member spotlight
Candice Le performs RPR syphilis serology testing.
Photo: PHSKC
Staff
In addition to Swenson, the laboratory
employs 11 people: Laboratory Manager
Alfred Iqbal, PhD, six microbiologists, one
laboratory assistant, two administrative
staffers, and a part time medical
technologist who oversees CLIA-
waived, point-of-care testing at county
clinics. Although the laboratory has
no current vacancies—“we seldom
do”—Swenson anticipates one staff
retirement within the next year.
The laboratory’s annual $2.4 million
budget comes mainly from fees for
services provided to PHSKC clinics. Those
fees are billed through a unique system,
started in 2012. As Swenson explains, “We
basically have no [dedicated] funding.
There is an internal system through
which we bill all of our public health
clinics for the testing that we do, and we
are expected to bring in sufficient revenue
from those clinics to meet all of our
expenses.” Theoretically, said Swenson,
“As our expenses increase over time, we
can increase what we charge our clinics to
cover those costs.” Yet, in practice, he said,
“We’re under tremendous pressure to be
cost-competitive and to keep our fees as
low as they can possibly be, because the
clinics are also under tremendous budget
constraints, and our fees are a big cost to
them. ... So raising fees is not an option
if there’s any way it can be avoided.”
In addition to internal clinic payments,
some CDC-funded work, clinical testing
for external providers and occasional
clinical studies for local biotech
companies “bring in a few dollars.”
Testing
The vast majority of the 90,000 or so tests
performed by the laboratory each year
are routine diagnostic analyses: serology
@APHL
• Finalizing a memorandum-of-
understanding (MOU) with the
Washington State Public Health
Laboratory to assure “the most
efficient, cost-effective laboratory
services for the state of Washington.”
Although some of the details are
still being hammered out, the MOU
allows the laboratory to free up
surge capacity at the state level by
taking on routine clinical testing
during public health emergencies
requiring state laboratory support.
In addition, the laboratory performs: Challenge
• TB cultures, smears and
QuantiFERON ® –TB Gold assay for
the county TB clinic at HMC. “Just maintaining adequate resources
to support the cost of the services
we provide is our biggest challenge.
The clinics [that provide the bulk of
the laboratory’s funding] are under
such budget constraints that they’ve
had to get smaller, and that can
trickle down to the laboratory.” In fact,
three county family planning clinics
closed in 2015, representing the first
clinic closures in three decades. The
county’s next biennial budget cycle
begins in 2019, and, said Swenson,
“There’s a fair amount of uncertainty
about what’s going to happen.”
• Surveillance and outbreak testing for
influenza and other respiratory viruses.
Revenue
PublicHealthLabs
tests for HIV, syphilis and hepatitis
and nucleic acid amplification tests
(NAATs) for chlamydia and gonorrhea.
Virtually all of this work is conducted
on behalf of 11 PHSKC clinics, including
STD and TB clinics co-located at HMC,
three primary care clinics, three family
planning clinics, a refugee screening
clinic and two jail health clinics. Almost
half of all the laboratory’s work comes
from the STD clinic alone, which is
within easy walking distance. A county-
operated courier service transports
specimens from outlying clinics.
• Miscellaneous, low-volume
serology and microbiology tests,
such as measles, mumps and
rubella antibody testing, gonorrhea
cultures and stool cultures.
Said Swenson, “There’s a lot of testing
that we don’t do, like clinical chemistries
or hematologies. We contract with a
commercial laboratory to do that work.”
Success Stories
• Interfacing the ApolloLIMS ® laboratory
information management system
(LIMS) with the Epic electronic health
record system used in PHSKC clinics.
As of late August, every clinic but
one is linked to the LIMS, and the
final clinic is slated to go live by
the end of 2017. Prior to this major
undertaking, said Swenson, “We were
still connected electronically [to the
clinics], and they could print their
lab reports, but they were getting a
paper report and would still have to do
data entry [into the electronic health
record]. Now, no one has to do that.”
• Replacing culture- or antigen-based
tests with faster, more sensitive
NAATs over the past year. Recently
implemented NAATs include assays for
trichomonas, Group A streptococcus,
pertussis, herpes, varicella zoster
virus and influenza. “The technology
is a good fit for our laboratory.”
APHL.org
Goals
• Evaluate the performance of the
QuantiFERON ® –TB Gold Plus test,
just recently approved by the US
Food and Drug Administration. “Our
TB clinic is eager to switch over to
that when it becomes available.”
• Examine the feasibility of running
NAATs for Mycoplasma genitalium,
bacterial vaginosis, vaginal
candidiasis and other targeted
infections on the laboratory’s
Hologic ® Panther testing platform.
• Evaluate possible use of the reverse
screening algorithm for syphilis,
which involves screening with
one of the new, highly automated
treponemal tests and confirming
with a rapid plasma reagin test.
• Maintain CLIA compliance in our
laboratory and in our public health
clinics, performing waived testing. n
Fall 2017 LAB MATTERS
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