Bobbi Pritt, M.D.  (00:05):

Hello, I'm Dr. Bobbi Pritt, a clinical microbiologist and laboratory leader at Mayo Clinic, and your host for today's episode. I'm excited to be here today with Mayo Clinic Laboratories CEO and president, Dr. Bill Morice. We're going to get the latest news, and then we're going to move to Dr. Eric Hsi. He will join us for our deep dive on the state of laboratory medicine and pathology. Bill, it's great to have you.

William Morice II, M.D., Ph.D. (00:28):

Yeah, great to be here, as always.

Bobbi Pritt, M.D.  (00:31):

So, we have a few things to talk about for the news update. One of them that caught my eye is a recent Becker's podcast that you were on talking about the future of diagnostics, and I thought you had some really good points that I was hoping you could share with our listeners.

William Morice II, M.D., Ph.D. (00:46):

Yeah, happy to and it maybe will make a nice preamble or context for Dr. Hsi's comments as well, which will be great to hear, right? We talked a lot just about, we are really seeing an acceleration when you look at the future of diagnostics. Sort of, many different factors that even I think in the span of our careers here, you and I at Mayo Clinic, have really changed lab medicine and I think will continue to change them into the future. One of those, you know, is genomic sequencing and other next-generation tools. First of all, that we can detect more and more low-frequency events. So, when you start thinking about minimal residual disease and you start thinking about even neoplasms that we don't even think conventionally as having detectability in the peripheral blood, like a glioblastoma. These tools are now not just conceptual or research, but they're becoming more and more actually introduced into clinical practice, often in the context of also guiding therapeutics. So, it's companion diagnostics.

I think we're going to continue to see those tools grow. Also, the technologies are going to get cheaper and cheaper, so they're going to be more and more available, right? Dr. Hsi might touch on it. I was just visiting DLMP yesterday and looking at, now the new Illumina instrument that can do whole genomes. I mean, clinical whole genomes quickly. I mean, it's just pretty mind-boggling how quickly we've gotten to that point. When you think about the future, start thinking about why is that, as those tools become more available, and of course, as they're available, they generate more data. As we develop more AI and things we can put on data to have observations, I think we're going to see an acceleration of the concept of precision diagnostics, truly. And that's going to extend beyond just nucleic acids. So, I think we've been pretty heavily observationally biased towards looking at DNA and RNA because they were the analytes that we understood because of PCR going way back.

They were the most individualized analytes that we could get to early on. But now, we really are advancing particularly in proteomics. That was my Ph.D., was more in proteome than on molecular, but we are really starting to see where I think proteomics, and you look at the future of diagnostics, are going to be much more routinely introduced into clinical diagnostics. Those are the things that I see coming forward. And all those things, of course, will increase accuracy and precision.

Bobbi Pritt, M.D.  (03:03):

Yeah, you know, I'll just put a plug in there, Bill, for microbial genomics and proteomics as well. And, I've been talking with Dr. Kipp, who's our chair of LGG, Lab Genetics and Genomics, and when they're detecting the human genome, they're detecting microbial reads as well. And of course, when we're looking at microbial reads, sometimes we want to know what the human host response is, the transcriptomes. So, there's going to be some exciting overlap in the future. It's not just going to be human or microbial, but the two together.

William Morice II, M.D., Ph.D. (03:32):

Yeah, and I think that's right. And, you bring up collaboration, which is of course one of our favorite themes. You know, collaboration between areas in laboratory medicine departments that maybe never saw themselves as necessarily interconnected, all of a sudden will be. So, you start to think about the future of our profession and how we're educating trainees, how we're building bridges between different divisions and different laboratories and different areas of laboratory medicine practice, which of course in and of itself reflects the breadth of medical practice, because you have divisions for hemologic malignancy and micro and all those things, and that now they get to start to converge a bit. The other is collaboration with outside entities, and really in two ways. As these grow, there's more and more companies that are out there that are interested in growing these diagnostics. Oftentimes, the way an innovative company works is they create IP, which they put a moat around through patents and other things.

And so, they really have access. But again, even those individual components will have the most meaning when they're analyzed in a broader context of a patient experience. And so, how do we collaborate with some of those companies that might have proprietary technologies or analytes that really would benefit from being in a more holistic environment of a patient diagnosis? And then, the other thing which I'm coming to realize too, that benefits us, is that as we collaborate, it actually is kind of like the rising tide lifts all boats. So, as we collaborate with outside companies that are helping to forge the way in metagenomic testing for infectious disease, it actually increases our ability as Mayo Clinic and a DLMP to participate in that. So really, the strength of collaboration really comes home.

