Progress on integrated diagnostics for breast cancer

This will be the first in, hopefully, a series of blog entries that will chronicle my institution's effort to establish integrated diagnostic reporting for radiology-pathology testing for breast disease.

The lab admin director with whom I work is also enthusiastic about this project and we have talked informally about this for a couple of months while gathering information from various sources, especially from LabSoftNews.  The first person with whom we met was her counterpart in radiology.  This conversation was open-ended and basically explored our "visions" of what something like this might look like and then a rough idea of where we needed to go to get started.  Unfortunately, my counterpart in rads was on vacation for the following week but the plan was for me to meet with him as soon as he returned.  In the meantime, the lab and rads admin directors were planning to present to the hospital administration a list of necessary resources and a projection of revenue and value to the organization.

I am fortunate to be working with a radiologist, Dr. Jeff Mendell, who shares my enthusiam for pursuing this project.  We hope to build on an initiative that he started in December of 2008 where we began presenting a monthly breast radiology-pathology correlation conference.  After a few months, it was decided to make this part of a weekly tumor board, so once a month we devote one weekly conference to breast with rad-path correlation.  After meeting last week, we outlined five initial goals:

1. Perform "real-time" mammographic-ultrasound/pathologic biopsy correlation prior to final report.
2. Develop an integrated report combining radiographic findings, pathologic findings, an assessment of correlation, and recommendations for follow-up.
3. Identify the IS barriers to #2 since radiology and pathology currently report from different systems.
4. Discuss with our radiology and pathology colleagues.
5. Discuss with surgical, gynecologists, key internists, medical oncology, and radiation therapy colleagues to get additional ideas from end-users.
6. Identify measures of "success" of this effort.
7. Develop indicators to track outcomes.

The recent The Dark Daily audioconference on integrated diagnostics lacked objective measures for University of Kansas Medical Center's integrated diagnostics project.  I think it is fair to ask: what is the value of doing this?  Intuitively, it seems logical to pursue this in one form or another--but before an administration commits resources, one must be prepared to demonstrate what the tangible benefits will be.  We are currently working this out and I will blog on this at some point.  But, for now, we are looking at reducing out-migration of patients from our area, reducing patients lost to follow-up, reducing TAT from time of screening mammography to postbiopsy follow-up recommendation.

If anyone has their own experience, please share comments or email me offline and I will post as a blog.