Lab Soft News

Digitally Decentralized Pathology Departments; Creating a Value Added Network

Although digital pathology is being adopted by a relatively small number of pathology departments, we now seem to be approaching an inflection point for the broader deployment of this technology. Adoption will be driven by at least two factors: (1) for surgical pathology reference labs, the portability of WSI case images and other DP features loom large as a strategic business advantage; (2) for academic pathology departments, potential trainee applicants will increasingly favor departments that have deployed the technology in order to be prepared for the future.

As pathology departments increasingly "go digital," another opportunity will then be available to them -- the creation of a decentralized surgical pathology department. For me, this idea harks back to an article I wrote 26 years ago: (see: Integrating information from decentralized laboratory testing sites. The creation of a value-added network). My focal point at that time was a discussion of the emergence of a "value-added networks" in clinical pathology. Such a goal is now achievable in surgical pathology. Here is a list of some important features and opportunities associated with the development of a surgical pathology, value-added network usingy digital pathology:

• First and most obviously, WSI files for the most difficult cases can be forwarded to outside skilled consultants for their diagnoses. This is already the norm for most practices but DP decreases the "friction" and lag time of such referrals from days to possibly hours. In so doing and in effect, the panel of pathologists in smaller departments is expanded virtually to include known experts with enhanced quality.
• Digital pathology enables cases to be interpreted remotely. At the present time, remote reading is actively practiced for frozen sections at night and on the weekends by pathologists in the same department. It can also be enabled if a department subdiscipline expert (e.g., neuropathologist) who works at a remote hospital. Moreover, a decentralized department enables the hiring of pathologists who wish to work remotely in their homes including those seeking part-time employment. There is also the opportunity for workload sharing across physically separate groups of pathologists with a decentralized model (see: Ontario and GE's Omnyx Establish Digital Pathology Center of Excellence).
• Large hospital groups have historically sought to create "laboratories of CP excellence" in one of the group hospitals to focus on special lab disciplines like molecular pathology (see: Sunquest Signs Contract to Provide LIS Support for 124 Hospitals in Australia). A DP centralized department can enable the same strategy in surgical pathology. A centralized histology lab is a common co-strategy under such a plan.

Possible Way to Avoid Some Unnecessary Visits to Emergency Departments

I recently encountered an article that quantifies the resources expended by unnecessary patient visits to emergency departments (EDs) (see: Diverting avoidable emergency department visits could save healthcare $32 billion annually). Many such visits could have achieved the same results and less expensively in a physician's office. Below is an excerpt from the article:

Diverting avoidable emergency department visits could save healthcare $32 billion annually. Primary care services rendered by hospital EDs come with substantially higher price tags than in primary care settings. Avoidable visits to emergency departments are among the major factors contributing to rising healthcare costs. Of the roughly 27 million annual ED visits by privately insured patients, about two thirds are avoidable....Part of the problem is that primary care services rendered by hospital EDs come with substantially higher price tags than in primary care settings. In fact, the average cost of treating 10 common treatable conditions at a hospital ED is $2,032, which is more than $1,800 higher than in primary care situations. The ED cost is 12 times higher than at a physician's office ($167) and 10 times higher than at an urgent care center ($193). The 10 treatable conditions examined in the brief were bronchitis, cough, dizziness, flu, headache, low back pain, nausea, sore throat, strep throat and upper respiratory infection....

Higher costs at hospital EDs are partially driven by a couple of different factors. For one, there are hospital facility fees (see: CMS Requires Hospitals to Post Prices for Medicare Patients; Useful Step?), which increase the cost of an average ED visit by $1,069. Then there are lab, pathology and radiology services, which average $335 at an ED. That's about 10 times more costly than at a physician office, where the same services average about $31. The money adds up. Of the 27 million annual hospital ED visits by privately insured patients in the U.S., 18 million were deemed avoidable, meaning those patients can be treated safely and effectively in high-quality, low-cost primary care settings. When those 18 million avoidable ED visits are multiplied by an estimated $1,800 cost reduction per visit, that translates to a $32 billion annual savings opportunity if care is diverted to a primary care setting.

