Dr. Mike Laposata who is Chairman of the Department of Pathology at UTMB in Galveston has been an advocate for diagnostic management teams (DMTs) and the clinical pathologist as a consultant for decades (see: The Clinical Pathologist as Consultant). He launched a conference about Diagnostic Management Teams (DMTs) last year that was highly successful and it will be repeated this coming February. In a recent article in CAP Today, Mike discussed the role of a DMT at the "front-end" of test orders for presumably complex patients (see: The what and why of diagnostic management teams). Here is an excerpt from that article:
The concept of a diagnostic management team, or DMT, is simple. It involves a group of experts who meet daily and focus on the correct selection of laboratory tests and the interpretation of complex test results in a specific clinical field. The experts are typically pathologists focusing on the diagnosis of a specific group of diseases, but doctors and laboratory experts other than pathologists can participate effectively. The front end of the process is assistance [to the test-ordering physician] in selecting the correct tests. This often involves the creation of expert-driven algorithms that are updated regularly to manage utilization of laboratory tests and dramatically minimize overuse and underuse. Use of such algorithms with reflex testing makes it easy for treating health care providers to order the right tests and only the right tests.
Ultimately, we are going to deploy algorithms at the front-end of the the lab test ordering process, as Mike notes, that will assist the clinician in selecting a set of sequenced test orders for complex patients. This will allow the treating physician to generate the correct diagnosis as quickly and inexpensively as possible. Until such algorithms become widely available, however, we need to deploy a team of lab experts, the DMT, who will substitute for the diagnostic algorithms or perhaps even use them to select the best tests. The question then arises about how a clinician "activates" the lab-based DMT to assist his or her management of complex patients. I think that the answer to this question is relatively simple.
By way of an analogy, I will refer to a type of order that has been in use for many decades for ordering crossmatched blood; the surgeon requests X units of crossmatched blood for a patient prior to surgery. The surgeon requires a product, blood for transfusion, but may have no idea whether the patient has an unusual blood type or atypical antibodies that will affect the provision of crossmatched blood. The surgeon thus depends on the expertise of the blood bank (diagnostic management) team to fill the blood order. In summary, an order for crossmatched blood is a general order for a product (i.e., safe blood) with no specificity as to what blood bank tests are necessary to actually fill the order.
I foresee a similar process when a clinician needs to diagnose a complex patient. In such a case, the physician merely checks the DMT box on the blood bank order form. The lab-based DMT receiving such an order would then review the patient's EHR record, perhaps round on the patient, and then generate the optimal set of sequenced test orders to arrive at the final diagnosis for the patient. Needless to say, the relevant treating clinicians are kept in the loop by the DMT concerning the diagnostic strategy that it is recommending on a consultative basis.
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