Worthy of your attention is a new white paper from Atlas Medical. Click on the image of the document on the right of the Atlas web page to download a copy. The basic theme of this report is that the coordinated care model of healthcare is gaining wide acceptance and that we should apply this same logic to the coordination of diagnostics across multiple encounters. This is to say that lab testing often goes unmanaged from both a clinical and cost perspective, particularly when testing is performed in multiple sites. Here's a cut-and-paste of a paragraph about the continuity of diagnostic information from the white paper that resonated most with me (page 8):
....The importance of Continuity of Information in the diagnostics practice is not to be underestimated. Historically, laboratories and other diagnostics organizations have treated each encounter with a patient (each order request and its related results) as an isolated transaction. Even though most physician EMRs associate numerous encounters for any given patient, the lab or hospital receives orders from multiple physician EMRs, in addition to other individual outreach, outpatient and inpatient encounters. Healthcare organizations need to take a patient-centric approach to gathering and accessing all of this data to ensure better clinical efficacy and enable better coordinated care. For example, many patients (particularly patients with chronic diseases under active management) have multiple tests performed over time, and when the information about these encounters is combined into a consolidated record, potentially valuable insights about that patient’s history and care emerge.
All of this leads to the point that we need greater EHR interoperability in order to achieve coordinated diagnostics (see, for example: What Will Motivate Hospital CEOs to Seek HIT Interoperability?; Epic Retains Lobbying Firm to Improve Its Interoperability Image on Capital Hill; Revisiting EHR Interoperability; Standardized Content and Vendor Strategy; ONC calls for interoperability by 2017). My recollection regarding lab testing many years ago is that tests were often repeated for patients admitted to the hospital based on the following assumptions: (1) past results were not available electronically; (2) many test results are highly dynamic so some past results were probably not relevant to current disease; and (3) some of the prior tests may have been performed in unreliable labs. Such an approach is probably unnecessary in most cases today. Note that the excerpt above from Atlas appropriately singles out patients with chronic diseases for whom historic results can be very informative.
There is a close relationship between Atlas Medical's call for coordinated diagnostics and my previous notes about integrated diagnostics (see: Revisiting Integrated Diagnostics and the Integrated Diagnostic Report; INTEGRATED DIAGNOSTICS & INTEGRATED DIAGNOSTIC SERVERS: THE PERSPECTIVE OF A PATHOLOGIST; Why the Culture of Pathology/Radiology Can Militate Against Integrated Diagnostics). The former is defined as correlation of lab information across encounters and the latter is defined as correlation of all diagnostic results (lab + surgical pathology + radiology), both within encounters and across encounters.