Looking at the ten treatable conditions cited in the article above that drive ED visits (bronchitis, cough, dizziness, flu, headache, low back pain, nausea, sore throat, strep throat and upper respiratory infection), most are relatively non-specific. I was wondering whether it would be possible for CMS, or perhaps even a large health insurance company, to make freely available on the web a clinical decision support (CDS) program that could assist consumers in evaluating the criticality of their symptoms and avoid unnecessary ED visits. Such software would, of course, be developed with consumers in mind as the end users and would display an appropriate warning statement that it was not providing medical advice. 

As one example of a condition that results in ED visits, headaches are rarely caused by a brain tumor. However, headache as a chief complaint in an ED might result in an expensive workup (see: Headache: Could It Be a Brain Tumor?). A CDS program oriented to healthcare consumers might be designed to guide a person with a persistent headache through the following "neurologic read flags" listed below that would suggest that a headache might actually be the result of a more serious condition. Absent any of them, the individual could take an aspirin and call it a day.

• Seizures
• Nausea and vomiting
• Numbness
• Swelling of the eye or vision problems
• Weakness or paralysis, especially on one side of the body
• Speech impairment
• Personality change

Hahnemann University Hospital Closing; 570 Residents Stranded

Very disturbing recent news is that historic Hahnemann University Hospital in Philadelphia is now scheduled to be shut down in early September (see: Hahnemann University Hospital to Close, Leaving Thousands Out of Work), Below is an excerpt from the article:

Historic Hahnemann University Hospital in Center City, Philadelphia, is slated to close later this summer....Nurses and other employees were told the hospital on North Broad Street is slated to close on Sept. 6....The closure would leave around 800 union nurses and about 3,000 total employees out of work, said the union, which represents around 8,500 nurses across the state....The union also called out Joel Freedman, the chairman and founder of American Academic Health System.....The ownership of Hahnemann changed hands in January 2018 when American Academic Health System bought the medical center — and St. Christopher's Hospital for Children — from Tenet Healthcare Corp. for $170 million....California-based AAHS has not been able to get Hahnemann on sound financial ground....Earlier this year, Freedman said the health system could be left with no option but to close Hahnemann as it lost between $3 to $5 million per month....The hospital was founded in 1848 as the Homeopathic Medical College of Pennsylvania. In addition to treating patients, the hospital also serves to train medical students and residents from Drexel University.

Another article discussed the number of residency positions that are being eliminated by the closure (see: Hahnemann University Hospital closure upends career paths for 570 doctors-in-training) and below is an excerpt from this latter article:

The impending closure of Hahnemann University Hospital is forcing about 570 residents who work at the Center City institution to find a new place to continue their training....Hahnemann’s closure is causing “the largest orphaning of medical residents in the history of the United States,” Drexel University said in a Philadelphia Court of Common Pleas lawsuit against Hahnemann and its corporate parents. Drexel handles the educational side of Hahnemann’s residency programs. Before residents can move to new programs, officials at Hahnemann, which employs the residents and receives about $100,000 in annual reimbursement from the federal government for each resident’s training, must release them. 

Here's more information about the financial status of both Hahnemann and St. Christopher's (see: CEO outlines plan to save Hahnemann University Hospital): 

California-based American Academic Health System, an affiliate of Paladin Healthcare, bought Hahnemann and St. Christopher’s Hospital for Children from Tenet Healthcare Corp in January 2018 for $170 million. [Paladin CEO Joel] Freedman said while St. Christopher’s is generating a profit of about $1.5 million to $2 million per month, Hahnemann has been losing between $3 million and $5 million per month.....Freedman did not absolve American Academic from blame in the hospital’s worsening financial condition.....Freedman said American Academic is committed to not letting Hahnemann’s financial problems adversely impact St. Christopher’s, and the health system is exploring the possibility of converting the pediatric medical center into a nonprofit facility.

