 

By keeping the societal value front and center, we can ensure these technologies can have the biggest impact in closing testing disparities. 

COMMUNITY CONNECTION 

There are endless opportunities to engage with communities in hopes of building trust and dispelling myths in historically underserved populations. These opportunities can only be realized if we take the time to understand and appreciate cultural differences in how healthcare is viewed and how knowledge is shared. Sharing of information will require at least as much, if not more, listening than talking.

This, of course, means that we need to step outside of our facilities—and sometimes out of our comfort zones—to hear the voices of people who aren’t visiting their local clinics so we can learn directly from them about how we can be most helpful in engaging their communities to improve their well-being and healthcare. 

Similarly, we need to engage in meaningful dialogue with policymakers. Whether we are in the lab, in a clinic office, or in the boardroom, we are intently focused on the patient. We think about what the patient needs and how to serve them best. We must be advocates for and the voices of patients to support policies to address the barriers patients experience in trying to access testing and treatments. 

To make the greatest impact, we need to reach out to other stakeholders who see the issues we are looking to address from different perspectives, such as companies that design and produce medical devices, patient advocacy groups, and other nonprofit organizations. Bringing stakeholders together will ensure that we deliver a compelling, holistic message and amplify its impact on policymakers and payers.

A ROLE FOR EVERYONE

We must continue to fight to remove bias and barriers in healthcare until the day that a person’s genes and healthcare decisions are a better indicator of their future health than their zip code. Closing health equity gaps may seem like too big of a challenge to solve. But we all have our own experiences and expertise—whether in diagnostics, treatments, or the business of medicine—that we can draw from to make us better listeners of, and advocates for, underserved populations.

Credit: Lab Manager