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Knowledge Management and the future of Clinical Pathology

Clinical pathology has reached a critical cross-roads. Where the pathology service operates within a competitive funding arrangement, such as in Australia, consolidation proceeds apace. In large part this consolidation is driven by both revenue and cost pressures. This results in a highly efficient factory-and-logistics model for laboratory operations – but with inevitable consequences for professionals and consumers alike.

These very efficient operators have become highly competitive internationally, and we increasingly see Australian-backed pathology competing in Europe, Asia and the US. In other regions, where public funding maintains more traditional hospital-based practice, these structures are also under threat. It seems certain that there will be more out-sourcing of the traditional heartland of teaching hospital pathology to the private sector – which will deliver huge efficiencies to taxpayers.

We in the industry lament this situation, and hotly defend the value of traditional structures, including the pathologist’s essential contribution. Yet it is apparent that our pleas are largely unheard. The chief reason for this, in my view, is our inability to demonstrate value to the decision makers.

Why are we in this situation? I believe we are victims of our own success. Laboratories traditionally are early adopters of automation – in sample handling, testing, and information management. The modern pathology laboratory is a marvel of technological innovation, automation and consistency. However this automation revolution is now mature – and I believe we are facing a serious existential crisis.

Pathology now seems ripe for another revolution. This time, however, the challenges are external. We must look to adapt and thrive in a new world. This transformation – the knowledge revolution – may be our most complex and challenging yet. It requires us to critically examine own professional roles and implement disruptive, transformational change.

Our core business will be the creation and management of clinical knowledge to support healthcare decisions. Our success will be measured by our contribution to clinical and commercial value. And, somewhat ironically, we will also be judged by a rather old fashioned-sounding metric: maintenance of valued, collegiate clinical leadership roles with clinicians, consumers and other stakeholders.

Currently, clinical pathologists fall short in this latter clinical role since their contribution too often is subsumed into, and therefore defined by, the role of “the laboratory”. This effectively limits others’ perception of our role to the passive, reactive and relatively low-value provision of test result data. In this situation, we are not seen to be adding clinical value. The consequence – we unwittingly abdicate our clinical and leadership roles in healthcare. Therefore, we are highly vulnerable to disruptive change.

In some ways, this outcome was predictable. We were rapidly overtaken by the massive scale efficiencies that our automation has delivered. Pathology has come to be defined by that transactional, commoditised model that we have created. While highly efficient factory-and-logistics is an essential component of our operation, the key clinical component – the value-added role in managing clinical knowledge – has been largely overlooked.

Discourse around funding of Pathology increasingly focusses on the cost of production of the test result. Our insistence on characterising Pathology under a “request-test-report cycle” only reinforces this distorted view of the Pathologists’ role. For instance, in Australia and elsewhere there is no discrete financial recognition of the clinical contribution of the pathologist.

Meanwhile, a new generation of doctors and other clinical stakeholders has grown up around us. Highly networked, and highly technically literate, this generation works easily in a distributed, virtual team environment. This new environment will see consumers play a more active and informed role, and this will challenge prevailing hierarchies. As well, commercial, professional and political stakeholders will demand greater transparency – including clearer metrics for understanding and managing the value contribution of pathologists and the laboratory.

Medical informatics – and especially new knowledge management tools – will underpin these new ways of working. For pathologists to remain an active participant in care, they will need to play an active role in leading this change. Challenges include redefining clinical roles and professional relationships; training and upskilling in informatics generally and knowledge management in particular; and innovation in knowledge management technology and its application – especially in the pivotal function of clinical decision support.

While these challenges may seem myriad and perhaps a little overwhelming, I believe that quite substantial change will happen soon. It may be led from within the Pathology industry – and I hope this is the case. More likely it will arrive in the form of new entrants with novel technology solutions and a clear focus on delivering value. As was the case for Uber, this change may be dramatic and sudden – a truly disruptive, transformational change.

Glenn Edwards
is currently Head of Chemical Pathology and National Medical Director, for St John of God Pathology, Australia. He spoke at the 2nd Digital Pathology Congress Asia.

View the agenda for the 3rd Digital Pathology Congress: Europe, held in London on December 1st – 2nd 2016. 

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