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Irreplicable Success

Apr 27, 2009 8:00 AM

In the World of Clinical Laboratory Diagnostics, the Pathology Department and ARUP Make a Unique Specimen

It’s the world’s biggest freezer—the size of a two-story house—but in 10 to 12 years, even it won’t be big enough to hold the millions of test specimens at Associated Regional and University Pathologists (ARUP) Laboratories.

Located in University of Utah’s Research Park, ARUP has grown into one of the nation’s pre-eminent reference laboratories and is a worldwide leader in academic laboratory research. The tests ARUP performs help doctors diagnose and make treatment decisions at more than 60 percent of the nation’s teaching hospitals, including Harvard University and the University of  Pennsylvania. Most U.S. children’s hospitals—along with regional hospital  networks, major commercial labs and clinics, and military and government facilities—also send their complex lab work to the Salt Lake City lab.

In an around-the-clock operation, some 2,200 employees perform every day more than 2,000 tests, ranging from cancer and newborn screenings to genotyping of organ donors and bone-marrow transplantation evaluations. New tests constantly are being introduced with ARUP adding 30 to 50 of its own each year. ARUP also supplies nearby hospitals with a quarter of all blood transfused in Utah.

Now the University of Utah-owned enterprise—conceived of, built, and run by faculty from the medical school’s Department of Pathology—is poised to experience even greater demand for its services. Not only are 80 percent of all diagnostic and treatment decisions made on the basis of laboratory results, but new understanding of the molecular underpinnings of disease is spurring development of more laboratory technology.

“It’s the most exciting time in the area of biological research,” said Peter E. Jensen, M.D., professor and chair of the pathology department, who also holds the ARUP Presidential Endowed Chair. “Every advance in medicine will have a counterpart in diagnostic testing.”

Twenty-four years ago, John M. Matsen, M.D., then professor and chair of the Department of Pathology, and Carl R. Kjeldsberg, M.D., professor of pathology, as well as several other faculty members, founded ARUP to help support the department’s academic programs. Since then, it has developed into a unique hybrid that entwines academics with business so intimately that the department and ARUP cannot be separated. Medical  directors for each ARUP laboratory department hold faculty positions; the offices of a third of the U’s pathology faculty are located at ARUP.

Within the department are six divisions: anatomic pathology, cell biology and immunology, clinical pathology, dental education, medical laboratory science, and pediatric pathology. Within ARUP are specialty areas: anatomic pathology, allergy and immunology, automated core laboratory, chemistry, clinical drug abuse testing, cytogenetics, endocrinology, fetal risk assessment, flow cytometry, genetics, hemostasis/thrombosis, hepatitis  and HIV, infectious disease, mass spectrometry, molecular diagnostics, hematopathology, neuropathology, and oncology.

In 1996, the department and ARUP added the Institute for Clinical and Experimental Pathology® to allow a core group of scientists to concentrate on developing new lab tests and technology. “Before that, research was scattered,” said Harry R. Hill, M.D., professor and chief of the department’s division of Clinical Pathology, who also serves as the institute’s executive director and ARUP’s senior vice president.

The institute’s 65 research scientists are expected to publish two peer-reviewed articles annually. Hill believes ARUP publishes more refereed articles—157 last year—than any other academic lab in the country. These ranged from “A 22-plex chemiluminescent microarray for pneumococcal antibodies” in the American Journal of Clinical Pathology to “The CpG island methylator phenotype (CIMP) in colorectal cancer” in the Journal of Molecular Diagnosis.

“It’s good for ARUP and the Department of Pathology, as well as the researchers’ careers,” noted Ronald L. Weiss, M.D., M.B.A., president and chief operating officer of ARUP. He exemplifies the duality of ARUP culture: magazines outside his office include both Fortune and R&D Directive. A professor of pathology specializing in hematopathology, Weiss earned an M.B.A. after starting work as an ARUP administrator, but still spends 25 percent of his time practicing his specialty.

ARUP also serves as a major tool for recruiting faculty to the Department of Pathology. “It attracted me here,” said Jensen, who came to the U from Emory University School of Medicine nearly four years ago. “There’s no question that, in the area of laboratory medicine, the University of Utah is one of the very strongest in the country and has the strongest diagnostic lab in ARUP.” Indeed, Emory is an ARUP client.

Recruiting enough medical technologists remains a problem. Even if ARUP landed every Utah clinical laboratory sciences graduate from Weber State University, Brigham Young University, and the U, it still couldn’t meet its needs. The country graduates about 5,000 medical technologists a year, loses the same number annually, and needs twice that number. To help ease the shortage, the U School of Medicine is increasing its undergraduate medical technology program (which resides in the pathology department) from 25 to 40 students next year. ARUP pays 100 percent of tuition fees for  employees enrolled in the program without requiring them to work at ARUP after graduation.

Although ARUP allows other institutions open access to its methods, no other U.S. university has been able to duplicate its model of advancing medical science while operating a commercially competitive reference lab. ARUP also shares its knowledge with clients. When test volumes reach a critical level, ARUP helps clients set up tests in their own laboratories. Local testing serves patients better and is more cost-effective, noted Jensen.

“Even though it might seem counterintuitive, it can actually be wonderful for us in the long term,” he explained. “There’s always some new test they need to send us. In addition, they become more successful, are doing more tests, and end up sending us some.”

Read the complete article at Health Sciences Report.

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