I was slightly taken aback by a recent email blast I received from Roche Diagnostics with links to a current and planned complementary articles about Diagnostic Management Teams (DMTs) (see: DMT series). I have posted a number of blog notes in the past about DMTs (see, for example: First Diagnostic Management Team Conference Scheduled for Next February; Deploying a DMT at the Front-End of Lab Orders for a Complex Patient). The concept of the DMT was pioneered by Dr. Mike Laposata in 1984 as a means to assist clinicians in the ordering and interpretation of coagulation tests about which he was a national expert. In the intervening years, DMTs have gained increasing support as a means to avoid diagnostic errors, decrease the length of hospital stay, decrease the cost of care, and as a tool in support of value-based care.
You might then ask why I was surprised by a broad endorsement of DMTs by a large in-vitro diagnostics company like Roche. This requires reference to some historical issues in clinical pathology. I started my career as a blood banker who was keenly interested in blood utilization. I published an article in 1976 about the maximum surgical blood order schedule (MSBOS) whereby a predetermined number of units of blood were crossmatched for a particular operation. The goal was to reduce blood outdating. I posted a blog note about this topic ten years ago (see: Hospitals Seek to Limit Blood Transfusions as a Cost-Saving Measure). In those days, blood reagent companies such as Ortho Clinical Diagnostics did not usually promote blood conservation strategies because it was not good for their business -- it resulted in lower use of testing reagents. The same approach generally applies to other IVDs regarding strategies to reduce test volume.
So, why the sudden interest on the part of Roche in DMTs? Theoretically DMTs could be "bad" for business and result in fewer tests being performed and less reagent usage. I think that the obvious answer is that we have now arrived at a point in lab medicine where some tests are so expensive and difficult to interpret that DMTs will play a critical role in lab diagnostics. Special talent and expertise is required to interpret some test results and the necessary talent is not always available among clinicians and even the majority of pathologists who tend to focus on surgical pathology because it is more remunerative. Hence, local, regional, and national DMTs need to be organized that have special expertise and can be called upon to help render timely and accurate diagnoses. Information technology can be used to bring the lab diagnostic experts, wherever they are physically located, into the local diagnostic process.
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