Defining the Future Together

Founded over 20 years ago by the University of Utah, Department of Pathology, ARUP has enjoyed consistent growth since its inception. ARUP's clients include more than half of the nation's university teaching hospitals and children's hospitals, as well as multi-hospital groups, major commercial laboratories, group purchasing organizations, military and government facilities, and major clinics.

Through excellence in laboratory testing, service, education and research, ARUP's mission is to continually improve patient care and support the mission of the University of Utah.

ARUP's 2,000+ employees accomplish this mission by:

• Providing an extensive menu of more than 2,000 tests and test combinations in clinical laboratory testing and anatomic pathology services
• Performing 98 percent of all testing on-site
• Maintaining an operation where testing is performed 24 hours per day, seven days a week, resulting in some of the best turnaround times in the industry
• Consolidating higher-volume esoteric testing - primarily in the areas of endocrinology, chemistry, and immunology - into a rapid-response, automated core laboratory where real-time testing is performed as specimens arrive
• Offering expertise in clinical diagnostic and anatomic pathology consultation
• Complementing the test menus of clients, allowing them to provide a full spectrum of laboratory services to their local physicians
• Developing new technologies and tests through active research and development

ARUP's professional staff focuses on designing cost-effective approaches for the delivery of laboratory services. In addition to individual consultation with medical staff, ARUP adopted a disease management approach toward laboratory testing.

Laboratories

With pathologists and clinicians as the target audience, test algorithms and disease management strategies are designed by teams of subspecialist pathologists and clinicians to optimize test utilization, enhance patient outcomes and satisfaction, and improve the cost of care. This effort will supplement and support the development of clinical pathways by clients in their respective hospital environments.

The Division of Anatomic Pathology is staffed by more than 20 full-time faculty providing top quality diagnostic testing and consultative services. The faculty provides full service pathology from small biopsies to large resections based on a diagnostic center of excellence model encompassing a wide range of specialties. The clinical practice of anatomic pathology is supported by several core laboratories. These core laboratories enjoy a full range of service including routine histology, immunohistochemistry, electron microscopy, molecular diagnostics and research support. The laboratories support a large menu offering of special stains and immunohistochemistry stains.

The Genetics Services at ARUP provide a comprehensive menu of testing to assist physicians in the diagnosis of patients with genetic disorders. This comprehensive menu includes tests for inherited metabolic diseases, carrier screening, cytogenetics, inborn errors of metabolism, newborn screening, predisposition assessment, pharmacogenomics, and sequencing.

Autosomal recessive metabolic disorders affect the body's ability to produce or break down amino acids, organic acids, and fatty acids needed for normal body functions. Early identification of a metabolic disorder may prevent death as well as other serious health problems. The ‘supplemental newborn screening and inborn errors of metabolism menu at ARUP identifies markers for more than 30 metabolic disorders in addition to the state-required initial newborn screen. Confirmation by molecular techniques of some of these disorders, such as MCAD, is also available.

The cytogenetics and molecular cytogenetics menu includes a wide variety of tests for clinical indications such as congenital anomalies related to inherited conditions due to sex aneuploidy such as Down syndrome, microdeletion syndromes such as Prader-Willi, and other chromosomal abnormalities. Peripheral blood and skin biopsy are the preferred samples to identify congenital anomalies, infertility, or other indications.

The molecular genetics menu offers more than 25 different DNA tests to assist physicians in the diagnosis of patients with genetic disorders, to identify pre-symptomatic, carrier and fetal testing; to follow up an abnormal newborn screen; and predictive testing for drug metabolism. In addition, full-gene analysis is available for tests such as cystic fibrosis, beta globin, and hereditary hemorrhagic telangiectasia. Genetic counseling is also available.

Each laboratory at ARUP is staffed by professionals dedicated to providing quality patient care. Testing is performed 24 hours per day and many of our assays are scheduled to provide some of the best turnaround times available in the industry. Although ARUP is recognized as an esoteric reference laboratory, it functions also as a hospital laboratory. A separate on-site laboratory and transfusion service fulfills the routine and critical care needs of the 490-bed University of Utah Hospitals and Clinics. This relationship enables ARUP to understand the needs and challenges faced by our clients, and to assist them effectively in attaining their goals.

Automation

ARUP is one of the most automated laboratories in the United States. A 1,100-foot transport and sorting system with a capacity of 8,000 specimens per hour is one of the key elements. Equally important to our success are two automated sorters that load finished specimens into storage trays and a two-story automated storage and retrieval system (AS/RS), which is housed in the world's largest clinical laboratory freezer. The AS/RS capacity exceeds 2.3 million specimens, while individual specimens are robotically retrieved in less than 2.5 minutes. ARUP has also installed the world's first automated thawing and mixing workcell. It thaws and mixes frozen specimens on the transport system at a rate of more than 1,000 specimens per hour, thus reducing pre-analytical preparation time. ARUP continues to develop cutting edge automation that improves the overall quality of testing and reduces turn-around time.

Total Laboratory Automation (TLA), as well as modular laboratory automation, has seen widespread adoption in the past decade. Globally, there are now an estimated 800 laboratories utilizing automation systems. However, ARUP's automation is unique when compared to the automation in other laboratories. These laboratories have generally applied automation to centrifugation, aliquotting, and the interfacing to analyzers for serum chemistry, immunoassay, hematology, and coagulation tests. ARUP, on the other hand, skillfully adapts automation systems to its esoteric testing environment. ARUP's accomplishments in automation are acclaimed in the laboratory industry, resulting in ARUP team members’ recognition in publications, speaking invitations, and a major award.

