Diagnostic Services Manitoba (DSM) touches the entire scope of the healthcare system from prenatal testing to autopsy and forensics; from pediatrics to geriatrics; from medical and surgical programs to public health and mental health and all other health services in between. While accounting for 3.5% of the provincial healthcare budget, their services influence over 80% of clinical decisions with laboratory and imaging results. As DSM celebrates its 15th year milestone, the company is keen to acknowledge the keys to its success.
“Our success over the last number of years has been a direct result of prioritising, collaboration and relationship building. We’ve developed important relationships with so many of our clinical colleagues and have really studied how best to deliver value to their work,” says Jim Slater, Chief Executive Officer.
And Slater is not alone acknowledging the role relationships have played in the success of DSM over the years. “Another unique dimension to Diagnostic Services Manitoba is our philosophy that relationships are collaborative partnerships,” states Petr Kresta, Chief Operating Officer. “We have 82 sites across Manitoba delivering diagnostic services and our staff work hand-in-hand with nurses, physicians or other allied health workers to deliver quality healthcare services to the communities they serve. Over the years we’ve seen a trend towards centralisation within laboratories, and while this may be true, it does not mean that we work in isolation from our clinical and regional partners. Without a strong collaborative partnership, we wouldn’t be able to provide efficient and effective diagnostic service models of care that deliver value for our patients.”
Not just a laboratory
DSM is Manitoba’s public sector diagnostic healthcare service provider. “We’re not just a laboratory, we’re a full-scale diagnostics service centre. We manage laboratory testing, rural diagnostic imaging and diagnostic cardiology, which is what makes our model so unique within Canada,” comments Slater. “Our tagline is, ‘We deliver results that matter’. Instead of passively providing lab results or conducting an x-ray or EKG, we work closely with clinicians to ensure that they’re ordering appropriate tests for their patients to help improve outcomes.”
The appropriate use of diagnostic tests has become a significant topic of conversation among the international medical community. A 2015 study published in the Academic Emergency Medicine Journal found that over 85% of respondents believed too many diagnostic tests are ordered in their own emergency departments, and 97% said at least some of the advanced imaging studies they personally ordered were medically unnecessary.
“If you think about it, unnecessary diagnostic tests can cause harm and delays to patients. It can also cause unnecessary costs that burden the healthcare system. What we’ve found in the last few years is that by working closely with our clinical colleagues we are able to collaborate on what clinical tests best improve their patient’s outcome and help minimise unnecessary testing,” Slater observes.
For example, every x-ray and even more so every CT, exposes patients to the increased risks associated with radiation. DSM has made it a priority to work with its partners to ensure that only necessary imaging tests are ordered and performed. “When we meet with the emergency department we can actually talk about these issues and discuss as a team what makes the most sense for the patient,” explains Dr. Amin Kabani, Chief Medical Officer.
“Patient care has always been our top priority. While we are working with our clinical partners to address the use of unnecessary tests and to extract the efficiency and resource savings that go along with that, patient safety and care is never compromised. We have checks and balances in place within DSM to make sure the patient always receives the most appropriate testing and best possible care. As an organisation we pride ourselves on our track record of being accredited by the Manitoba Quality Assurance Program (MANQAP) and College of American Pathologists (CAP), which is one of the highest ranked accreditation agencies for medical laboratories in the world.”
By creating such efficiencies, DSM has been able to increase investments in other areas. “By eliminating unnecessary testing we’ve been able to redirect resources and significantly invest in genetic testing, which is one of the biggest challenges we are facing today,” Slater observes.
“The future of diagnostics is becoming very genetics-based. There are drugs, for example, which will not work if you do not have the right gene, gene combination, gene expression or gene inhibitor. A major challenge for everyone across the world, frankly, is how do we keep up with the science of genetics with high quality, reproducible genetic testing? Many cancers now are not only diagnosed or staged simply on traditional pathology morphology, but are now using genetics to differentiate them.”
A broad mandate
Of course, as a province-wide provider of diagnostics services, DSM has not solely invested in genomics. “We’ve made a significant investment, between CA$25mn and CA$30mn, in our provincial laboratory information system,” advises Slater. “A significant portion of that is a critical Provincial Laboratory Information System (PLIS) – chemistry, hematology, microbiology – that we call the core laboratory and we’ve rolled out the PLIS across the province.”
Having one repository of laboratory data across Manitoba has greatly benefitted DSM. “Fifteen years ago, we used to have limited data that was very fragmented and we couldn’t use it as effectively for decision making. We can now look at costing data, utilisation data, stocking data in an integrated way that allows us to make rational decisions, particularly when we’re talking to our stakeholders,” adds Kabani. “All our provincial sites are linked up to our information. It doesn’t matter which site you’re talking to, you’re working from the same system. This allows us to actually be cost-effective and economic, but more importantly in our minds, it helps us make good decisions.”
In addition to the laboratory information system, DSM is also rolling out a provincial Anatomic Pathology Laboratory Information System (AP-LIS), due to be fully implemented by the end of the fiscal year. “A big part of that investment was publicly funded by our provincial government. We also have partnered with the Canadian Partnership Against Cancer (CPAC) who has provided funding to DSM to make significant investments in AP-LIS that will enable synoptic reporting, along with another federal funding partner, Canada Health Infoway,” notes Slater.
“Manitoba has made a major investment in digital imaging contributing to the creation of a province-wide digital imaging system. Most recently, the province of Manitoba made a CA$25mn investment in digital mammography that was delivered under the leadership of DSM and funded almost entirely by our provincial government. DSM receives 95-99% of our funding through the public sector. As we are a Canadian Corporation this allows us to enter into partnerships with industry, business and funding agencies. It makes us unique in the country, unique in the world, I would think, because we have such a broad mandate.”
Indeed, DSM’s mandate is broad both in the sense of the services that it provides but also geographically. “We have a land mass that is 1.5 times the size of the state of California and so we’re a very large geographic area,” Kresta advises. The population is also not evenly distributed. The 2016 Census of Canada found that approximately 1.3mn people live in the province and around 778,000 of those live in the metro Winnipeg area, located 68 miles from the US border.
This uneven distribution can be a struggle for DSM at times. “It’s very challenging at some of our sites. If you look at the map, we have pretty remote and isolated sites – sites which you can only fly into,” Slater observes. “If you look at our farthest northern site on the map, which is Churchill, it is only accessible by air travel and by ship for part of the year. So, it’s a very big challenge.”
Despite this, DSM works hard to service such communities. “We’re actually able to provide remote support to our rural staff through technology, and this is an area where I think others in the country are looking to learn from our various models of diagnostic service delivery,” advises Slater.
Looking ahead, DSM is in a period of transition, as they become part of a new provincial health organisation called Shared Health Services Manitoba on 1 April 2018. “All of the value and all of the benefits, the positive things that we’ve been talking about for DSM are going to get even broader. Shared Health Services Manitoba’s mandate is set to transform Manitoba’s health care system and will go well beyond just diagnostic services. It will look at how to deliver more connected and coordinated health care services across the province,” Slater concludes.