If I were a cynic, I might be inclined to suggest that Freedman and American Academic/Paladin Healthcare bought Hahnemann and St. Christopher's a year and a half ago with the intention of shutting the former down and spinning off the latter for a profit. He even admits above to the press that he is partly to blame for the Hahnemann failure. A lot of careers and the health of a city are being ruined by these financial machinations.

Majority of Physicians Now Salaried Employees of Health Networks

The trend continues that an increasing percentage of physicians in the U.S. are salaried as opposed to self-employed and in private practice. This trend is particularly true for younger ones. This development was discussed in a recent article (see: Latest AMA Benchmark Survey Shows Number of Physicians Employed by Health Networks Now Exceeds Those in Independent Practice) with an excerpt below:

For the first time, more doctors are employed by health networks than are in private practice.... In a press release, the AMA describes the event as “the continuation of a long-term trend that has slowly shifted the distribution of physicians away from ownership of private practices.”....According to the new release, employed physicians made up 47.4% of all patient care doctors in 2018—an increase of 6% since 2012. Meanwhile, self-employed doctors represented 45.9% of physicians in patient care—down 7% (from 53.2%) since 2012.....Physicians can be employed by other doctors in physician-owned practices, by hospitals directly, and by hospital-owned medical practices....The AMA partly attributed the increase in employed physicians to age: 70% of doctors under the age of 40 reported as employees in 2018, compared to 38.2% of doctors 55 and over who reported as employed.

So what are the possible implications of this shift, both for healthcare and for the physicians themselves? Below are as list of consequences that come immediately to my mind. You may be able to think of others:

• The shift toward the corporatization of healthcare organizations continues, sometimes referred to as the emergence of Big Medicine (see: What ‘Big Medicine’ Means for Doctors and Patients), continues apace (see: Blurring of Definition of Big Medicine; Corporatization of Healthcare). Salaried physicians working for these organizations will generally have lower salaries than those with their own practices, allowing for differences by specialty.
• Whether the merger of large systems and their corporatization of healthcare will result in lower quality is a matter of debate (see: How Big Medicine is hurting patients and putting small practices out of business). Bigger can mean both better and worse. 
• I suspect that the average salaried physician will have a "better" lifestyle than colleagues in private practice, defined partly as a shorter workweek. Theoretically, this should results in a better quality of life for them.
• Physicians within large health systems who are salaried may be faced with fewer entrepreneurial opportunities than their colleagues in private practice who aspire to managerial positions. However, many large health systems are probably looking for ambitious physician to fill C-suite jobs. Such physicians could probably improve their chances for such positions by earning an MBA, perhaps on the weekends.
• Some may claim that being a salaried physician converts it into just another job, albeit one with rigorous educational requirements. I would state in rebuttal that being a physician continue to be prestigious and cite the difficulty that persists in gaining admission to a medical school (see: Why Is It So Hard to Get Into Medical School?).

A New Tool for Obtaining Crowd-Sourced Diagnoses for Pathology Images

Below is an announcement from Dr. Ulysses Balis, Professor of Pathology and Director of Pathology Informatics at the University of Michigan Medical School in Ann Arbor, Michigan:

The University of Michigan Department of Pathology, Division of Pathology Informatics is very pleased to introduce a new educational tool for the global Pathology Community: www.Histoquery.org.

With use of this new crowd-sourcing tool, following a simple and fast user registration process, users will be able to post educational cases to the site (comprised of one or more pathology images and an associated diagnostic question), and then be able to receive a crowd-sourced answer in a matter of seconds. Similarly, users can log on to the site as a crowd-sourcing participant, with the option of either providing a new answer or providing a vote on an already-submitted answer. Every respondent gets one vote, which may be changed as needed (but, no ballot stuffing is possible).