Bobbi Pritt, M.D.  (05:03):

Yeah. Collaboration, definitely a favorite topic. You know, the other thing you spoke about on the Becker's podcast is changing patient expectations. And I wonder if you could touch on that a little bit as well.

William Morice II, M.D., Ph.D. (05:16):

Yeah, it's pretty fascinating, right? When we were in the midst of COVID, you and I talked about this, you know, that COVID was going to be the tipping point where patients wanted access to at-home diagnostics in some way, shape, or form. Really did not persist. There were a lot of companies that were created trying to catch that wave. The wave never came. But, what we've seen on the back end of that is are companies like Function Health and others that are out there and getting kind of consumer interest in getting access to diagnostics. And something you and I have talked about for a long time, we're actually seeing start to come to fruition, and that's this sort of convergence of wearables and laboratory testing, right? And so Oura, Apple, first of all, I find it fascinating that Apple advertisements now talk about the accuracy of their heart rate on their watch, and what kind of insights you can get from that. And they're also now serving as a aperture for patients to get testing. I think we're starting to see some of those forces come together, where people are interested, they'll have easier access, their expectation will be access to diagnostics. Their expectation will be that maybe they're coming to their doctor, those results will come with them, or they'll be able to load it into their interface to say, "Here's your CBC and you know, you need to be drinking more fluids."

Maybe patients and consumers don't think of it as a laboratory, but they're really changing expectations around the laboratory. The good news for us is that one of our primary roles of helping people understand how all this information should flow together to make a decision is still going to be there, even more so than in the past.

Bobbi Pritt, M.D.  (06:50):

Oh, yeah. Information overload and laboratory tests, you can imagine how overwhelming this could be for a patient. It's already starting to be because patients can get online. There's special programs now that are targeted to certain patient populations. For example, I get a lot of the ones towards women, and it's amazing, all of the different opportunities now where I can order my own tests for a whole variety of potential disorders. So, I think as laboratories, we're going to have to continue to play an important role in all of this and helping to guide what the meaning of various tests are and ordering algorithms. It's like test stewardship, but now at the patient level.

William Morice II, M.D., Ph.D. (07:29):

Exactly. Almost at the societal level, if you will.

Bobbi Pritt, M.D.  (07:31):

Society, yes, exactly. Well, interesting times and lots of great things to keep talking about in the future.

William Morice II, M.D., Ph.D. (07:38):

Yeah. I agree. And I think it drives home one thing you and I have talked about as well, and that is, laboratory medicine is really at the intersection of technology and healthcare, right? And everything we just talked about is all the technological advances. And so again, that's not going to go away anytime soon either. So, we'll have lots to talk about, as you say.

Bobbi Pritt, M.D.  (07:56):

Always. Yeah. Well, thanks, Bill. Thanks again for joining us. Welcome to the deep dive. We're going beyond the headlines today with Dr. Eric Hsi, chair of Mayo Clinic's Department of Laboratory Medicine and Pathology in Rochester, Minnesota. And we're going to explore how the department is working to transform healthcare and laboratory medicine. Dr. Hsi, welcome back to our podcast.

Eric Hsi, M.D. (08:23):

Oh, thank you very much, Dr. Pritt, and I'm glad to be here.

Bobbi Pritt, M.D.  (08:26):

Yeah, it's great to have you on, and I have a number of questions for you. Again, thinking about how our department is really transforming healthcare and laboratory medicine. So, my first question is, how is working within this large and highly integrated healthcare organization that is Mayo Clinic, changed your perspective, if at all, on laboratory medicine's role in healthcare?

Eric Hsi, M.D. (08:51):

As some of you may know, I've been here now a little over two and a half years. And during that time, I think, being at Mayo Clinic has really reinforced my perspective, actually, that lab medicine plays an integral role in healthcare. I think the thing that's unique about Mayo is really the confluence of the expertise and the innovation, where both the practice can influence the laboratory direction and vice versa. I think it's really a special combination of laboratory and clinical practice coming together and doing amazing things.

Bobbi Pritt, M.D.  (09:26):

Yeah, that's wonderful. I've always felt that way ever since I've been here, and now I'm going on 19 years, which, it's been a wonderful career. Well, that's great. So, my next question then is about science and discovery. You know, we always talk about science and discovery behind new diagnostic tests, how we're always trying to innovate to create the new tests that are really going to help our patients. As department chair, you've worked a lot on thinking about innovation and how lab medicine supports patient care. What innovations are you most excited about right now?

