• by Jaye Connolly , June 11, 2013

The diagnosis is grim: the American healthcare system is suffering from an acute shortage of integrated health information networks. Technically, it’s more than a shortage: such networks simply don’t exist. 

And that’s why the prognosis is equally unsettling. Even as the first state-run health insurance exchanges point to some brake on runaway healthcare costs, the health information network void means money, big money, misallocated and misspent. Consider:

• 1.5 million Americans are diagnosed with cancer every year, at a cost to the U.S. healthcare system of more than $100 billion, double what was spent just 20 years ago. That number is expected to rise dramatically over the next several years, with 10,000 baby boomers turning 65 every day in this country.

• Cancer diagnoses are performed by specialized physicians called pathologists, who typically serve patients at small-to-medium-size community hospitals. 

• The rising cost of cancer diagnostics can be largely attributed to two key factors:

• First, most pathologists are currently using outdated software platforms that don’t enable them to electronically share patients’ medical records with oncologists, surgeons, radiologists and other healthcare providers. This lack of an “integrated health information network” costs patients and the U.S. tax payers billions of dollars annually in waste, inefficiency and inappropriate or ineffective patient care.

• Second, although there are many new powerful anti-cancer drugs now on the market, many pathologists either aren’t aware of, or don’t have easy access to, sophisticated laboratory tests that will determine whether or not their patients will benefit from these drugs. 

The cloud represents powerful transformative technology that directly addresses both of these issues. Diagnosticians are finally acclimating themselves to robust yet affordable, web-based software platforms that enable them to easily and seamlessly share medical records with other physicians. These platforms also give them access to sophisticated new laboratory tests that help them recommend “personalized” treatment regimens for their cancer patients. A bona fide integrated network also ensures ”true” digital pathology, enabling pathologists to share electronic images of their patients’ tumor specimens with other network physicians for instantaneous second opinions and expert consultations.

A network needs to be designed as a turnkey online tool for busy practitioners, delivering on at least five prerequisites for cost-effective – and just plain effective – diagnostics:

• Easy-to-use consultation and collaboration tools that are available in several languages
• A scanner and viewer-agnostic platform 
• Immediate access to subspecialty experts around the world
• Faster and lower cost turnaround of secondary consults 
• An opportunity to attain an ongoing, additional revenue source needed due to reimbursement rate cuts 

As with so many things, for the healthcare cost debate, the devil is in the details. And healthcare marketers, absorbed as they may be in the big, systemic issues, might well have missed the issue highlighted in that final bullet. Recent developments in Medicare reimbursement underscore the urgency of finally delivering on the promise of digital pathology. 

This year, pathologists are facing a 52% reduction in the technical component (TC) reimbursement for CPT code 88305 in the surgical pathology family, per the 2013 physician fee schedule from the Centers for Medicare and Medicaid Services. The takeaway? It’s more important than ever for diagnosticians to centralize/consolidate their cystology and digital imaging services.

According to Dr. Keith Kaplan, noted pathologist and blogger, it’s all about the 4Rs of pathology: “The right slide, the right patient, the right pathologist, the right time.”

With the integrated healthcare information network shortage bumping into Medicare/Medicaid reimbursement reductions, the right time is now.