An example of how this educational tool might be helpful would be: seeking consultation from your colleagues on a particularly difficult case in a weekly slide teaching set. Simply post an image or two along with any salient history (but no protected health information, please) and simply wait for the flow of answers and their associated histogram to appear, in real time. Result answers and counts are tabulated in real time for all to see, as a dynamically updated histogram and consequently, no web page updates or refreshes are ever required.

Just as much fun as submitting questions is the opportunity to respond to them! Users may assist in the answering of as many questions as they would like, in the sub-specialty or specialties of their interest. In responding to submitted questions, you become an important and essential component of the crowd-sourced equation! Background: The site is designed with the latest audience-participation, real-time web architecture and will easily accommodate hundreds of concurrent users without skipping a beat. When registering, you will have the choice of selecting as many pathology sub-specialties as you would like, for case monitoring purposes.

Cases may be submitted at any time to any available sub-specialty board, independent of the monitoring board elections that you have previously logged. An all-board-monitoring category is also available, for those who feel confident in assisting with any type of inbound question. Please forward all user support questions to me directly, at: [email protected] There is no fee to use this educational service and I very much look forward to hearing back from you on your initial experiences with the use of this new class of educational tool.

I think that this is an incredibly useful idea by Ul and his colleagues. We all know about the value of crowd-sourced knowledge. As noted in the note above, the web site will serve as a valuable education tool for residents and fellows as well as practicing pathologists.

Need for More Verbal Communication Between Pathologists and Radiologists

I first discussed the merits of collaboration (or even merger) between the specialties of pathology and radiology in October, 2006 (see: Ten Reasons for Merging Pathology/Lab Medicine with Radiology). Since that time, I have commented on this same topic from time to time as well as how to improve pathology/radiology reports (see, for example: Radiologists and Pathologists as Information Specialists; Merger of the Specialties?; Making Surgical Pathology and Radiology Reports More Patient-Friendly; Pathology and Radiology Collaborate with a Concordance Conference). I recently came across a longish article encouraging pathologists to communicate verbally with radiologists when certain findings are encountered. Below is an excerpt from it:

Discordance between radiology and pathology studies compounds...[the problem or arriving at the correct diagnosis]. As good practice, frequent verbal communications between pathologists and radiologists ensure that we recognize and minimize potential diagnostic confusion prior to issuing the pathology report. The radiologist-pathologist conversation may provide valuable feedback to the radiologist (because the pathologic findings may add to their understanding of imaging findings and improve interpretive skills), and to the pathologist (who may develop a better appreciation of the clinical question asked with the biopsy and provide a more relevant pathologic answer).....Importantly, the radiologist...[is] able to convey the degree of suspicion for malignancy much more thoroughly to the pathologist in direct conversation than in the biopsy requisition, which has only limited ability for nuanced communication.....

When should a pathologist contact the radiologist? We propose the following situations: (1) negative/benign biopsy result, (2) surprising/unexpected finding on the biopsy, (3) clarification of specific requests for the biopsy, and (4) insufficient material on the biopsy. We define a negative biopsy as one that “is negative for any pathologic process or contains only nonspecific findings.” In this setting, sampling during the biopsy may have missed the intended lesion, or the findings may reflect a process that is not the radiographic lesion of concern (for instance, inflammation adjacent to a malignancy). Additionally, the biopsy may have been performed on an atypical or unusual radiographic presentation of a typically benign process with a lower level of suspicion for malignancy, such as an apical cap or rounded atelectasis. Without an assured radiologic-pathologic correlation comment, the patient may be subjected to an additional, unnecessary needle biopsy or even a more invasive surgical biopsy....

Suggested Reading

J Sorace et al., “Integrating pathology and radiology disciplines: an emerging opportunity?”, BMC Med, 10, 100 (2012). PMID: 22950414.

AS Oh et al., “Imaging-histologic discordance at percutaneous biopsy of the lung”, Acad Radiol, 22, 481–487 (2015). PMID: 25601302.

National Academies of Sciences, Engineering, and Medicine, Improving Diagnosis in Healthcare. The National Academies Press: 2015.

