Imagine taking your child to the pediatrician for acute gastroenteritis, concerned about dehydration. Reassuring tests identify Salmonella, which will likely resolve on its own. Relief comes first, followed by surprise when a sizable laboratory bill arrives weeks later. Similarly, frustration mounts when a respiratory test required for school or work confirms rhinovirus yet still screened for more than 20 additional pathogens, inflating the cost beyond clinical need. These scenarios raise a key question about the value of testing aligned to the individual clinical need of the patient.
As comprehensive FDA-cleared molecular panels for pathogen detection have become more readily available, access to patients has increased. This offers clear advantages, including the potential for testing in decentralized or near-patient settings that result in faster turnaround times, reduced test menu complexity, and broader pathogen detection with potential surveillance benefits.
Cost vs. clinical need: when more isn’t better
However, a major limitation persists: many targets on these broad fixed panels offer limited clinical actionability. Results may add informational value but lack a subsequent change in patient management, which may raise questions about overall utility. Detection of organisms with uncertain significance can also increase follow-up burden for specialists (e.g.,infectious disease physicians). When higher-cost testing does not yield proportional clinical benefit, it invites payer scrutiny, inconsistent reimbursement, and ultimately greater expense for patients and health systems.
Customizable panels offer a compelling alternative, combining the flexibility traditionally associated with laboratory-developed tests with the reliability and usability of commercial assays. They enable targeted testing based on symptoms, risk factors, epidemiology, or geographic context while retaining the capacity to cast a broad net to detect rare or unusual pathogens (e.g.,in immunocompromised patients). These tailored strategies align closely with evidence-based guidelines for targeted testing and are not mutually exclusive; a single health system might implement different versions depending on the setting or patient population.
Tailoring panels for patients, not just pathogens
To return to the original cases, gastrointestinal testing can be tailored by exposure risk, care setting (targeting community vs. hospital-acquired pathogens), and clinical presentation (e.g., bloody diarrhea), while respiratory testing can be adjusted seasonally to reflect predictable shifts in local prevalence. Testing strategies may also vary by immune status, age, or specific exposures. Tailoring panels to the appropriate patient population increases pre-test probability and improves the signal-to-value ratio, yielding higher-confidence results and reducing the risk of false positives that may prompt unnecessary follow-up.
From a laboratory perspective, offering flexible panels on a single platform presents benefits and trade-offs. Economies may improve pricing, simplify inventory management, and reduce consumable waste by limiting cartridges. However, reliance on a single platform can create vulnerabilities if panel issues arise or regulatory updates are slow. A customizable approach, albeit including all targets on a single test, may also streamline workflows by reducing hands-on time and reflex testing. Importantly, access to aggregated, anonymized data across all panel targets would be central to supporting laboratory efforts in designing panels and maintaining appropriate targets.
Beyond operational efficiencies, customizable panels support diagnostic and laboratory stewardship and align well with value-based care models. As payment structures increasingly emphasize efficiency and outcomes, panels with a transparent rationale for high-value targets can help payers align reimbursement with clinical necessity.
Moving beyond “more is safer” in molecular testing
Adoption of customizable panels represents a cultural shift from the view that "more is safer" in comprehensive, all-inclusive molecular testing. Successful implementation will require support of laboratory infrastructure for thoughtful panel design and regulatory compliance, alongside provider education on panel selection. Because few platforms have implemented customization at scale, generating real-world evidence will be essential to building payer confidence. Industry partners can facilitate this transition by offering modular test design, implementation and reimbursement support, and transparent performance data. Most critically, user-friendly analytic tools for robust data access will be central to supporting evidence-based testing strategies. Looking ahead, one can envision AI-informed target selection or epidemiology-driven dynamic panels transforming diagnostic stewardship even further, but this is only possible if driven by the data.
Molecular syndromic testing for infectious diseases has evolved significantly: from highly flexible and variable laboratory-developed tests to fixed, comprehensive commercial panels. As the field continues to mature, a return to flexible, targeted, and clinically relevant panels represents a logical next step. Targeted panels support diagnostic stewardship by promoting efficient, effective care while enabling a more personalized approach to infectious disease diagnostics. Ultimately, a data-driven strategy for designing targeted molecular panels offers a promising path to enhancing diagnostic value for patients, laboratories, and health systems alike.
Rebekah Dumm, PhD, D(ABMM) is the Medical Director of Microbiology & Molecular Infectious Disease at Barnes-Jewish Hospital and an Assistant Professor in the Department of Pathology & Immunology at the Washington University School of Medicine in St. Louis.
This article was sponsored by Diasorin. The views and opinions expressed in this article are solely those of the author and do not necessarily reflect the views of the company.