Jamel Giuma is president and CEO of JTG Consulting Group of Miami, FL.
Tell me about yourself and the company.
I studied finance in college, but I was always in IT. I started working for a retail company while I was in high school in their corporate IT department, and did that through my first couple of years of college. I got tired of working for corporate America pretty quickly and started applying to IT jobs in Jacksonville, Florida, where I was raised. The first place to call me back was the University of Florida health system. I started working in their desktop support group, and one of the areas I was responsible for was the laboratory. I was replacing the lab director’s computer and she said, have you ever thought about becoming a systems analyst? I said, what’s that? I fell in love with the lab, and here I am 16 or 17 years later.
I was recruited by the University of Miami to start their lab team and manage that to grow it to what it is today. I worked at Sunquest as director of interoperability in their product strategy group for a number of years. The travel got out of control, especially being in Australia for a over a year and missing family and friends. I left to work for a five-year-old startup, and after nine months, decided that I was smart and hardworking enough to do this on my own. I started JTG five years ago in September.
Lab was always a healthcare technology pioneer, being the first to recognize the benefit of scale, to implement barcoding and tracking systems, to integrate with systems inside and outside the hospital, and to create a market for health IT that included the formation of Meditech and Cerner with lab as their first offering. What are the lab’s biggest issues today?
Historically, lab leaders were not always the best businesspeople to sell their service, either internally to the health system or externally. I’ve definitely seen a change in lab administration, where we’re starting to see more MBAs and MPHs who understand the business side and can take the lab to the next level. Taking advantage of excess capacity, economies of scale automation, and overall delivery of service for providing providers the first point of diagnosis.
Lab has a huge impact in the ecosystem of a patient’s journey. Without the lab, very few decisions can be made. If you have no radiology or no labs, you have no diagnosis in most cases, or it’s harder to make a diagnosis. With the onset of enterprise EHRs becoming the standard, we’ve seen things change from integration projects to workflow and optimization projects in health systems that allow providers to get more rich data and get it more quickly. It has been interesting seeing the evolution from best-of-breed lab systems to enterprise systems that have that best-of-breed technology embedded in them.
What laboratory-related external technology connections add value?
Folks are looking at more genetic data and genomics. That’s a lot more data than they can even handle. It’s more of a concern at times for providers because of the liability of missing something and understanding and interpreting those more complex and lengthy reports. Hospitals want to provide those services to their providers and patients, but they are also taking a close look at the risk of offering those tests, not just the financial risk of being reimbursed, but also how to interpret these results.
How do we ingest these results? Some of these new reports are 50-plus pages long, where historically doctors are used to receiving a metabolic panel or a CBC that has more discrete results with 20 or 30 assays in it as opposed to interpretative results that are more qualitative and quantitative results that impact how they make decisions to place those orders. They want to be able to provide the patient care, but if they can’t interpret the results or don’t have enough time to review and understand what the results are telling them, then are they adding any benefit to the patient’s overall care?
Are health systems changing their policies or technologies to comply with the Cures Act requirement to release electronic results immediately to the patient?
Health systems historically were risk averse to releasing those results. They don’t want patient going to Dr. Google to figure out how to interpret these results, whether it’s right or wrong. But with the onset of things like Meaningful Use and other technologies that have been embedded in these systems, they are having to release these results. If it’s being sent to a reference lab, patients are getting savvy enough to know that they can register with Labcorp, Quest, or Sonic to create a patient account login and get those results before their provider. A lot of EHRs and lab systems now have automatic release of those within certain parameters. Certain tests, such as STIs and other infectious disease results that are more sensitive, might be released within five to seven days if the provider hasn’t reviewed it. But overall, health systems are becoming more open to the fact that they have to do it, and we are starting to see that paradigm shift at larger health systems.
The introduction of artificial intelligence will bring a lot of opportunities to health systems to provide even better economies of scale to their providers, who can interpret the results before they are released and decide whether they need to add comments. We’ve seen Epic talking about utilizing ChatGPT and Cerner is talking with the FDA on some AI tools as well. AI can be powerful and potentially dangerous, but with the right guardrails, it will help providers, patients, and health systems take advantage of the data that’s already there.
Generative AI seems ideally suited to turn medical language into patient-understandable reports or instructions. Will that effort be led by companies like yours, or vendors themselves?
We are going to all have to partner together to take advantage of those new opportunities and tools. With lab, I’ve seen things like CellaVision, who has been doing artificial intelligence before it was called AI in identifying different cell types in a hematology slide. We’re also seeing things like the Copan WASPLab, a microbiology total lab automation tool that can take pictures of Petri dishes, interpret what’s growing, and group them for the tech to review. Their machine learning and algorithms are getting better every day to help the tech skip things that aren’t value-add, like no growth on a micro plate, and also categorizing things for them to review and confirm.
We will see more of that in chemistry and other areas, doing anything we can to avoid having a tech review a result, using a confidence interval set by the lab’s medical director to allow auto-verification. That will reduce turnaround time and hopefully improve patient care by getting a diagnosis sooner.
Telehealth, remote patient monitoring, and other virtual medical services are limited by the last-mile problem of collecting lab specimens and delivering prescriptions. Several companies have attacked the second issue. How are they approaching the lab collection challenge?
Direct-to-consumer labs is a great example of that. Because of the EUA that the FDA approved for COVID testing, we’re starting to see restrictions and legislation change on patients being able to order their own lab tests. It’s only a matter of time before it crosses all of our states. Across our country, providers and health systems are looking at ways to make it more convenient for patients. Going to a hospital, parking in a garage, and finding the right location are going away. We are starting to see Walgreens, Walmart, and Safeway embedding labs in those shopping centers. You park in a parking lot easily, walk in, get your test done, pick up your Starbucks after you are finished fasting, and you’re out.
That’s one step. But direct-to-consumer, where patients can order the test and self-administer the swab or void into a cup, is another example where we will see this evolve. The concerns that people are raising are also valid. Was the test collected correctly? Is it the same patient who ordered it? Who is responsible for that authorizing provider and interpretation of that result for the patient? There’s still a lot of work to do, but health systems know that to compete with Amazon, Walmart, and CVS they are going to have to change. That will also require lobbying work with the government to make that direct-to-consumer testing possible.
Which of your services are in highest demand?
With the great resignation, it’s difficult to get people to go to work for some reason, so staff augmentation is a big part of our business. We embed full-time employees at organizations to augment the needs of positions they can’t fill. A lot of the work we do can be done remotely, and the pandemic was a great representation of what we can do without having to physically be on site. We’ve done big implementations of new lab systems and EHRs with other vendors and consulting firms that were completely remote, and it’s incredible the amount of work that can be done remotely. Those are some of the big things that are being requested. Also, folks are looking to upgrade their systems constantly and they just don’t have enough people or time with all the competing projects.
Integration work is top of mind for health systems, laboratories, and even private reference labs, being able to interop with their clients, vendors, and patients. Those are quick wins. We are starting to see demand for talking about digital pathology and what that could do for the pathologist, automating some of their workflow and providing remote capability for the pathologist who was historically eyes on a microscope. That still has way to go, but we’ve seen some good headway in the last couple of years.
What have you learned in starting a company and setting its strategy?
From the beginning, I knew that we had to remain focused and not try to be everything to everyone. We’re not afraid to turn down business that doesn’t align with our goals, competencies, and strengths. We are laser focused in the laboratory. and there’s enough business in the laboratory space for not just JTG, but for other firms and vendors. We are happy that we’ve been successful in remaining focused and providing that excellent service to our customers.
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