The suggested readings above may be of value but, unfortunately, there is not a large literature on this topic. The most important steps to take to improve pathology-radiology communications would be to develop specific guidelines when oral communication is required for a case, as discussed above, and the launching of a periodic hospital diagnostic concordance conference (see: Pathology and Radiology Collaborate with a Concordance Conference).

Surgical Coaching as a New Option; Will Busy Surgeons Respond?

All practicing physicians are challenged by the fact that healthcare is constantly changing because of new scientific and therapeutic advances. Additional burdens in the U.S. are the complex bureaucracy and reimbursement requirements as well as technical challenges such as those associated with EHRs (see: Relationship Between Clerical Burden and Characteristics of the Electronic Environment With Physician Burnout and Professional Satisfaction). Surgeons, in particular, face additional burdens as they age because of the manual dexterity that is required in the operating room. I was not familiar with coaching programs for surgeons until I read a recent article (see: What Tom Brady and Beyoncé can teach surgeons: Coaching can keep you sharp). Below is an excerpt from it:

Today’s surgeons are under enormous systematic and cultural pressures to see more patients, juggle electronic medical records, and ensure good online ratings. It is a daunting challenge for them to provide optimal care under these circumstances. So how can they not only maintain their skills but actually improve them while staying up-to-date with constantly evolving surgical knowledge and technology? Coaching is one promising approach to help them do this.....A surgical coach is a peer or expert surgeon who uses effective communication skills to guide another surgeon to improve a specific skill....Over the past few years, formal surgical coaching programs have developed around academic medical centers in Wisconsin, Michigan, and Illinois. Last year, surgeons at four of Harvard Medical School’s teaching hospitals began participating in a new surgical coaching program in Boston....Will busy surgeons want to participate in coaching? Early reviews of these programs have shown that many of them actually enjoy the coaching interactions. What we don’t yet know is whether surgeons who work with a coach improve their patients’ outcomes. Coaching has great potential to become a standard component of surgical practice. Instead of allowing skills and techniques to plateau after surgical training, surgeons can turn to coaching to continue honing their skills so they are at their peak for every operation throughout their careers. 

In theory, the idea of coaching surgeons in, say, mid-career is a promising idea. It's a new twist on what has for decades been called continuing medical education. However, I am sure that coaching goes beyond knowledge acquisition and includes operating room time with a coach to learn new techniques. Coaching could also be used perhaps to evaluate whether an older surgeon has lost some of his or her manual dexterity. Here's a passage about surgical coaching from the American College of Surgeons (see: Surgical Coaching):

...[Surgical coaching] is a departure from the current surgical professional development models that rely on didactics and short courses without incorporating self-reflection. In surgery, coaching is a partnership between a trained surgeon coach and a surgeon with self-identified goals that are pursued through collaborative analysis and constructive feedback. This interaction aims to refine technical, cognitive, interpersonal, and stress management skills to produce practice change and improved performance. Surgical coaching has broad applicability across a variety of contexts.

A key final question is who pays for such surgical coaching. For salaried surgeons at large academic center, the answer is relatively clear: the health system that employs the physician. For such organizations, the benefits seem obvious. The institution bears the brunt of the cost of malpractice litigation that may result from surgical errors. It seems to me that part of the acceptance of surgical coaching within health systems lies, in part, in which surgeons are asked to participate. If it's viewed primarily as corrective measure, there will be a stigma associated with it. On the other hand, if its viewed as a reward and opportunity to enhance one's skills, it will surely be more accepted.

Questions about the Interpretation of BRCA Testing by 23andMe

Lab testing for the genes that predispose a person to develop cancer is highly complex, both to preform and interpret. For example and relating to BRCA, I have blogged about some of the pitfalls of such testing (see: BRCA Exchange Available on the Web; Understanding BRCA Variants). Here's a quote from this note discussing some of the complexities that are encountered:

It's not known among some healthcare consumers that there are a host of BRCA variants other than the standard ones. Normal BRCA testing looks for three specific genetic variants that are linked to hereditary cancers. Two of these variants — 185delAG and 5382insC — are in the BRCA1 gene. One variant — called 6174delT — is in the BRCA2 gene. A patient may test positive for a variant other than these common ones and it may not be clear under such circumstances what treatment to offer to the patient.

