You need to pay close attention to the Diagnostic Management Teams (DMTs) that Mike Laposata is developing at Vanderbilt. He lectured on this topic at the just-completed Pathology Informatics 2012 conference (see: The Diagnostic Management Team: How it Works and Its Clinical and Financial Implications; audio plus synched PowerPoint; PDF only). When Mike was at Harvard/Mass General, he worked for years developing a diagnostic team focusing on coagulation problems. Now at Vanderbilt and on a far broader scale, he is using a coagulation DMT to assess coronary stent patients for the efficacy of chronic treatment with Plavix (see: Vanderbilt Launches New Genetic Screening Program to Prevent Problems Associated with Plavix, the Most Commonly Prescribed Clot-Preventing Drug for Heart Patients). No longer content to restrict DMT efforts to coagulation problems, he has also launched DMTs in hematopathology, microbiology, and transfusion medicine.
The Vanderbilt DMTs receive consultation requests from clinicians, make rounds on these referred patients, record their diagnostic and treatment findings in the EHR, and are reimbursed for their efforts. Plans for the future are to develop similar teams for endocrine diseases, toxicology, and autoimmune diseases. Keep in mind that the work of these teams would not be possible, as Mike points out in his lecture, without a very sophisticated informatics infrastructure that acquires clinical information about the patients for whom a consultation is requested and generates the consultative reports for posting in the EHR.
The analogue to these DMTs on the clinical care side are the multidisciplinary teams (MDTs) that are now the standard of care in cancer hospitals (see: Does Multidisciplinary Care Enhance the Management of Advanced Breast Cancer?: Evaluation of Advanced Breast Cancer Multidisciplinary Team Meetings). I have also suggested in previous blog notes that integrated diagnostic centers with multidisciplinary teams should be developed for the rapid diagnosis of tumors in outpatient settings (see: Plan for the Evolution of Integrated Diagnostic Centers Beyond Breast Clinics; Multidisciplinary Diagnostic Teams and Integrated Diagnostic Centers; Integrated Diagnostics and Its Relationship to Digital Pathology: A Strategic Analysis).
An interesting question to consider is why so few pathology departments have chosen to emulate Mike's many successes over the years by of developing their own DMTs. I think that the answer to this question is multifactorial and based on the following problems: (1) most community pathologists and even those based in teaching hospitals are more skilled and interested in surgical pathology than clinical pathology; (2) many academic clinical pathologists are focused in part on bench research and do not devote all of their work efforts to the enhancement of patient services; (3) lab scientists (i.e, lab professionals with Ph.D. degrees) and medical technologists, under current rules, cannot be compensated for direct consultative services to patients; (4) the perception that hospital-based clinical pathology consultative services cannot be financially successful. There is no question is my mind that Mike's efforts are critical in showing the rest of us how our diagnostic efforts can be enhanced to improve the quality of patient care.
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