Eric Hsi, M.D. (10:02):

Yeah, that's a great question. I think there's kind of two things that come to mind. First is, you know, how we can innovate with AI in ways that are really visible and invisible to our clients. I think one thing that might be sort of invisible to the patients might be the digital pathology things that we do and even digitizing our frozen section process, which not only gives us patients during the frozen section access to subspecialty pathologists in real time, the way we're digitizing that process, it also gives the surgeons direct access to what the pathologists are doing in real time. And it's almost like the pathologist is in the OR showing the clinical care team about what they're seeing and what the important features are to note. I think that, you know, obviously that's all invisible to the patient, but highly, highly impactful.

I think something that may be more visible to the patient is actually things that we're doing around our remote collection strategy, which falls in line with organizational strategy to have, you know, care beyond walls. And I think our contribution is to have and develop the capability for remote collection so that patients can be in contact, essentially with Mayo, no matter where they are. So, if they need a blood draw for laboratories, they don't need to come to Mayo Clinic. They could find a local place to get drawn, have those labs done here at Mayo Clinic so clinicians can monitor their progress in the EMR and not through some mystery facts that comes in from somewhere. So, I think that's going to be both visible to the patients for the convenience and the knowledge that they're getting quality results and their providers seeing those results in real time, but also is really going to impact the quality of their overall care.

Bobbi Pritt, M.D.  (11:50):

Yeah, I love both of those examples. You know, my lab does a fair amount with AI these days and it's been really exciting. Definitely behind the scenes. The patient doesn't necessarily know that we're using AI, but the result we're getting is better for the patient. So, we're providing that better patient care. And then the whole idea of having people being able to be drawn where they are, not to have to come here just for a blood draw. And then of course, in my lab, a lot of the testing we do, you want to continue doing the test with the same method at the same laboratory for quantitative results. So, getting the specimens here, but not making the patient come here just for a blood draw, that's just very innovative and really a game changer for them.

Eric Hsi, M.D. (12:31):

Yeah. I would say, you know, we talk about continuity of care and people kind of think about it just as the provider, right? But I mean, there's continuity of laboratory care, right?

Bobbi Pritt, M.D.  (12:39):

Absolutely. Well, this kind of leads into my next question, which is about digital pathology, which you've touched on a little bit. That's really gained tremendous momentum. Here we are talking about AI and the frozen section lab and how the surgeons can kind of feel like we're in the OR with them. So, we've done a lot in our department, but implementing all of those new technologies, that can be challenging. What advice would you give to other laboratory leaders who are also looking to incorporate digital pathology into their practices?

Eric Hsi, M.D. (13:12):

Yeah, I would say, you know, the time is now to embrace these tools. I mean, it's really essentially the price of admission. The digitization process of a physical asset, like a glass slide, as you know, kind of adds work, actually. But what it really does is turns those slides and images into data. And we're now using those images actually as sources of data to run AI algorithms that, you know, yield new insights that are really not just a human looking at an image on a slide and making a diagnosis while predicting biomarkers and response, genetic profiles, using these tools. And unless you digitize, you will not be able to take advantage of those. And so, I think the older use cases for digitizing and even less than five years ago, many were seeing that it's just a way to make their remote work more possible or to manage multiple sites with a central histology lab. That was kind of the initial use case. But now, it's gone far beyond that. And I think if you're going to have the ability to use AI algorithms, you have to go digital.

Bobbi Pritt, M.D.  (14:23):

Yeah, you have to digitize. And people think of digitizing glass slides, but I would say anything that is visual, you could digitize. It could be an ELISA, lateral flow assay, immunofluorescence, anything you could take an image of.

Eric Hsi, M.D. (14:36):

That's right.

Bobbi Pritt, M.D.  (14:36):

Yeah. Well, with all of these innovations, these are really exciting. Of course, they require resources, and healthcare systems everywhere are being asked to do more with fewer resources. So, then it really comes to, how can we justify putting resources into systems? So how do you think lab medicine can help improve both quality and efficiency and perhaps really show that value?

Eric Hsi, M.D. (15:02):

Some of the things we've always been doing but need to do more of and get better at it, which is influencing testing guidelines. We have a seat at the table so that the most efficient testing algorithms are used and people are getting the most information from the right tests. We're also contributing, as you know, with what we're calling the DLMP management system, just enabling better processes in the lab to be more efficient and increase our capacity without increasing our cost. I mean, we have to do these things because the advances mean that we are doing more and that there's more capability.

