Novel markers, a payer's perspective: commissioning a new service.

Diagnostic technologies assist clinicians and care givers in making decisions about the care of individual patients. The demands for an evidence-based approach to practice, is proving to be challenging in the field of laboratory medicine as: (i) there has been little formal requirement to demonstrate evidence of effectiveness prior to the introduction of new tests, (ii) generating evidence of effectiveness of tests depends, in most cases, on complementary actions being accomplished e.g. making the correct decision on receipt of the result, and taking the right action, (iii) the principles of evidence-based laboratory medicine highlight the fact that diagnostic tests have the potential to solve a wide range of problems, in a number of clinical settings, with the potential to generate a varied range of benefits (outcomes), and (iv) outcomes invariably accrue to parts of the health economy outside of the laboratory, which can prove challenging for health service managers. Commissioning a new service involves (a) assessing the local health care needs - and the expected outcomes, (b) specifying the services required-including the resources, and transformational change required, (c) securing the services required - and the implementation strategy to be employed, and (d) monitoring against the contract issued, as well as evaluating the outcomes against the expectations. In this way the purchaser can ensure that diagnostic services are meeting clinical needs, and are being used appropriately to generate the best outcome for the patient and the exchequer, thereby meeting clinical and fiscal governance requirements.