An effort to improve communication among specialists scattered in various outpatient clinics in a busy city might also be promising for speeding care in rural areas where the nearest specialist is perhaps hundreds of miles away.
It’s becoming increasingly rare, said Dr. Ossama Tawfik, that pathologists and radiologists assessing breast cancer patients work in the same building.
And within the next several years, as much as 70 percent of medical practices will likely operate as outpatient clinics instead of being located in a hospital or medical center, said Tawfik, vice chairman and director of anatomic and surgical pathology at the Department of Pathology and Laboratory Medicine at the University of Kansas Medical Center.
The shift to smaller neighborhood clinics or surgical centers may be more convenient for patients. But physicians and specialists who are part of a care giving team will be physically separated to a greater degree. Even now, pathologists and radiologists at the KU Med Center work in office buildings two miles apart.
Generally, Tawfik said, radiologists do diagnostic tests, write a report, then send the information to pathologists, who write a separate report. The findings then go to the primary care physician or specialist who first saw the patient.
It’s rare that any of the specialists discuss their findings directly with the others.
“We’re all in different silos, or in different orbits,” Tawfik said. “Each of us is issuing reports that are going to a third or fourth person — the primary care physician and/or the surgeon, without any of us talking to each other.
“Everybody’s assuming the other person is understanding him or her. Unfortunately, that’s not the way we should be when we’re talking about a particular lesion in a woman’s breast that could be turning into cancer.”
Face-to-face discussions, Tawfik said, are out of the question.
“I could go to them, but that would be taking a half-day of my time,” he said. “You multiply that around the other people who would be involved in the treatment plan — gastro-intestinal specialists, lung specialists, other breast cancer specialists, the liver, kidney and heart people — there’s no way I’d be able to do any work. All I’d be doing is running around from one conference to another to take care of those guys.”
The medical school several years ago started a pilot project to link pathologists and radiologists through Web conferencing, pairing the school’s digital slide-reading and imaging technology with inexpensive Web cameras and teleconferencing equipment.
During the short weekly conference, the doctors reviewed cases in which breast cancer had been suspected but which the testing showed was not present or benign.
The Web conferencing pilot project quickly became standard practice, Tawfik said, after the doctors saw the conferencing sometimes resulted in a change of diagnosis or prompted additional testing of a patient.
“We found some discrepancies,” Tawfik said. “That is what made the tremendous difference in the value of this type of approach. In 32 percent of the cases, we needed to do something extra for the patients. Fortunately, the majority are OK, but there were a few cases that we had to go back and tell the patient that we needed to do additional testing.”
That simple extra step of a weekly Web conference has shown promise in reducing errors and improving communication among the specialists, Tawfik said. And it also has prompted talk about expanding the use of the Web conferencing to reach rural areas for consultations.
Digital equipment and advances in teleradiology and telepathology now make it possible to quickly transmit laboratory slides and patient information from small clinics to specialists or subspecialists almost anywhere.
“Telepathology has been around for 25 years,” said Jonathan Linkous, chief executive officer of the American Telemedicine Association. “It started out with the idea that you could have a robotic microscope that you could control from a distance. Now we have digital slides, cameras that take thousands of pictures that are instantaneously melded together to produce an image that is just as good as looking through the microscope.”
As use of the digital scanners spreads, doctors will no longer have to wait for a set of a patient’s glass slides to arrive in an express shipment from a rural clinic, but instead will be able to provide a consultation almost immediately and report back to the patient’s primary care physician via Web conference.
“Waiting for the glass slides could take a week to 10 days,” Tawfik said. “This is a real-time consultation. With this system on board, it could take 10 minutes. We’re expediting patient care.”
Linkous and Tawfik said that the technology would likely supplement, rather than replace, physicians and specialists in rural or smaller urban areas.
“Imagine that you have someone in Hays doing brain surgery,” Tawfik said. “They need someone to review a frozen section while they’re doing the surgery. Neuropathologists are not available everywhere. We could be on stand-by at KU so we could review it and the surgeon in Hays would have an answer right away. This could be huge in the way we practice medicine in the future.”
“It really provides access to specialty care for people who could not otherwise get it, who would have to travel a very long distance,” Linkous said. “It also helps hospitals and clinics to share the costs of having specialists — in rural Kansas, there aren’t that many subspecialists. It doesn’t replace those physicians, it doesn’t challenge hospitals.
“If anything, it helps hospitals — if patients don’t have to leave to visit a specialist, they tend to stay there and remain the hospital’s patients instead of moving closer to those urban areas.”
Tawfik’s team members have presented their findings at a few scientific conferences. To their knowledge, they are the first group that has added Web conferencing to the cancer review process.
Linkous, too, said use of the technology was not widespread.
“It’s somewhat novel,” he said. “This is certainly a very cost-effective way of doing this. It makes a lot of sense. It’s the kind of technology that we didn’t have available before now. It has great potential for use in other areas.”
-Sarah Green is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. She can be reached at sgreen@khi.org or at 785-233-5443, ext. 118.