Managed health care. Managing the risks of laboratory testing in an integrated delivery system

Decentralized testing must be viewed as a component of the decentralized patient care that is prevalent today. It cannot be considered a separate component of the total laboratory process, but must be examined in the context of test ordering and test performance through test result disposition and use. The evolving configuration of the health-care delivery system necessitates a redefinition of risk to include four categories of risk: business, financial, insurable, and clinical quality. Reengineering the clinical laboratory process in today's health-care environment needs to incorporate all these risk issues, systems thinking, and available technology along with the changing practice of medicine.