A recent article in the New York Times warns consumers about the fact that the 23andMe BRCA testing may be misleading (see: Don’t Count on 23andMe to Detect Most Breast Cancer Risks, Study Warns ). Below is an excerpt from the article: 

In 2010, Dr. Pamela Munster mailed her saliva to 23andMe, a relatively new DNA testing company, and later opted in for a BRCA test. As an oncologist, she knew a mutation of this gene would put her at high risk for breast and ovarian cancer. She was relieved by the negative result. Two years later, after she learned she had breast cancer, she took a more complete genetic test from a different lab. This time it was positive. A study of 100,000 people released earlier this month suggested that this experience could be widespread. Nearly 90 percent of participants who carried a BRCA mutation would have been missed by 23andMe’s test, geneticists found. 23andMe’s testing formula for this risk is built around just three genetic variants, most prevalent among Ashkenazi Jews. The new study demonstrated that most people carry other mutations of the gene, something many doctors have long suspected....

Dr. Munster said that 23andMe was “not doing anything actively deceptive.” But she is still concerned that many customers do not grasp the limits of mail-in genetic testing. 23andMe now has more than 10 million customers. Even if only a small percentage take the test, that’s thousands who could be misled. Mary-Claire King, a professor at the University of Washington who discovered the region on the genome that became known as BRCA1, had a more blunt assessment of the Food and Drug Administration’s decision to allow the test....“The F.D.A. should not have permitted this out-of-date approach to be used for medical purposes,” Dr. King said. “Misleading, falsely reassuring results from their incomplete testing can cost women’s lives.”

For me, the fundamental question here is whether consumers "can be trusted" to order lab tests and interpret the results without physician intermediation. I have blogged frequently on this subject (see, for example: Comparison of "Traditional" Lab Testing with Direct Access Testing; An Estimate of the Size of the Direct Access Testing (DAT) Market). The excerpt from the article above focuses on an oncologist who seems to have been lead astray by a negative BRCA test from 23andMe, assuming that she was negative for any BRCA variant. I suspect that Dr. Munster was chosen as the focus of this story to make the point that the interpretation of the BRCA test results is so complex that even an oncologist, ordering the test for herself from 23andMe, could misinterpret the result.

I believe that allowing consumers to order certain routine lab tests for themselves is desirable because I also think that it will result in a general improvement in public health. Some people are too busy or not predisposed to visit a physician frequently. For them, ordering lab tests on the web may improve their health status. The pivotal issue in this discussion, then, is how laboratory tests should be reported to consumers. The most complex tests, particularly those requiring complex interpretation, should not be directly available to consumers. Consumers will generally not be lead astray by the performance of common lab tests but must be provided with reference ranges and instructed to seek the help of a physician for results that fall outside of normal ranges and/or when they have symptoms of a disease.

Predatory "Publisher and Conference Organizer" Hit with a $50M Court Judgement

I first became aware of the Omics Group six years ago when I blogged about the fraud that the company was perpretating (see: Welcome to the World of Pseudo-Academia: Pathology-2013). Here's a quote from that note about how the company was offering a set of fake scientific conferences and journals to fleece the unwary:

Here's a link to the twenty different conferences that the Omics Group has planned for....[originally 2013 but the web site has now been updated to the present time]. The only way that I can describe this conference enterprise, putting aside the journals, is comprehensively audacious. Do registrants actually show up at these conferences or is the audience just faculty members?  Aside from some grammatical slips and the misstep into plant pathology for Pathology-2013, the web content does have a semi-authentic feel. The biggest clue, of course, is the grandiosity of it all. It seems to be an example of pseudo-academia writ large.

