I recently delivered a lecture about integrated diagnostics and integrated diagnostic servers at an interim meeting of the International Society for Strategic Planning in Radiology (ISSSR). Here is a copy of my lecture for your review: Integrated Diagnostics & Integrated Diagnostic servers: the Perspective of a Pathologist. On slide #5 of the slide deck, I define integrated diagnostics as the aggregation of pathology and radiology test and procedure results from complex patients to facilitate their analysis and interpretation and to increase the quality and reduce the cost of care. I proceed in the lecture to suggest that these goals are best accomplished by the deployment of integrated diagnostic servers that I have discussed in a previous note (see: Development of Integrated Diagnostic Servers by Pathology and Radiology). It became clear to me during the subsequent discussion of these ideas with audience members that one of the major barriers to integrated diagnostics is the "culture" of pathology and radiology. To facilitate further discussion, here's the best definition for organizational culture that I could find on the web (Organizational Culture):
Organizational culture is the behavior of humans within an organization and the meaning that people attach to those behaviors. Culture includes the organization's vision, values, norms, systems, symbols, language, assumptions, beliefs, and habits.
The primary purpose for integrated diagnostics is to help clinicians arrive at a diagnosis for a patient faster, better (i.e., more efficiently and effectively), and less expensively. If my claim is correct that some aspects of the organizational cultures of pathology/radiology are antithetical to this goal, it's important to try to understand where within the vision, value, and norms of these two specialties the problem lies. I personally think that it's in the following two assumptions made by pathologists and radiologists regarding the operation of their departments and the pursuit of their careers:
- It's important to perform an increasingly greater number of tests and procedures each year.
- It's important for the practitioners of these two specialities, particularly in academic centers, to develop an increasingly specialized set of skills.
In pathology, we frequently cite our increasing number of tests per year and increasing revenue, compared to expenses, as a justification for budgetary increases. This approach flows from the fact that we operate under a fee-for-service model where an increasing test volume is more remunerative. However, I also believe that we are slowly moving to a value-based healthcare delivery system where reimbursement is based on more efficient and effective care delivery (see: The Strategy That Will Fix Health Care). Hence, this particular facet of the pathology/radiology culture must quickly change to adapt to the provision of faster, better, and less expensive services.
I will refer to the pursuit of greater specialization in pathology/radiology as the "siloing" of the fields. In pathology, we even develop silos within silos: for example, pathology>surgical pathology>GI pathology>liver pathology. Similar trends exist in radiology. Although there are pleas for training more generalists to serve as data integrators, I don't think that this will happen. There are too many rewards for academics for a specialized practice. This is the reason why I advocate the use of software tools installed on integrated diagnostic servers (e.g., heuristics, business rules, and algorithms) to perform most of the heavy lifting in terms of mapping optimal integrated diagnostic workups for patients.
Note also in the lecture that I describe the need for the creation of virtual department of diagnostic medicine. I use this term to describe close collaborative, daily interactions between pathologists and radiologists without any disruption of the formal boundaries of these two medical specialities.