By John Minielly, M.D. Pathology Laboratory Associates (PLA) and Regional Medical Laboratory (RML) began their journey in the early 1980s thanks to the efforts of two pathologists, Dr. C. Terrence Dolan and Dr. John Minielly. Together the two doctors envisioned a regional laboratory that was a center of excellence for both patient care and referring physicians. They believed that a regional laboratory would allow for growth in outreach testing and consultation services, leading to more efficient use of the existing facility and providing the economic advantages of increased volume. Although recruited to St. John Medical Center from different parts of the world, Drs. Dolan and Minielly were no strangers. Both had worked together as pathology residents at the Mayo Clinic in Rochester, Minnesota, in the mid-1960s. Together they built PLA and RML on their shared experience at the Mayo Clinic, along with their individual experiences in Missouri (Dolan) and Ontario, Canada (Minielly). Dr. Dolan arrived in Tulsa in February 1980 from Kansas City, Missouri, after being recruited to head up the St. John Medical Center laboratory. Dr. Minielly soon followed in September 1980. He was recruited from the district laboratory program affiliated with McMaster Medical Center and School in Hamilton, Ontario, Canada, to direct the Anatomical Pathology section of the laboratory. When the doctors were recruited, the St. John Medical Center laboratory only served the needs of St. John Hospital. The lab included six pathologists, three in anatomical pathology and three in clinical pathology; five section managers; one overall technical supervisor and a technical staff of approximately fifty. At the time, the laboratory processed about 8,500 surgical pathology specimens and 700,000 clinical pathology tests. THE GENESIS: Regional Medical Laboratory & Pathology Laboratory Associates, Inc In 1981 Dr. Dolan and Dr. Minielly, in partnership with Utica Services, Inc. (the for-profit arm of St. John Medical Center), purchased Research Medical Laboratory from Dr. Murray Cash. This laboratory was a small private facility that served a physician clientele in Tulsa for many years. There were three sites: Utica Square Medical Arts Building, Doctors’ Building, and Warren Medical Center Doctors’ Building. The operations at the Utica Square Medical Arts Building and the Doctors’ Building were retained after purchase, and the name was changed to that it holds today: Regional Medical Laboratory (RML). Between the two locations there were five employees and one leased courier car. Routine work was done on-site, while more advanced work was referred to the hospital laboratory. Surgical pathology specimens from the two offices were picked up by Dr. Minielly on his way home from St. John Medical Center in the evening and taken to the hospital laboratory the following morning for processing. Around this same time, PLA became the professional corporation for the St. John pathologists, RML, and directly related support staff. The original pathologists in the group were Dr. C. Terence Dolan, Dr. John Minielly, Dr. Walter LaMar, Dr. Jimmy Strange, Dr. Kenneth Hoffman, and Dr. David Potts. Additional early recruits to the corporation were Dr. William Sheehan, a Hematopathologist from Parkland Hospital in Dallas, Texas, and Dr. William Fitter, from Harper Hospital in Detroit, Michigan. Dr. Fitter was recruited to head up Clinical Chemistry, and as a resident, he had worked with Dr. Minielly at the McMaster Clinical Chemistry Department in Ontario. Transition to For-Profit Status In 1984 Drs. Dolan and Minielly sold their interest to Utica Services, Inc., and in 1985 RML merged with the St. John Medical Center laboratory, becoming a for-profit independent laboratory. In this unique professional arrangement, although the laboratory space belonged to the hospital and the staff was employed by the hospital, both were leased from the hospital by RML. RML and PLA Expands and Grows 1985 was a year of pivotal growth for RML and PLA, due, in part, to the capable and industrious management staff including Steve Bowers, Mary Hydrick, Diane Hayes, Cheryl More, Beverly Tolson, and Carol Ghere. During the following years the laboratory, its clients, and the areas served continued to grow. Over the years PLA recruited pathologists with expertise in breast, renal, genital urinary, and gastrointestinal pathology; dermatopathology; molecular pathology; cytology; blood banking and coagulation; immunology; microbiology; and information technology. By 2017 PLA included twenty-two pathologists. As numerical growth continued, RML and PLA’s geographical service area widened into Ponca City, Oklahoma; Oklahoma City, Oklahoma; Norman, Oklahoma; Southeast Kansas and beyond. And, as the volume increased, growth was seen in both routine testing and specialized testing. Additionally, as the demand for specialized testing increased, so did the laboratory’s expertise. By 2017 less than two percent of RML’s volume is referred to outside laboratories for testing. At the end of 2016 there were a total of 32 patient service centers with thirteen of the 32 centers having over 2,500 physician/office clients. Annually RML has over 700 employees performing more than 9 million clinical tests, processing and interpreting nearly 125,000 surgical pathology specimens and nearly 90,000 cytology specimens. St. John Facility Expansion In 1980, St. John Medical Center’s entire laboratory operation was on the fifth floor of St. John Hospital’s North Tower. In 1985 there were some minor structural changes, and in 1989 the fifth floor was remodeled. Many of the concrete block walls were removed at this time, producing more efficient open space into which hundreds of feet of movable bench space was installed. In 2003, the laboratory was relocated to the fourth and fifth floors of the new Siegfried Tower on the St. John Campus. Anatomical pathology and administration were on the fourth floor and clinical pathology on the fifth floor. This move greatly increased the available testing space. Soon, however, more space for current and expected growth was necessary. In 2011, the anatomical pathology and administrative operations moved to a new twelve acre campus at the corner of 41st Street and Mingo. Billing and information technology operations were already occupying part of the St. John Physicians’ Building on the same campus. In 2013 the core clinical pathology operations moved to this new campus as well. The total floor