It appears that the the FTC has finally caught up with the India-based Omics International as described in a recent article (see: ‘Predatory’ Scientific Publisher Is Hit With a $50 Million Judgment). Below is an excerpt from it:

In the world of scientific research, they are pernicious impostors. So-called predatory journals, online publications with official-sounding names, publish virtually anything, even gibberish, that an academic researcher submits — for a fee. Critics have long maintained that these journals are eroding scientific credibility and wasting grant money. But academics must publish research to further their careers, and the number of questionable outlets has exploded. Now the Federal Trade Commission has stepped in, announcing on Wednesday that it has won a $50 million court judgment against Omics International of Hyderabad, India, and its owner, Srinubabu Gedela. Omics publishes hundreds of journals in such areas as medicine, chemistry and engineering. It also organizes conferences. The F.T.C. claimed that Omics violated the agency’s prohibition on deceptive business practices.

In addition to the judgment, a federal judge in Nevada — where Omics has mail drops — ordered the company to cease its deceptive business practices, including failing to disclose fees, misleading authors about the legitimacy of its journals and marketing conferences with star speakers who never agreed to participate....Critics of the journals hailed the decision. “It’s great news,” said Jeffrey Beall, a former scholarly communications librarian at the University of Colorado Denver who has studied questionable scientific journals. “There are hundreds of predatory publishers, but Omics is the evil empire.” Predatory publishers pepper academics with pleas to submit papers or speak at conferences. When they receive papers, the journals often accept and publish them immediately, with a perfunctory review or none at all.

I am pleased that some sort of justice has been achieved regarding the predatory Omics. However, I continue to wonder about the extreme naiveté of anyone who would register for one of their conferences or submit an article to one of their faux journals. By 2015, it claimed over 700 journals although about half of them were defunct (see: OMICS Publishing Group). I can only assume that the multiple victims were very naive or desperate for journal citations for their research. Also, take note: there said to be hundreds of other predatory publishers still in business.

Pathology and Radiology Collaborate with a Concordance Conference

The University Hospitals Cleveland Medical Center (UHCMC) is in the process of deploying a digital pathology system and therefore exploring ways to educate and prepare their pathologists for this new technology (see: Digital Pathology Pilot Predicts Prosperity: Pondering Pathology’s Pivot). As part of the process, a pilot study was undertaken with a focus on frozen sections. In the study, pathologists’ diagnoses using digitized slide images were compared with diagnoses using standard microscopy. Frozen sections were chosen as the focus of this study because digital pathology allows remote access by a specialized pathologist if necessary. The results showed an average overall concordance rate of 95% for the two methods across 11 organ systems.

In the article referenced above, brief mention was made about a routine rad-path conference in the hospital that was greatly improved by the use of digital images. The article went on to discuss the purpose of this rad-path concordance conference: to resolve issues of concordance between imaging findings and the microscopic findings to also determine whether or not patients need additional surgical intervention or can be followed with imaging. In the support of this goal, it was deemed necessary for all conference participants to examine both the radiologic images and the microscopic images. 

In October, 2006, I first proposed close collaboration (or even, shockingly, merger) of the two medical specialties of pathology and radiology into a new one called "diagnostic medicine" (see: Ten Reasons for Merging Pathology/Lab Medicine with Radiology). I think that a concurrence conference similar to the one at the UHCMC would be an important first step in promoting collaboration between radiology and pathology in any hospital. One major goal that could be accomplished by such a conference would be to determine whether reports generated for a particular patient by both departments were in agreement and/or consistent with each other.

To put the matter more bluntly, the continuing goal of the conference would be to determine whether a significant pathologic finding by one group of diagnostic specialists was overlooked or deemphasized by the other group. Another important goal would be for pathologists and radiologists to better understand the reporting conventions and medical vocabulary of the other group and, in so doing, promote better concurrence in the future. In this same spirit, it would be possible to determine which pathologic changes in an image or specimen noted by one group would prompt a telephone call to to the other group rather than communicating solely by "formal" reports that may not always highlight subtleties or uncertainties.