Informatics as the "Secret Sauce" in the Integration of Pathology and Radiology

I have posted many notes about the potential benefits of the integration or merger of pathology, lab medicine, and radiology. Robert Michel is presenting a conference on this specific topic in Philadelphia on February 10-11, 2009 (Molecular Summit). A review of the conference program reveals a number of lectures devoted to the topic of informatics which one could describe as the "secret sauce" without which this integration of these medical disciplines could never take place. 

Siemens Healthcare is the corporate underwriter of this conference. The company has been a powerful advocate for the blending of in-vitro and in-vivo diagnostics and has just launched a clinical initiative in a Barcelona hospital (see: SIEMENS HEALTHCARE AND HOSPITAL CLINIC, BARCELONA ENTER AGREEMENT TO USE INTEGRATED LABORATORY DIAGNOSTICS, IMAGING AND INFORMATION TECHNOLOGY SYSTEMS TO ADVANCE PATIENT CARE) with special attention to the diagnostic integration of care in three specified clinical areas: liver fibrosis, fetal medicine and colon cancer.

I want to document here some of the informatics-based processes that will be required in order for diagnostic integration to succeed:

• On the most basic level, pathology and radiology departments have assumed responsibility for their own specialized information systems -- LISs and RISs. The basic management and control of electronic reporting in both departments is obviously the sine qua non of modern medical diagnostics and a prerequisite for the next generation of integrated diagnostics reports. I believe that, in time, LISs and RISs will merged into a common diagnostic report management system, the Diagnostic Information System (DIS).
• All radiology departments maintain their own PACSs, the repository of the images generated in the department. Pathology departments are on the early part of the curve in terms of their own management of digital images. I envision that integrated diagnostics professionals will ultimately be responsible for installing and maintaining an enterprise-wide diagnostic image repository (i.e., PACS) that will include images generated by other specialists in hospitals such as cardiologists and gastroenterologists.
• I have previously referred to the emergence of multi-maker panels, referred to by the FDA as IVDMIAs. Most such panels require the use of computerized algorithms to interpret the clinical significance of the results of the testing. The use of such algorithms have, in part, stimulated the special interest of the FDA in these new and more complex forms of biomarker testing.
• Finally, a whole new type of software will be required if and when in-vitro and in-vivo diagnostics becomes more closely integrated -- rules-based systems that provide recommendations about the cross-referrals between pathology and radiology departments in order to arrive at diagnoses using the most cost-effective, efficient, and effective diagnostic paths.