I recently participated in a wide-ranging discussion about integrated diagnostics and the term digital collaboration cropped up. I had not heard if before so I thought it would be useful to analyze it in this context. Integrated diagnostics refers to the closer collaboration, or even eventual merger, of the diagnostic specialties, particularly lab medicine, pathology, and radiology.To get the ball rolling, digital collaboration can be defined in the following way: working together [by] sharing ideas and [information] using online technology. What then is its relevance with regard to the emerging closer collaboration across the boundaries of the diagnostic medical specialties and also with regard to the broad effects of digital pathology and radiology on the daily work of clinicians?
Historically, pathologists and radiologists have always been willing, and sometimes even enthusiastic, about providing access by clinicians to histology and radiology cases. However, such reviews were often a time-consuming process for harried clinicians. In complex cases, a "guided tour" of these materials by pathologists using a double-headed microscope and radiologists at a view-box was often necessary, which was sometimes difficult to arrange. Hence and in the past, many clinicians relied primarily on the reports from pathology and radiology for information and guidance. An important exception to this rule were certain groups of clinicians such as orthopedic surgeons and neurosurgeons who frequently prided themselves on their ability to "read" their own radiology studies.
Digital pathology and radiology radically shift the rules of this previous scenario such that all radiology images, and soon pathology images, are stored in a hospital enterprise PACS can be readily accessed by all clinicians. Let me put off for another day the question of how this technology alters healthcare delivery in general. A more focused question for now is how digital collaboration affects the day-to-day relationship between pathologists and radiologists. This will be a pivotal question in the emergence of integrated diagnostics. I have a hunch that the following will occur:
- The norm for pathologists and radiologists, in time, will be to review not only the narrative reports of the collaborating specialty but also all available digital images when signing out cases. This practice will emerge first in the diagnostic subdisciplines, by which I mean pathologists who specialize in GI and GU, for example, and cardiovascular or neuroradiology, for example, on the radiology side.
- This scenario seems to me to be the most logical starting point for the emergence of integrated diagnostics because there is a tendency for diagnostic subspecialists to seek all forms of information underpinning their diagnoses -- digital images on both the pathology and radiology sides constitute key elements in the pursuit of the best diagnoses.
- Starting from this subspecialty corner, I suspect that the standard of practice for all diagnosticians (e.g., pathologists, radiologists, cardiologists) will evolve to a standard of practice encompassing the review of all available diagnostic studies, including serum biomarkers and images, before rendering a diagnosis. In effect, this shifts the information integration burden from the clinician to the diagnostician.