Next Generation Public Health: Can Laboratories Enhance the Value Stream?

By Glen P. Mays, MPH, PhD, Director, National Coordinating Center for Public Health Services & Systems Research; The University of Kentucky, Lexington

Next Generation Public Health:  Can Laboratories Enhance the Value Stream? |

Dr. Glen Mays will present the Dr. Katherine Kelley Distinguished Lecture on Tuesday, June 3, at the APHL Annual Meeting and Eighth Government Environmental Laboratory Conference in Little Rock, Arkansas. Attendees, please mark your program for this presentation scheduled for 2:00 pm in the Grand Ballroom. Dr. May’s PowerPoint presentation will be available on the APHL conference website as of Wednesday, June 3.

The Affordable Care Act and related state health reform initiatives are triggering diverse and far-reaching changes within the nation’s public health system.  Public health agencies are renegotiating their responsibilities and relationships with other health system stakeholders and to more clearly define their unique contributions to the “value stream” that produces population health.  My upcoming talk at the APHL Annual Meeting will explore strategies for demonstrating and enhancing the value that public health laboratories bring to the task of improving population health.  Here’s a preview of some of the trends and strategies I’ll discuss in my talk.

Next-generation public health places much greater emphasis on the catalytic functions of information acquisition, analysis and dissemination to mobilize and guide the actions of multiple stakeholders in the health system to achieve population health improvement.  Much of the information needed to support successful population health strategies is generated, analyzed and disseminated through the work of public health laboratories.  Counterfactual examples like the recently documented problems with newborn screening highlight the population health risks that can arise when information flows are suboptimal.  The converse is also true – generating the right information at the right time and getting it into the hands of the right decision-makers can fuel population health improvement.  Consequently, public health laboratories must think strategically about the roles that they can play in using their information flows to build, steer and sustain collaborative efforts in population health improvement, including:

  • Increasing the breadth, volume and quality of information generated through laboratory testing, particularly as the demand for testing increases as a result of expansions in health insurance coverage and new technologies for detecting and preventing disease.
  • Helping policymakers and other stakeholders understand the cost/benefit trade-offs associated with new testing technologies and opportunities.
  • Accelerating the timeliness with which information is produced and disseminated through laboratory operations.
  • Developing and testing innovations that improve the transmission and exchange of laboratory information – from specimen collection and transport through the dissemination and communication of test results. These actions include public health laboratory roles in meaningful use of electronic health records and in population-wide health information exchange.
  • Harnessing and harvesting opportunities for scientific research using the information flows that are generated and/or facilitated by public health laboratories, including the creation of specimen bio-banks, disease registries and test result archives.
  • Improving the resilience of the information flows generated by public health laboratories, including ensuring the continuity of testing and information dissemination capabilities during large-scale emergencies and hazardous events.
  • Using real-time laboratory information to better target and tailor public health interventions to the population groups that can benefit most, in keeping with the movement toward “personalized prevention and public health.”

Implementing these types of strategies will require improvements in public health laboratory capacity, which in turn requires an ability to demonstrate the health and economic value of expanded investments in public health laboratory capacity.  This task –articulating the societal return-on-investment (ROI) gained through enhanced laboratory capacity – is a central challenge for laboratory professionals and the public health community writ large.  Analytic techniques such as value stream mapping, information network analysis and value-of-information (VOI) analysis offer extremely powerful ways of valuing the information flows that are generated, processed and disseminated through public health laboratories.  These techniques can be used to show how the work of public health laboratories fuels the many processes involved in producing population health: from surveillance to investigation, prevention, protection, mitigation and resiliency.

Health reform’s push for improved population health requires more, better and faster information.  Public health laboratories are key to realizing this vision, but progress will require demonstrating and enhancing their value added.  I look forward to exploring these strategies in greater detail at the APHL annual meeting.

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