And so we have to scale in new ways. And so, just to keep up with the amount of work, we have to get more efficient and use automation and AI. And so some of these are almost self-preservation things that we have to do to be able to continue to do our work.

Bobbi Pritt, M.D.  (15:58):

Yeah, really well stated. Well, you've done an amazing job fostering this culture of innovation, creating our strategic management system, making sure that we're gaining efficiencies while improving patient care. How do you think about this? How did you foster this culture of innovation in a department that's as large and diverse as DLMP at Mayo?

Eric Hsi, M.D. (16:20):

First of all, I want to give credit where credit's due. I mean, all the lab staff, yourself included, are actually outstanding in innovation, and that wasn't the thing that was missing, actually. But I think what I could bring was really maybe helping to define our priorities and maybe intentionally committing to going after it in a transparent and clear way. Communication, as you know, is really important, and being transparent about what we're doing. I think all of those go to serve DLMP well so that we are messaging what we're doing, people understand where we're going, everybody understands what our priorities are to meet the strategic goals of the organization. And I think that's kind of my small contribution, I think, to what's been happening.

Bobbi Pritt, M.D.  (17:09):

Yeah. I'd say it's been a big contribution, but I agree, just getting everyone excited about things, but then putting it into some sort of management system. And tracking goals and having everyone know the strategy of where we're going together as a department has been very powerful. Well, I have a last question for you that's kind of fun, a little off topic, which is, you know, we've been talking most of this conversation, we've been discussing your leadership role, but you're also a recognized expert in hematology, hematopathology. So, what advances in hematopathology are you particularly excited about?

Eric Hsi, M.D. (17:42):

Well, that's a great question. You know, I think from a diagnostic perspective, the continued advancement of classification of disease using molecular tools as the basis that we understand biology and therefore translate that into better classification systems, which ultimately lead to better treatment and better outcomes, that is really just accelerated dramatically over the last, say, 10 years. And we're now at another, inflection point's a little too dramatic or whatever, but we're developing the next classification of hematologic malignancies. I was asked to be an editor for the WHO monograph in the hematopathology space. And I'm very excited about that, because it's going to allow me and Mayo, really, to influence that next classification. We have a lot of experts, as you know, in the Division of Hematopathology. Being asked to be involved in that and having access to so many experts in DLMP is really exciting.

I think the second thing is really just, yeah, we're making advances in diagnosis, but we're also making advances in treatment. And the explosion of immunotherapy options in the hematologic malignancy space is really amazing, that we are now talking about cellular therapies with CAR-T cells, bispecific antibodies, tri-specific antibodies, immune modulation. It's really kind of shaped, or really changed, the way the field was going from a small molecule, heavy kind of pathway inhibitors, which is still going on, but realizing how powerful these immune therapies really are. And then finally, bringing all the AI work that is just such a huge effort of the organization and also, you know, DLMP. But as you know, we've developed LymphoVision, which is a foundation model for lymphoma diagnosis in a very small amount of time. And, we have people working on the bone marrow and peripheral blood side, and really bringing these applications into daily workflows that are going to lead to faster and more accurate results is really an exciting thing to consider and then realize that we can actually start to execute on that here at Mayo.

Bobbi Pritt, M.D.  (19:53):

Yeah, that's great. I'm not a hematopathologist. That was a long time ago when I did my training, but things have changed so much when I hear you talking about these things. It was just so different 20 years ago. Well, this has been a great discussion. I really appreciate you joining us. So again, thank you for a great discussion.

Eric Hsi, M.D. (20:10):

Well, I appreciate the time and the invites that be on the podcast. So again, thanks a lot.

Bobbi Pritt, M.D.  (20:21):

Let's wrap up with the top takeaways and how to learn even more on the topics we've discussed. Dr. Morice joined us for the news segment, where he shared his thoughts on the future of diagnostics, and we explored an article about advances in wearable technology that will impact diagnostics. If you want more of Dr. Morice's perspectives, you can find a link in the show notes to an interview he did with Becker's Healthcare. Then Dr. Hsi shared his perspectives on how laboratory medicine is supporting innovation throughout healthcare and what that looks like at Mayo Clinic. Thank you for joining us today. If you haven't already, make sure to subscribe so you never miss an episode. For our next episode, Drs. Andrew McKeon and Anastasia Zekeridou will join me for a discussion about autoimmune neurology testing. I hope you'll join us.