[Marketing] RE: [IMPROVEDX] [Marketing] Re: [IMPROVEDX] Fwd: Coverys report on diagnostic errors

Robert Bell rmsbell200 at YAHOO.COM
Wed Mar 28 17:21:44 UTC 2018

 Thanks Brian, Stephanie,
So Interesting.
Basically, does the team make better decisions than an individual? I would like to hope that the answer is YES!
What are the time/payment restrictions on having teams for diagnosis management?
What are the considerations made by the team on the level of all the tests to be requested or already reported upon?  
The various tests/evaluations that we use have various degrees of error. Many of which we do not know precisely (BP, imaging, and the Stethoscope come to mind).
Finally, what is the average level of error on final diagnoses due to the errors of the tests/evaluations that we do? Do we have any idea?
Rob Bell, M.D.
   On Tuesday, March 27, 2018, 1:10:05 PM MST, Stefanie Lee <stefanieylee at GMAIL.COM> wrote: 
 Agree, it's very interesting to learn more about this concept of Diagnostic Management Teams. Excerpt from attached newsletter below:
“ 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... Within the DMT’s specific clinical context, an expert-driven, patient-specific interpretation of the test results in a specific clinical context is generated by the members of the DMT....This requires the knowledge of a true expert—not someone who may have a general idea about the meaning of a particular laboratory test result—and the participation of someone to help that expert search the medical record for relevant data to be included in the interpretation."

Within Radiology, many reporting systems have been developed which grade findings along the spectrum of benign/insignificant to malignant/needs specific action:
For example, lung cancer and breast cancer screening:
https://www.acr.org/-/media/ACR/Files/RADS/BI-RADS/BIRADS-Poster.pdf (see assessment categories at the bottom in green)

On 22 March 2018 at 10:38, Jackson, Brian <brian.jackson at aruplab.com> wrote:

I think the main opportunity here is in the word “Team”.  Healthcare desperately needs better diagnostic teamwork.  I don’t mean to imply that it’s always bad everywhere.  But radiology and pathology have become structurally less integrated into care team decisionmaking over the years.  Bob Wachter has a great chapter on the radiology problem in his book The Digital Doctor, and suggests that healthcare information systems are at least part of the problem.  Mike Laposata is a pathologist (actually department chair) down at UT Galveston, and has done a lot of work developing pathology-centered diagnostic management teams.  Essentially he’s had to create his own workflow and communication mechanisms that go around certain aspects of the EHR.


Having said all that, you might be on to something.  Categorizing into 5 grades of risk might be more feasible than trying to cram everything into 2 (normal versus abnormal).  And maybe this would help the clinician to prioritize his/her review time.  The gatekeeper will need to be the treating clinician; pathologists and radiologists don’t have enough context and are too far from the patient to make those decisions.



---------- Forwarded message ----------
From: Dark Daily <info at darkreport.com>
Date: 11 January 2018 at 08:00
Subject: Pathologists Use Diagnostic Management to Improve Outcomes

Dark Daily laboratory news ebrief service

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Innovative Pathologists and Clinical Laboratory Scientists Use Diagnostic Management Teams to Support Physicians with More Accurate, Faster Diagnoses

At institutions such as University of Texas Medical Branch, Galveston, and Vanderbilt University Medical Center, pathologists are using diagnostic management teams to improve patient outcomes while lowering the medical costs

Diagnostic Management Teams are a hot concept within the medical laboratory profession. In fact, a new annual DMT conference in Galveston, Texas, is the fastest-growing event in the clinical laboratory industry. This year’s Diagnostic Management Team Conference will take place on February 6-7, 2018, and is produced by the Department of Pathology at the University of Texas Medical Branch (UTMB) in Galveston.

In simplest terms, a diagnostic management team (DMT) is described by pathologist Michael Laposata, MD, PhD, as “involving 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. Typically, DMTs are led by pathologists focusing on the diagnosis of a specific group of diseases, along with physicians and other lab experts involved in the disease or health condition that is the focus of the DMT.”

How Pathologists Use Diagnostic Management Teams

“What differentiates a DMT are two changes from the classic diagnostic pathway,” continued Laposata. “First, the ordering physician gets assistance in selecting the correct tests. This can be done in several ways, such as creating 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 healthcare providers to order the right tests and only the right tests.

“The second key difference in this new diagnostic pathway is that, within the DMT’s specific clinical context, an expert-driven, patient-specific interpretation of the test results in a specific clinical context is generated by the members of the DMT,” he said. “This requires the knowledge of a true expert—not someone who may have a general idea about the meaning of a particular laboratory test result—and the participation of someone to help that expert search the medical record for relevant data to be included in the interpretation.

DMTs Typically Organized to Support Specific Diseases or Health Conditions

He pointed out that the DMT has a rather simple organization. There is a front-end and a back-end. The front-end starts when “physicians order tests by requesting evaluation of an abnormal screening test or clinical sign or symptom,” explained Laposata. “Upon receiving that request, the expert physician and colleagues in the DMT then synthesize the clinical and laboratory data and provide a narrative interpretation based upon medical evidence. This happens not only when specifically requested by the referring physician, but also for every case handled by the DMT.” 

