Revisiting Integrated Diagnostics and the Integrated Diagnostic Report

In previous notes, I have been a strong advocate for integrated diagnostics, defined as closer collaboration, and perhaps eventual merger, of pathology, lab medicine, and radiology (see: The Evolution of Integrated Diagnostics into Integrated Diagnostic Centers)). A key central concept of this idea is the integrated diagnostic report (see: New Attention Being Directed toward Diagnostic Adverse Events (DAEs)). As currently conceptualized, such a report consists of a "super" or "bottom-line" diagnosis for a patient. It would be created by the integration of all of the "sub-diagnoses" for a patient that are generated serially and independently within the radiology sub-specialties (e.g., CT, MRI, PET) plus surgical pathology diagnoses plus data/diagnoses from the various from the various clinical laboratories, particularly molecular diagnostics.

The goal of the integrated diagnostic report is to relieve the test and procedure-ordering clinicians of the burden and challenge of integrating all of the various diagnoses and clinical data that are reported to them from radiology, pathology, and the clinical labs. This integrative process is moved upstream to the diagnostic specialists themselves. There are two major barriers to creating an integrated diagnostic report. The first is accessing all of the requisite diagnostic and clinical information on which the "super-diagnosis" is based and the second is that there are few, if any, individuals among the highly specialized diagnosticians who are sufficiently skilled and sufficiently knowledgeable to generate such super-diagnoses on a routine basis.

The answer to this first problem is relatively simple. What is required are web-based diagnostic dashboards or consoles with interfaces to the back-end hospital LIS, RIS, PACS, and EMR for use by diagnosticians. Such dashboards can assemble, organize, and display all of the available diagnostic and clinical information, both textual and image, that are necessary to arrive at a super-diagnosis for a patient at a given point in time (see: Horizon Anatomic Pathology Offers an Integrated Pathologist Dashboard).

Now to address the knowledge issue pertaining to the creation of a super-report. I envision that such a task would be performed by virtual multi-disciplinary teams of diagnosticians consisting of pathologists, radiologist, and perhaps even clinicians. Each member of such a team would have access to his or her own diagnostic dashboard and would teleconference together at agreed-upon times during each work day. Each would bring specialized diagnostic knowledge to the "virtual" table. Together they would come to agreement on a super-diagnosis for patients, particularly the most complex ones. To put this process into a broader context and cite precedent, these diagnostic teams would be analogous to the multi-disciplinary teams (MDTs) that are of such great value in cancer hospitals (see: Most Oncologic Surgeons Do Not Adhere to Cancer Care Standards). They convene to mutually agree on a particular therapeutic regimen for an individual patient.

I will be lecturing on the topic of integrated diagnostics at the Pathology Informatics 2010 conference next week in Boston (see: Integrated Diagnostics: The Perspective of a Pathologist). As a counter-point to my lecture, Dr. Ron Arenson, chairman of radiology at UCSF, will be discussing the topic from the perspective of a radiologist (see: Integrated Diagnostics: The Perspective of a Radiologist).

Comments

[Rebecca Owens]

I agree with idea of diagnostic summaries, as this will lead to comprehensive care. With multiple systems and multiple vendors, it will take an informatics approach to bringing all textual and image based data together. Then there is security of transferring that data and security of the data at rest; the first being most complicated. We need more Pathologists leading this effort and understanding that they must integrate more thoroughly. It all comes down to what tools can be used, how much and how to implement.

[lee steve]

great piece/article just thought id say thanks

[Suren Avunjian]

Great Article! We had built an integrated reporting feature in to the LigoLab AP/LIS last quarter of 2009, for a large reference laboratory. It is widely used by hematopathologist, reports can be combined from multiple sources and a final report delivered via PDF or HL7.

[infopathic]

Help lead the crusade! Whereas I agree that your advocacy is progressive and forward-thinking, I really can't fathom many seriously doubting a trajectory of diagnostic aggregation. I know, the road will be long and winding, but in the spirit of patient care, as well as in stewardship of the mighty healthcare dollar, integrated diagnostics is an all win solution.