By Dr Ahmed Bentahar

Dr Bentahar received his MD and PhD from État de Liège University, Belgium, and his master’s degree in health management and leadership from the European Institute of Health and Social Wellbeing in Madrid. As a member of the Sociedad Española de Hematología y Hemoterapia (SEHH) and Asociación Española de Biopatología Médica (AEBM), Dr Bentahar has earned international recognition as a respected thought leader and uniquely qualified facilitator of hematology industry seminars, workshops and congresses.

He has been working at Beckman Coulter for 34 years now, giving him a ‘historical’ perspective on the development of relations between the different disciplines within the laboratory, and on the communication between medical pathology specialists and clinicians. He has experienced the sector’s development first-hand, moving from an approach initially focused on increasing the volume of all tests carried out to the modern era, where the value is now seen as quality. Here, Dr Bentahar discusses the importance of integrated diagnostics and the need for enhanced collaboration and communication between the various actors involved in patient care.

Beyond defining our present-day operations, integrated diagnostics is also our future, notably with the integration of tools that employ artificial intelligence. Every patient is unique. They go to the doctor with symptoms, and the doctor prescribes tests. After all, some studies indicate that test results received from laboratories account for 60% of the weight of a doctor’s decision. Once the tests are ordered, the various samples collected are distributed to the various laboratory units. Each unit then analyses the sample received and produces results. The individual results are then sent back to the doctor but may not be always adequately interpreted – meaning, the patient results, thus, won’t be integrated. Instead, the doctor works from the raw data and strives to narrow down the differential diagnoses based on their own personal knowledge.

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We firmly believe, especially in complex cases, that the various disciplines (hematology, clinical chemistry, coagulation, immunoassay, etc.) must communicate, discuss and share their expertise and, whenever needed, communicate with the clinicians, who can provide additional information to help laboratorians better interpret test results

In this model, integrated diagnosis means synergy and two-way communication between laboratories and clinicians. Let’s take the specific case of a new syndrome described for the first time in 2020: VEXAS syndrome. A patient presented with what seemed to be rheumatological problems, so a rheumatologist took care of this difficult case. Eventually, the patient developed a macrocytic anemia, the origin of which was not understood. So, tests were run, levels of vitamin B12 and folic acid were measured, and no underlying cause was found to explain this macrocytic anemia. The patient was, therefore, referred to the hematology department. The hematologist investigated, ran tests, and finally proceeded with a bone marrow aspirate/biopsy to assess the bone marrow stroma. There, the hematologist found that most of the immature cells from different lineages, which we call blasts, had cytoplasmic vacuoles. This was the first time that this abnormal phenomenon was described in that hospital. During the discussions that followed, one of the hematologists recalled reading a recent paper that described a syndrome called VEXAS – the first patient had been diagnosed in the UK. That is how they started collaborating – rheumatologist, hematologist, hematology laboratory – and were able to prescribe a treatment, thanks to an integral approach to a complex syndrome.

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Integrated diagnostics can impact the clinician’s daily practice and fluid communication between the different actors involved can facilitate the final diagnosis and, thus, the effective therapy

The example described above shows how effective communication and integrated diagnostics can be. In fact, the benefits of such an approach are threefold.

• The first is a shortened response time by the clinician. By integrating the various findings and discussing them, the patient’s data can be interpreted more quickly, and these interpreted results provided to the clinician. Time is a fundamental factor!
• Then, the information provided to the doctor forms a more solid base from which to approach a differential diagnosis, enabling them to prescribe an effective therapeutic strategy as quickly as possible.
• Finally, and above all, this approach benefits the patient, who is at the heart of the healthcare provider’s mission, as stated by the World Health Organization.

This approach can, therefore, potentially limit diagnostic delays and shorten the long and challenging journey some patients find themselves on, sometimes being referred from one service to another for years before they get any answers or find effective treatments.

Nowadays, diagnostic companies seek to contribute to strengthening this multidisciplinary approach to different disease states.

They seek to provide a better support to the laboratorians by developing more efficient and sophisticated solutions, enabling laboratorians to streamline overall laboratory workflow and improve test sensitivity and specificity to detect various abnormalities.

