At the 2018 Executive War College event, XiFin Vice President of Informatics, Patricia Goede and I discussed the value and importance of integrating pathologists and pathology lab data systems into the cancer care team workflow. Below you’ll find a recap of our talk about integrated pathology approaches—how they impact diagnostics, coordination of care, and improve the patient experience and outcomes.

Many of the recent innovations in healthcare, such as the increased use of telemedicine, can be traced back to the adoption of new technologies that fostered a different way of working. Innovation in pathology and care coordination is no exception. Pathology plays a central role in the process of disease detection, interpretation, and diagnosis however, it is among the last disciplines in medicine to benefit from automated and digitized workflows.

The reality of digital pathology for primary consults is now closer than ever though and is poised to be a game changer for cancer diagnostics. Soon, we will no longer be constrained by the physical location of a pathologist or the associated time in transit of glass slides. Beyond capturing a digital image of a glass slide though, digital pathology still needs to include the management, workflow and collaboration considerations unique to a digital imaging environment.

Approximately 80% of all medical records contain a diagnostic image. In the U.S. alone, it is estimated that nearly 1 billion diagnostic images are created every year. That’s an incredible amount of data to store, collate and share, and with advancements in molecular testing, this number will likely grow year over year.  Fortunately, data storage costs have decreased dramatically and open API’s are a hallmark of modern technologies enabling disparate systems and disciplines to share complex and varied data, including images, much more seamlessly than in the past.

In an integrated virtual environment, pathologists will be able to view whole slide images from any geographic location and can collaborate with peers or colleagues in a tumor board with full access to the entire patient record including ancillary radiology and/or genomic data. Research has shown that the benefits to the patient are significant when the care team members collaborate – studies have shown that radiologists and pathologists will change their diagnosis up to 33% of the time after consulting on a case. 

LIS: The Core Lab System to Manage Pathology Case Workflow and Reporting

Pathologists spend much of their day in the APLIS. The Lab Information System is the laboratory hub connected to the digital pathology platform and provides the source of analytical test data to the EHR, billing platforms, and tumor board solutions. Regardless of your LIS, or the make, model, and number of your whole slide scanners, system-wide integration is the key to successful implementation of a cohesive digital pathology service.

Connecting systems for consolidated reporting now plays a critical role in how the lab and/or physician gets paid. Combining critical LIS pathology data with molecular test outcomes and relevant clinical notes in a claims submission can significantly decrease denials and increase cash collected. For example, XiFin internal analysis showed that a lack of supporting evidence in claims submissions prevented lab reimbursement on up to 60% of molecular procedures.

Leveraging Digital Pathology in Quality Reporting and Diagnostics Outcomes

In the value-based care landscape, reimbursement is tied to evidence-based and practice-specific quality data — effectively, the reward for physicians is in the value of care, not the volume. The pathology diagnosis is a critical component and part of the overall calculation in the multi-specialty team environment that determines how the healthcare system is reimbursed under quality initiatives such as MACRA. Remuneration will be calculated on the quality of information submitted to CMS. As the quality scores will be made public, reputations may be negatively impacted. The use of digital pathology improves quality as part of the overall clinical information system and is a key component to accurate reporting to CMS.

At the end of the day we are all part of a system of complex interrelationships between those who receive, provide and finance care. The ultimate goal of course is to help the care team combine patient data with current best evidence to produce better patient outcomes through informed decisions. We are cognizant of the evolving nature of diagnostic informatics and the current gap in clinical collaboration and data exchange capabilities in patient care.  However, there are lots of opportunities to provide pathology with greater visibility and connectivity through technology enabled solutions – collectively we can deliver solutions that bridge the gaps and enhances the timely and accurate delivery of healthcare.

Sources:

1. Berwick, D. M., MD, & Hackbarth, A. D. (2012). Eliminating Waste in US Health Care. JAMA.