Repurposing Outpatient Clinics and Medical Procedure Units as Integrated Diagnostic Centers

I have been an advocate of the merger of pathology and radiology into what could be described as the new medical specialty of diagnostic medicine. This merged specialty can also referred to as integrated diagnostics. The integration of pathology and radiology is related to the idea of the development of Integrated Diagnostic Centers (IDCs). These are clinics staffed by multidisciplinary teams and focused on the goal of diagnosing disease faster, better, and less expensively than the norm today. Most such centers today specialize n the diagnosis of breast masses. In the U.K, they are referred to as one-stop breast cancer clinics (see: The Value of "One-Stop" Breast Cancer Clinics Confirmed in the U.K.).

What is the basis for the claim that IDCs can arrive at diagnoses faster, better, and less expensively? The faster and higher quality assumptions are derived from the multidisciplinary nature of these centers. Professional hand-offs, communication, and procedure scheduling is easier and more efficient when health professionals are working side-by-side. The less expensive assumption relates to the fact that diagnoses can be arrived at faster and with fewer administrative costs. As experience accumulates in such centers, the workflow can only improve. In time, computerized algorithms can be developed for these centers that automate workflow. Dr. Jonathan Braun, Chairman of the Department of Pathology at UCLA, has created a Radiology-Pathology Center in Los Angeles in collaboration with the Department of Radiology. He discussed the project in a lecture presented at the 2009 Molecular Summit (see: UCLA Radiology Pathology Center (Or, Slouching Towards Bethlehem: Gestation of a Multimodality Diagnostics Initiative).

Many existing clinics with examining rooms, pathology, and radiology services could be adapted, in part or totally, to IDCs. Similarly, existing colonoscopy centers could also be modified to include the services of pathologists and radiologists and to provide one-stop diagnostic services. In this way, biopsies of suspicious polyps, for example, could be quickly processed and diagnosed while the patient is on-site. In other words, there is no reason that the "one-stop" concept should be confined to patients with breast masses. Small hospitals that are no longer economically viable currently might also be suitable for conversion to IDCs.

Comments

[Mark Terry]

The conversion is an interesting thought. I'm wrapping up a large report on integrated diagnostics and have recently been interviewing and profiling hospitals that have (or say they have) some level of integration in diagnostics, ie., pathology and imaging. Very few, if any, think this is actually a trend. They think it's a good idea, more or less, but not many are willing to call it a trend. And I think when you look at the 8000+ hospital laboratories in existence in the U.S. and then try to figure out exactly how many of those have anything even remotely resembling "integrated diagnostics," those who are doing it probably can't even be called leading edge so much as experimenters. Only time will tell, perhaps.