The Development of National Electronic Pathology / Laboratory Networks

foundation.cap.org v. #

The Development of National Electronic Pathology / Laboratory NetworksA Framework for the Diagnostic Collaborative NetworkRobert Atlas, President & CEO, ATLAS Medical April 16, 2011

© 2011 Atlas Development Corporation. All rights reserved.

Agenda

• The Challenge• The Opportunity• Evolution of the Collaborative Network• Characteristics and Benefits of an

“Open” Network • Technology Components and Potential

Workflow Paradigms• Questions for Future Consideration

2


The Challenge

• Increasing complexity of diagnostic disciplinesoMulti-modal

−Molecular / Imaging / Digital Pathology

oHighly personalized−Patient history including genome


The Challenge

oAggregation of disparate data elements from multiple sources−Test results, interpretations−PHR (genomic map)−Knowledge bases−Specialized Consults (genomic

counselors, e.g.)


The Opportunity

• Traditional “Consultative” relationship between Pathologist/Laboratorian and Clinical Physician must evolve

• Are there IT solutions that can enable this evolution?


The “Shiny Object” Problem

• Greater collaboration among professionals can be enabledoTechnical issues are not the barrier

• If we build it, will they come?oAdoption depends upon utility to

practitioners, patients and other stakeholders

• What are the typical use cases that could benefit from the wider availability of collaboration through technology?


Use Case 1 – Surgical Pathology Referrals or Send Outs• Pathologist reviews list of all new

cases• Identifies those cases that will not

or cannot be performed in-house• Pathologist needs to identify

resource (other lab or diagnostician) to consult, perform work, pack up specimens / paperwork


Use Case 2 – Community Hospital• Case / Patient with multiple types of

tests performed (AP, CP, molecular)• Requires expertise from various

diagnosticians• Limited in-house resources available• Often requires patient and family to

travel, sometimes across the country


Use Case 3 – Centers of Excellence• Centers of Excellence (COE) model

depends on patient encounter to perform sophisticated diagnostics

• Patient travel to COE location is expensive, time consuming and burdensome

• COE may expand through “satellites” in other markets, but this is capital intensive and does not fully leverage expertise of key personnel


The Collaborative Network Solution* Collaborative networks are work networks

designed to solve issues more efficiently by leveraging the knowledge and experience of the user base.

[The collaborative network] is a web based service, computing platform, and communications vehicle designed to merge enterprise data, forums, and social networking to solve business objectives.

* Adapted from Wikipedia


Evolution of the Collaborative Network• Closed/conditionally closed

community o Centralized

management/mediation of communication flow

o May serve important business need

o This model exists today


The Next Generation• The Collaborative Network v 2.0

o Open - Can accommodate multiple modes−Business, academic/research, etc.

o Flexible rules and constructs−Support for governance by consensus−Ad hoc rules based on particular interaction−Strict rules governing conduct of parties over time by agreement

o Multiple communities−Open and conditionally closed

o Peer to peer


Benefits of Collaborative Network• Leverage

o Amplifies capability of any given network participant

• Adaptabilityo Organic (crystalline) structure

accommodates multiple use cases o Allows participants to define new use cases

within broad parameters of acceptable use/conduct

• Disintermediationo Peers deal with peers - nearly “frictionless”


The Seven Elements of a Collaborative Network*• Search – data, experts or content• Participant driven – add or share content• Data integration – accessible by all nodes,

subject to security, consent and other rules • Dashboards – manage workflow and data• User follow – allow users (peers) and their

content to be followed and accessed• Dynamic content – instant update availability• Governance – Controlled access to content and

data with defined security levels* Adapted from Wikipedia


The Diagnostic Collaborative Network• Participants (“Nodes”) can be connected by a

communications infrastructure supporting robust interaction and data sharing enabling diagnosticso Examples of sources of data to be shared

−Diagnostic testing services providers (Clinical, Pathology, Molecular, Imaging, etc.)

−Sources of patient information (HIEs, PHRs, EHRs)−Knowledge bases (best practices, payer driven rules,

preauthorization rules, wellness profiles, disease management and decision support, etc.)

−On-line research resources (Academic, published clinical trials, publicly available information from Centers of Excellence)


Technology Components and Workflow Paradigms• Standards-based connectivityoValue-added network/clinical clearinghouse

16

Connecting EMRs to Labs Instantly

18

19

20


Technology Components and Workflow Paradigms• Lessons to be drawn from social

media

oPeer-to-peer networks with flexible rules that allow ad hoc formation of communities that are open or conditionally closed to new members based upon relationship, interest, need, etc.

21


Technology Components and Workflow Paradigms

o Communities−Facebook Friends, Community Pages

o Standards based on peer review, as used in current apps− “Like” (Facebook)− “Followers” Twitter −“Recommendation” (LinkedIn)− “Ratings” eBay

o Decision support based on network behavior/data received or sought−Amazon (people who bought this also

bought . . .)

22


Technology Components and Workflow Paradigms• Diagnostic Desktop – “Diagnostic EHR”

o Distinct from “Clinical EHR”o Uniquely suited to collaboration

−Multi-modal Dashboard−Support for disparate data sources−Smartsearch, predictive search, agents− “Workbench” for merging/synthesizing

aggregated data−Collaborative communication using Chat, push to talk, other tools

o Facilitates “super diagnosis”23


Creating the Super Diagnosis

24

ReportsConsult

Reference Material

SUPER DIAGNOSIS

Biomarker


Questions for Future Consideration

• How are the rules and constructs developed?

• How is “membership” determined?• What business models will support an

open collaborative network?• What are the obstacles to effective

deployment?

25

Documents

The Development of National Electronic Pathology / Laboratory Networks