 Click here for image

Diagnostic Management Teams are making significant contributions at the University of Texas Medical Branch (UTMB), Galveston. Pictured above, the members of UTMB’s coagulation DMT are (L-R): Jack Alperin, MD; Michael Laposata, MD; Aristides Koutrouvelis, MD; Camila Simoes, MD; Chad Botz, MD; Aaron Wyble, MD: and Jacob Wooldridge, MD. (Photo copyright: University of Texas Medical Branch, Galveston.)

The back-end of the process involves the DMT conducting an “expert-driven, patient-specific interpretation of the test results in a specific clinical context.” Here is where the participating clinical experts—supplemented by staff who conduct an informed search of the medical record to identify and collect data relevant to the diagnosis—sift through this much richer quantity of information to develop the diagnosis.

Overworked Physicians Value the Expertise, Diagnostic Accuracy of DMTs

Laposata points out that individual physicians who already may be overworked in their daily routines generally welcome the help of DMT experts who are up-to-date on the current literature, and who have decades of experience in these diseases and health conditions. He likes to point out that, in coagulation alone, a physician could have as many as 60 to 90 tests that can be ordered. He also notes that typical primary care physicians, for example, are generally not experts in selecting the best coagulation test to order for every group of symptoms, nor do they know how to order the most appropriate reflexive test to continue the diagnostic pathway.

Knowing how to interpret the results of the 60 to 90 different coagulation tests is equally challenging to most physicians.

Over the course of his career, Laposata has signed out more than 50,000 cases in the field of coagulation. “Every positive case that identified a diagnosis resulted in an earlier and more accurate diagnosis,” stated Laposata. “Every case negative for coagulopathy allowed the treating healthcare provider to focus on a diagnosis other than one related to bleeding and thrombosis.”

Using Clinical Laboratory Data to Improve Patient Outcomes, Reduce Costs

There are other reasons why a growing number of medical lab administrators and clinical pathologists believe that DMTs are the right solution at the right time. One reason is the steady reduction in reimbursement from Medicare and private payers. Another is the trend to measure and publish the quality metrics of hospitals and individual physicians.

There are ever more quality metrics that include diagnostic accuracy and total cost per healthcare encounter. Diagnostic Management Teams are proven to improve diagnostic accuracy and ensure the patient gets the right therapy faster. Both of these benefits contribute to substantial reductions in the cost per healthcare encounter.

Pathologists and clinical laboratory professionals interested in learning more about diagnostic management teams have two opportunities.

At the Galveston Island Convention Center on Feb. 6 -7, 2018, the second annual Diagnostic Management Team Conference will take place. Last year, several hundred-people attended. Information can be found at: http://www.dmtconference. com/.

Special Webinar on Diagnostic Management Teams on January 17

For those interested in learning via webinar, Dark Daily is presenting Laposata and his colleagues in a special session on Wednesday, Jan. 17 at 1:00 PM EASTERN. It is titled, “Using Diagnostic Management Teams to Add Value with Clinical Laboratory Tests and Pathologists’ Expertise.”

During this valuable webinar, you’ll hear from three experts. First to speak will be Michael Laposata, MD, PhD. He will provide you with a detailed overview of DMTs, including:

·       How to assemble the right team;

·       How to engage with referring physicians; and,

·       How to work through individual cases.

Laposata will introduce you to the structure and organization of effective diagnostic management teams, organized around a specific disease or health condition and made up of pathologists, other lab scientists, and physicians who are expert in their particular clinical field. The objective of the DMT is to meet daily with the goal of coming up with faster, more accurate diagnoses in support of a patient’s care team.

Experience from a Diagnostic Management Team Focused on the Liver

Next to speak will be Heather Stevenson-Lerner, MD, PhD, a liver and transplantation pathologist and Assistant Professor, Department of Pathology, UTMB. She will discuss a DMT organized around diseases of the liver. This is a useful, step-by-step description of an effective DMT, illustrated with case studies that demonstrate how diagnostic management teams can make a positive and substantial contribution to improving individual patient outcomes.

The webinar’s third presenter is Christopher Zahner, MD, a resident pathologist at UTMB. He will share how to pull together all the information needed to support DMT interpretations. From the electronic health record (EHR) system to other overlooked sources of useful data, Zahner will explain the most productive ways to assemble any information that will be useful to the diagnostic management team and that will make a positive difference in patient care.

To register for the webinar and see details about the topics to be discussed, use this link (or copy and paste this URL into your browser: https://www. darkdaily.com/webinar/using- diagnostic-management-teams- to-add-value-with-clinical- laboratory-tests-and- pathologists-expertise).

This is an essential webinar for any pathologist or lab manager wanting to put the lab front and center in contributing clinical value in ways that directly improve patient outcomes while reducing medical costs. With hospital lab budgets shrinking and fee-for-service payments being slashed, the time is right for your lab team to consider how organizing diagnostic management teams can be the perfect vehicle to demonstrate why clinical lab tests and expertise can be a diagnostic game-changer within your hospital or health system.

And don’t forget, your participation in this webinar can be the foundation for a highly-successful effort to collaborate with physicians and clinical services, to the benefit of both the parent hospital and individual patients. That makes this webinar the smartest investment you can make for crafting your lab’s test utilization and added-value programs in support of clinical care.

—Michael McBride

Related Information:

Webinar: Using Diagnostic Management Teams to Add Value with Clinical Laboratory Tests and Pathologists’ Expertise

Pathologist Michael LaPosata, MD, Delivers the Message about Diagnostic Management Teams and Clinical Laboratory Testing to Attendees at Arizona Meeting


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