Using the 20/80 rule, most labs that have implemented some form of TLA agree that 20 percent of their test menu makes up approximately 80 percent of their test volume. In these labs, 35 to 55 different tests typically comprise 80 percent of the total workload. These tests may include serum chemistry profiles, CBCs with differentials, thyroid profiles, some additional high-volume immunoassays, urine analyses, protimes, electrolytes, and a few TDM tests. Because ARUP performs esoteric testing that is often considered "sendout" testing for our clients, ARUP cannot follow a 20/80 rule. It takes more than 1000 different tests in ARUP's menu to comprise 80 percent of ARUP's test volume, with many of these tests being infrequent manual tests performed in small batches. ARUP’s automation needs have clearly been different. It has involved the elimination of excessive handling and sorting, improved tracking, storage and retrieval of specimens for repeat or additional testing, and real-time communication among all of ARUP’s laboratory-related software systems.

Automation by itself generally does not improve processes. Poor laboratory processes may function faster with automation, but they are still poor processes. That's why the key to ARUP's automation success lies in the other changes implemented in conjunction with automation - in the adoption of a standardized transfer tube, in the consolidation of higher volume testing in an Automated Core Laboratory, in the development of a new rules-based, intelligent order-entry and support software system (Expert Specimen Processing or ESP), and in the redesigning of the specimen processing workstations to be used with the Automated Transport and Sorting System (called Automated Track System for short). Also, as ARUP re-engineered its various processes, ARUP utilized its internal Continuous Quality Improvement program that uses employee teams to recognize and address improvement opportunities. Thus, ARUP achieved a superior overall outcome that has been successful from ARUP's perspective, as well as from the perspective of ARUP's clients.

While ARUP's commitment to esoteric testing, our core competency, has enabled us to provide clients with the quality testing they deserve from a reference laboratory, ARUP also offers a suite of tools and services designed to complement clients' ability to provide laboratory services within their local and regional communities.

Suite of Integrated Services

In keeping with ARUP's philosophy that health care is best provided at the community level, ARUP has expanded its outreach services into a seamless new system. ARUP Direct™ delivers a complete package of services designed to assist clients in their local and regional hospital outreach business.

ARUP ATOP® is a laboratory analytics service offered by ARUP Laboratories to assist health care organizations in improving utilization of laboratory tests. ATOP analyses identify potential over-, under-, and mis-utilization of individual laboratory tests and in each case assesses the clinical and economic impact of suboptimal ordering. Laboratories and pathologists can share this information with local clinicians in order to reduce costs, increase efficiency, and improve patient care.

ARUP's ATOP program assists clients in:

• Improving management of test ordering according to evidence-based guidelines
• Engaging physicians and administrators regarding clinically appropriate testing
• Prioritizing educational outreach efforts
• Promoting the value of laboratory medicine to enhance the role of laboratorians in clinical environments.

ARUP Consult®, the Physician's Guide to Laboratory Test Selection and Interpretation, is a dynamic tool that provides instant, point-of-care access to ordering and interpreting hundreds of laboratory tests:

• Over 1,000 lab tests categorized for diagnostic decision making
• Disease-specific topics with background information, test ordering suggestions, and concise diagnostic advice
• Co-authored and maintained by ARUP's expert panel of medical faculty and consultants
• Recommendations congruent with national guidelines
• Diagnostic algorithms available
• Automatic updates for Web and PDA platforms

ARUP Connect™ is ARUP's online client information system. Registered clients can take advantage of Connect's lab test information services to access test results, transmit patient data required by public health agencies, or use ARUP's Secure File Transfer system to securely retrieve documents containing patients' Private Health Information (PHI).
A key feature of the ARUP Connect system is Electronic Notification, an e-mail service that delivers electronic invoices, ARUP announcements, and reflex test billing notification.

Additional services within ARUP Connect include ARUP's Institute for Learning online Client Training programs as well as access to ARUP's Pathologist-on-Call e-mail service.

Information Technology

Expertise in the area of information transfer truly distinguishes ARUP Laboratories from its competitors. ARUP offers clients customized tools for facilitating patient lab test ordering and results retrieval. ARUP's information technology staff provides industry-renowned service through installation, customization, validation, client training, and support for all technology services.

ARUP utilizes the latest health care industry standards, such as Health Level Seven (HL7), Virtual Private Networks (VPN), and interface engine technology to develop and maintain interfaces to all the major laboratory information systems. Interface clients who connect to ARUP's system via the Internet using VPN technology have their laboratory results delivered to their information system within seconds after result verification at ARUP. This direct exchange of patient data provides clients with full control of storage, access, and retrieval of patient data, and allows clients to use their own LIS to order and report referral testing.

ARUP's Windows-based System 2000® workstation is PC-to-LIS software system customized to meet clients' needs for ordering and retrieving results, and streamlining sendout procedures. This system allows the client to use a PC workstation to interface directly with ARUP's LIS. System 2000® enhances the accuracy and speed of information flow, increases reporting capabilities, improves turnaround time, and reduces clients' time and effort spent in managing sendout functions.
For more information on ARUP Laboratories, call our Client Services at (800) 522-2787 or visit our Web site at www.aruplab.com.