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Dr. Michael Astion and PLUGS – a Laboratory Stewardship Program to Foster Precision Medicine Best Practices


Laboratories could be considered the epicenter of the precision medicine industry, so we were thrilled to have Dr. Michael Astion, Medical Director for the Department of Laboratories at Seattle Children's Hospital join us. In this episode, he introduces us to PLUGS, (Patient Centered Laboratory Utilization Guidance Service) a grassroots program he co-founded that exists to promote and strengthen laboratory stewardship.

Michael Astion PLUGS Lab Stewardship - Michael Astion
Listen to the full episode above and download the full PDF transcript here.

As a company that promotes collaboration in precision medicine, the Trapelo team was excited to learn more about the PLUGS program, which promotes laboratory stewardship with the goal of bringing all stakeholders together for more accurate molecular testing. Dr. Astion summarized the four key goals of PLUGS as:


  1. ensuring providers are ordering the right molecular tests;

  2. making sure they are retrieving that test;

  3. interpreting the test correctly; and

  4. negotiating fair payment for everyone involved.


In order to pursue those four aspects of laboratory stewardship, PLUGS helps its members create stewardship programs and share tips, policies, procedures, educational materials, and best practices with each other.


During our time with Dr. Astion, we discussed some astounding numbers with regard to laboratory ordering and management. 

An estimated 1.3 billion-plus molecular tests are performed each year, and about 30% of those tests are ordered inappropriately.


Dr. Astion pointed out that PLUGS members have access to genetic counselors who systematically review cases, and those counselors regularly have a 25%, 30% correction rate with a 5% medically significant error rate. In fact, 10% of the tests don't need to be done at all, because they are duplicates or aren’t medically necessary.


He notes that these numbers are one of the main reasons that insurance companies are hesitant to cover molecular testing. Dr. Astion believes that by changing the conversation between providers, labs and payers to be less about putting blame at each other to one that truly considers the other’s point of view, the confusion around testing for precision medicine can be resolved.


We couldn’t agree more. Dr. Astion is doing incredibly important work towards making precision medicine a reality. We were honored to have another industry champion as a guests on The Precision Medicine Podcast.

Listen to the full episode above.

Download the full transcript of the episode here (pdf).


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About Our Guest

Dr. Michael Astion

Medical Director, Dept of Laboratories at Seattle Children's Hospital, Co-founder of PLUGS

Dr. Astion is a clinical pathologist who is Medical Director, Department of Laboratories at Seattle Children’s Hospital and Clinical Professor of Laboratory Medicine at the University of Washington. 


His career is divided between clinical service, teaching, and research and development. He has authored more than 20 software titles, 40 peer-reviewed papers, and 40 editorials. He is the former editor-in-chief of Patient Safety Focus, which appeared quarterly for 10 years within AACC’s Clinical Laboratory News. He is currently an editor of Laboratory Stewardship Focus, which is also featured inside Clinical Laboratory News. He is working actively, through grants and intellectual property held by the University of Washington and Seattle Children’s, with the insurance industry in the United States to create utilization management rules for clinical laboratory testing.


In addition, he is one of the founders of PLUGS, the Patient-Centered Laboratory Utilization Guidance Service, a unique service that helps hospital-based and commercial laboratories actively increase the value of lab testing. Dr. Astion is a frequent speaker at professional meetings, where he lectures on issues related to laboratory test utilization; test interpretation; laboratory economics and outreach; and medical errors.

Learn more about PLUGS

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