Also, by listening to the clinicians themselves to better comprehend their concerns the diagnostic companies can develop new clinical applications that meet the clinician’s explicit needs and fill the existing gaps.

For instance, let’s take the case of bone marrow analysis. During my training as a clinical pathologist, we could only use manual microscopy to provide the bone marrow differential after analysing at least
500 cells. We could only have dreamed that, someday, this task would be fully automated. Today, this is a reality! Applications are available that combine light microscopy and artificial intelligence, providing a fully automated bone marrow differential.

Furthermore, diagnostic companies are continuously seeking to develop novel biomarkers. These cutting-edge biomarkers are then integrated into our systems, which may provide real added value to patient assessments. For example, we recently developed a biomarker to help establish the risk of severe infection and sepsis and integrated it into a hematology analyser, which made it available in all CBC/DIFF (complete blood count with differential) tests with no workflow changes and no need for the Emergency Department physician to order additional tests.

It may take an average of 4 to 6 hours from a patient’s admittance at an Emergency Department to the time when a clinician suspects that they may be at risk of developing sepsis. This could delay effective antimicrobial therapy, increasing both morbidity and mortality rates.

Finally, diagnostic companies may better support laboratorians and clinicians by providing continuous educational and training materials. For instance, Beckman Coulter has a group of Medical Directors dedicated to providing that support by developing scientific materials and interacting with laboratorians and clinicians to tackle their concerns and help them better interpret the results provided by the analysers. Not less important is the role played in the promotion of a multidisciplinary approach to different disease states and strengthening the synergy between laboratorians and clinicians for a better patient care.

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The contribution of artificial intelligence (AI) at the diagnostic level may help accelerate communication between laboratories and clinicians

Artificial intelligence (AI) is a tool – as such, the more data are collected to develop its algorithms, the more added value may be provided. The main goal of implementing these tools in the daily routines of labs is to improve patient care. For example, a laboratory professional may be a subject matter expert in clinical chemistry but not in hematology or immunoassay, etc.; this is where AI can provide useful ancillary information, e.g. suggesting several approaches to interpreting a test result.

AI can, on the one hand, fill gaps in knowledge or expertise and, on the other, suggest following steps to help narrow down a differential diagnosis. Moreover, another contribution of AI may consist in allowing healthcare professionals to go beyond the boundaries of the different disciplines for the sake of an integrated diagnostics approach. Tools are emotionless, they are not subject to human error, and above all, they can compute a huge amount of data in a very short time. This makes them extraordinarily time-saving and enables us to standardize the approach taken to diseases, regardless of the level of expertise of each professional. Doctors, like all humans, have different levels of experience. We are specialists in one field but not all, and expertise levels also vary within the same speciality. Therefore, we need to share knowledge in the most effective way possible.

Where I see a challenge is in the rejection of these new tools by health professionals

“Will I always be needed?”, “Will my job still exist, or will a robot do the work for me?”, they wonder. Personally, I am convinced that those most likely to disappear are the professionals who don’t learn to use AI! It’s an inevitable development, and I think we need to be aware of that and accept the idea that AI is, quite simply, a tool at our disposal. Diagnoses are not made by AI; they are made by clinicians, but in the future, clinicians will be able to rely on the data provided by AI and will benefit from the speed and integration of this tool when making decisions.

Finally, I would like to conclude by quoting Professor Steven H. Kroft, a clinical pathologist (Medical College of Wisconsin, Milwaukee, WI, USA):

“Laboratory professionals are not number providers.”

Indeed, that’s what we were doing until recently. Instead, laboratory professionals can play a crucial role in providing interpreted results.

Here, once again, the importance of synergy between diagnostic companies (not just Beckman Coulter!) and healthcare professionals comes to the forefront in providing information, education and the means to better interpret results for the benefit of all patients.

The author

Ahmed Bentahar MD, PhD
Medical Director of Medical and Scientific Affairs at Beckman Coulter Diagnostics
Beckman Coulter Inc., Miami, FL, 33196, USA

Email: EUPublicRelations@beckman.com