Multidisciplinary Diagnostic Teams and Integrated Diagnostic Centers

The notion of integrated diagnostics focuses on the practicality and feasibility of closer collaboration, or even merger, of pathology, clinical lab medicine, and radiology (see: The Evolution of Integrated Diagnostics into Integrated Diagnostic Centers; Revisiting Integrated Diagnostics and the Integrated Diagnostic Report). The Integrated Diagnostic Center (IDC) is a physical or virtual facility where diagnoses are rendered for patients after referral from clinicians. I delivered a lecture recently at the AHIC conference in Toronto on this topic (AHIC 2012: Towards Integrated Diagnostics: Bringing Crucial Information to the Point of Care). You can review the lecture in PDF format (see: Integrated Diagnostics and Its Relationship to Digital Pathology: A Strategic Analysis). One of the primary goals of my presentation in Toronto was to emphasize the critical role that digital pathology will play in the emergence of the new merged specialty of diagnostic medicine. In this same context, I want to describe the role of multidisciplinary diagnostic teams working within these IDCs as an analogue of the multidisciplinary clinical teams that work so effectively within cancer hospitals.

For me, one of the most important innovations in cancer hospitals have been their deployment of multidisciplinary teams (MDTs) (see: Most Oncologic Surgeons Do Not Adhere to Cancer Care Standards). One of the key advantages of managing cancer patients with a multidisciplinary team is that the various medical specialists on the team are incented to downplay some of their natural specialized training instincts for the good of the patient.

I have been proposing that patients with complex diagnoses such as undiagnosed tissue masses be referred to integrated diagnostic centers. These centers would be staffed primarily by diagnosticians such as pathologists and radiologists. The rationale for the development of such centers is that diagnostic procedures and the integration of test and report results in this era of genomic and complex imaging procedures should be moved "upstream" to the diagnosticians themselves. This should result in the more efficient diagnosis of unknown masses or other complex diseases, ideally, in a matter of two to three days.

Both radiology and pathology are now so specialized that no one individual could function autonomously in the diagnosis of a patient with a newly discovered tumor. The members of the diagnostic team would therefore need to convene either physically or virtually at the end of each work day and jointly sign-off on the diagnoses for the most challenging cases. Part of the efficiency of such an IDC is that, behind the scenes, a series of computerized, work-flow algorithms will guide the patient through the most appropriate and relevant imaging studies, biomarker studies, and tissue biopsies in order to arrive at a final diagnosis in the shortest amount of time. These algorithms will take into consideration all previous positive test and studies in order to navigate quickly through the entire diagnostic process.

Comments

[Cancer Hospital in India]

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