space at the new location (greater than 90,000 square feet of space) provided the ability to expand volume and facilitate sophisticated testing. The blood bank and a rapid response laboratory remain on the fifth floor of the Siegfried Tower at St. John Medical Center. Surgical pathologists rotate to the hospital for onsite pathology consultation and frozen section diagnosis in a small laboratory located near the surgery suites on the third floor in the main hospital tower. EXPANSION CONTINUES: Regional Hospital Laboratory Management & Supervision RML and PLA expanded to acquire total laboratory management and/or supervision of numerous local hospital laboratories: Jane Phillips Medical Center in Bartlesville, Hillcrest Medical Center in Tulsa, Hillcrest Hospital South in Tulsa, Hillcrest Hospital Claremore in Claremore, Tulsa Spine Hospital in Tulsa, Oklahoma Surgical Hospital, and all St. John Health System laboratories. PLA also expanded the supervision, pathology support, and medical directorships of laboratories in over 44 institutions of varying types and sizes throughout Oklahoma and Kansas, including oversight of technical-only histology labs. The histology laboratory at RML continued to see increasing volumes as it provided histology technical services for several area hospitals, preparing greater than one million surgical pathology slides in 2016. SOFTWARE DEVELOPMENT: Cerner Laboratory Information System: “Pathnet” St. John Medical Center was the alpha client and development partner for the first software offering from Cerner Corporation: Classic Pathnet Laboratory Information System (LIS). The early planning for LIS began with Dr. Dolan and Mr. Neal Patterson (Cerner President and CEO) while Dr. Dolan was still in Kansas City. Early development of the LIS took place in 1981 and 1982 and in 1983 the first version of the Classic Pathnet LIS went live at St. John Medical Center. The partnership between Cerner, RML, PLA and St. John Health System (SJHS) has continued through the years with RML’s installation of the Cerner AP Millennium LIS in 2005 and St John Health System’s installation of the Cerner electronic medical record (EMR) in 2010. In 2016, after 34 years on the Cerner Classic LIS, RML migrated to the Cerner Millennium Pathnet LIS. RML, PLA and Cerner continue to collaborate to further develop and fine-tune LIS technology. DATA WAREHOUSING: Enterprise Data Warehouse In 1995 RML and PLA developed a data warehouse initially focused on laboratory information. Dr. Dolan was inspired by Sam Walton’s ability to utilize data warehousing in Walmart stores to revolutionize the retail market. Dr. Dolan believed that the healthcare industry could benefit from this powerful technology, both in the improvement of patient care outcomes and in the reduction of healthcare costs. As a pioneering expert in data warehousing, RML and PLA has spent over 20 years developing its Enterprise Data Warehouse, and it has become one of the most robust data warehouses in the healthcare space. This warehouse has gone far beyond the initial harvesting of laboratory data, and now includes a plethora of healthcare data from all facets of the health system including medical, financial, and operational information. An important distinction of the Enterprise Data Warehouse is the high level of data integrity. As pioneering experts in the use of data warehousing and business intelligence in healthcare, RML and PLA provides the industry with added value associated with its expertise in business intelligence and analytics. With greater than four terabytes of harvested and optimized data, the warehouse continues to grow daily, providing real-time analytics related to utilization, clinical studies, population health, outcomes (medical and financial), cost analysis, productivity, and data mining, to name a few. The Enterprise Data Warehouse has been a formidable part of PLA and RML’s history and success and will continue to be an important part of its future and the future healthcare delivery. THE RML MODEL OF SUCCESS: Adopted by Ascension Health In 2014 St. John Health System partnered with Ascension Health, headquartered in St. Louis, Missouri. It is the largest not-for-profit Catholic healthcare Integrated Delivery Network (IDN) in the United States. The RML model of patient-centered, high quality laboratory testing, cost-effective laboratory management, expansive outreach growth, data warehousing capabilities, and the ability to increase volume became of great interest to Ascension Health. This interest resulted in plans to replicate the RML model through all of Ascension Health’s 129 facilities across the country, and for RML to become the first national reference lab for all of Ascension Health. This journey began in earnest in July of 2016. THE JOURNEY CONTINUES In October of 2022, Labcorp of America purchased select assets of Ascension Health’s inpatient and outreach laboratory business which created the opportunity for PLA to take over the AP technical laboratory previously owned by RML/St John Health System/Ascension Health. PLA continues to provide medical oversight and lab directorship to Labcorp and Ascension laboratory facilities in Oklahoma and Kansas. After 40 years it was time to say goodbye to RML while PLA advanced as a fully independent physician owned pathology group taking all the decades of physician expertise to the future. PLA currently has 25 board certified anatomic and clinical pathologists with 7 dermatopathologists, 3 cytopathologists, 3 hematopathologists, one PhD in molecular pathology, and one PhD in immunology. PLA continues to reinvent pathology services by offering 100% second review on all biopsies and surgical specimens with an unparalleled accuracy rate. Our published ‘significant error rate’ is 8 per 100,000, a standard unheard of in the industry. The vision of the founders to expand quality and reliable laboratory services to communities and markets in need, provide superior client and patient service, state of the art laboratory information, cost-effective laboratory services, immediate pathologist availability, and a positive working environment has not changed. PLA continues to evolve and works to meet the challenges of an everchanging healthcare landscape by using high-quality medical expertise, ingenuity, and the power of data to seize every opportunity to improve healthcare delivery. Information Assistance by Norman Gayle, Steven Bowers Editing by Cynthia Webb Formatting by Alfred DeStefano III
