PASCV’s “Gone Viral” Episode 12: Flexible and Customizable Molecular Panels offers insights into implications for reimbursement alignment, smarter reflex testing, and practical lab strategies
In Episode 12 of PASCV’s Gone Viral podcast, an expert panel of Clinical Microbiology Laboratory Directors and infectious disease experts explored how flexible syndromic panels are reshaping diagnostics. What was at the center of the conversation? Diasorin’s LIAISON PLEX® Respiratory Flex Assay (RSP Flex), a purpose-built solution for labs navigating rising costs, staff shortages, and evolving clinical needs. We’ve included some key highlights from the discussion.
Podcast Panelists
- Dr. Logan Patterson, PhD, D(ABMM), Medical University of South Carolina (MUSC)
Host and Director of Microbiology and Molecular Microbiology - Dr. Heba Mostafa, PhD, MD, Johns Hopkins University
Assistant Professor of Pathology, Director of Molecular Virology - Briana Castillo, MD, MS, Massachusetts General Hospital (MGH)
Infectious Disease Physician - Phyu Thwe, PhD, D(ABMM), Montefiore Medical Center
Associate Director of Infectious Disease Testing, Associate Professor - Nicholas Decker, MBA, MLS(ASCP), Holland Hospital & CoxHealth System
Administrative Director of Laboratory Services
What are flexible syndromic panels, and why are they important?
Episode 12 Insights: The conversation began with Dr. Heba Mostafa breaking down what syndromic panels are—tests that look for multiple pathogens tied to a specific disease state, like respiratory infections.
Diasorin’s Perspective: Fixed syndromic panels frequently include unnecessary targets, especially for immunocompetent or outpatient populations, often wasting resources, and slowing workflows. Enter customizable panels. Rather than always running a 22-target panel, what if labs could tailor the test based on patient type, season, or local prevalence? That’s the promise of flexible syndromic panels like the LIAISON PLEX RSP Flex. It gives labs the flexibility to run what’s relevant and avoid over-testing.
Are labs already using customizable panels?
Episode 12 Insights: Nicholas Decker’s lab has implemented the LIAISON PLEX RSP Flex Assay and shared that his lab underwent a full seasonal respiratory cycle, initially launching with age-specific panels, which his team later adapted mid-season in response to shifting pathogen trends. “At the initial launch we hadn’t considered a panel of simply Bordetella and Mycoplasma together… But due to prevalence and due to what we were seeing mid-season we opted to build that panel to get that access to our clinicians,” Decker stated. Additionally, Dr. Patterson noted, “Having simplicity and being able to streamline that testing to do all the major targets on one platform is a huge advantage. It’s a lot less headache as a director and as a laboratory manager to not have to deal with the validations of proficiency testing of all the different platforms.” Other labs, like Dr. Mostafa’s at Johns Hopkins, evaluated the LIAISON PLEX RSP Flex platform and have since published their findings, while Dr. Phyu Thwe’s team use LIS-based workarounds. Dr. Castillo described an algorithm-based ordering system.
How do you decide which targets go into your top-tier panel?
Episode 12 Insights: This question sparked much agreement: choosing the right tier one targets isn’t one-size-fits-all. Dr. Mostafa said her team looks at local seasonal trends, population-specific data, and clinical relevance. Dr. Castillo added that infection control policies also shape what’s needed in tier 1 versus tier 2 testing.
Diasorin’s Perspective: The LIAISON PLEX RSP Flex offers customizable panel configurations with up to seven tier one targets, allowing labs to tailor testing to actual needs rather than manufacturer defaults.
Can customization become too complicated?
Episode 12 Insights: Host Dr. Logan Patterson asked the million-dollar question: Do you end up with so many panel variations that it’s just easier to run a full panel? Not quite. Most labs stick to a basic structure—like a five-target core panel and a broader full panel for sicker or admitted patients. Nicholas Decker’s team began with four defined panels, adding a fifth panel mid-season based on rising Mycoplasma and Bordetella cases.
Diasorin’s Perspective: The LIAISON PLEX RSP Flex makes this easier by offering unmatched target customization—without adding new instrumentation, LIS burden, or validations.
How often should you update your targets?
Episode 12 Insights: Panelists agreed that updates should reflect clinical and epidemiologic data, but IT resources can be a bottleneck. Nicholas Decker likened it to seasonal “campaigns”, using historical data to guide panel shifts.
Diasorin’s Perspective: With the LIAISON PLEX RSP Flex, you choose the targets that are reported and analyzed, so you can build panels in advance and instantly reveal additional results as needed, without repeating the sample run.
How do you help providers understand what they’re ordering?
Episode 12 Insights: This sparked a candid discussion. Dr. Castillo admitted that if she sees “respiratory panel” in the EMR, she expects a full panel. But when she receives five results instead of 20, it can be confusing. Panelists stressed the importance of naming conventions, showing included targets, and embedding educational cues in the EMR.
Diasorin’s Perspective: Ideally, the ordering process should be intuitive, something that the LIAISON PLEX® System supports through its software-guided test selection and reflex algorithms.
Can reflex rules be automated?
Episode 12 Insights: Most labs avoid fully automated reflex rules due to reimbursement and compliance concerns. Instead, they require provider input before escalating to a full panel. However, all agreed that their dream is a platform that can test all targets upfront, then report more if requested—without rerunning the test.
Diasorin’s Perspective: That’s exactly how the LIAISON PLEX works. The system simultaneously processes all targets in one run, and results can be analyzed and released immediately on demand—saving tech time, reducing operational costs, and improving turnaround for clinical decisions.1
Is there a place for a middle tier of testing?
Episode 12 Insights: There was no consensus here. Nicholas Decker and Dr. Mostafa’s labs reflex directly from small to full panels, while Dr. Castillo sees value in intermediate tiers—if supported by stewardship oversight, clear pricing, and education.
Diasorin’s Perspective: The LIAISON PLEX RSP Flex gives labs the ability to design any panel menu strategy they want, without operational or financial penalty. Thanks to tiered pricing, the total cost of the test is based on the final number of targets reported—so labs can scale panels up or down as needed and only pay for what they use. This flexibility can significantly reduce costs compared to fixed syndromic testing strategies, where every target is paid for regardless of clinical relevance.
How do you deal with reimbursement limitations?
Episode 12 Insights: Many payors only cover 3–5 targets, especially for outpatients. Nicholas Decker commended the LIAISON PLEX RSP Flex’s tiered pricing structure, which allows institutions to stay within reimbursable levels while still customizing target selection. Some labs even added “dollar signs” in the EMR to help clinicians understand cost differences between panel options.
Is it ethical to hide results that were technically run?
Episode 12 Insights: Dr. Patterson raised a tough question: if the platform amplifies all targets but only reports five, is it ethical to “hide” positives that go unreported? Dr. Mostafa clarified that with LIAISON PLEX, unselected targets aren’t analyzed unless requested.
Diasorin’s Perspective: There’s no ‘hiding’— just a more efficient and compliant approach that helps labs stay ethical while avoiding unnecessary retesting.
How do you know when to update your panel to catch emerging pathogens?
Episode 12 Insights: Dr. Logan Patterson noted that this capability supports epidemiological decision-making. Meanwhile, Nicholas Decker imagined a future where the Flex® Software could proactively flag rising background positives, triggering alerts to review or modify panels, which would take diagnostic stewardship to the next level.
Diasorin’s Perspective: This is where the LIAISON PLEX really shines. Software currently in development will enable aggregate review of all targets, allowing labs to dynamically adjust panel configurations in response to emerging trends—such as spikes in Bordetella or Mycoplasma.
Diasorin's Final Thoughts
Wrapping with enthusiasm, the panel offered some wish list ideas for vendors—like simplified reflex workflows, integrated education, and smarter software prompts. But across the board, the panelists agreed: flexible syndromic testing is here to stay.
The LIAISON PLEX RSP Flex makes precision testing easier by offering unmatched target customization—without adding new instrumentation, LIS burden, or validations.
1) Norton, J. M., Dashler, G., Klein, E., & Mostafa, H. H. (2025). The utility of syndromic respiratory pathogen panels: The premise of flexible and customizable approaches. Journal of Clinical Microbiology, 63(7). https://doi.org/10.1128/jcm.00313-25.