Can pathology informatics heal sick health systems?
As electronic health records (EHRs) make their way into the mainstream, and as diagnostic technologies evolve, the field of pathology informatics is also expanding. This expansion seems to be a welcomed development, especially since it has the potential to improve the quality of care.
One way that pathology informatics is helping patients is through the use of genomic technologies, or more simply put, genetic testing, since some people are genetically predisposed, and therefore at a higher risk, for developing certain diseases such as sickle cell anemia and familial adenomatous polyposis. Currently, the majority of these tests examine single genes and are used in the diagnosing of rare genetic disorders. Some other genetic tests detect rare inherited mutations of otherwise protective genes, such as BRCA1 and BRCA2, which scientists now claim are responsible for certain forms of breast and ovarian cancers. Additionally, more tests are being developed to examine multiple genes that might have the potential to increase or decrease a patient’s risk of developing lifestyle diseases such as type 2 diabetes and obesity, or even their risk of adverse drug reactions. For instance, pharmacogenetic testing could be used to determine the presence of genetic variations that might influence how a patient’s body responds to medications.
These emerging and evolving technologies have the potential to help prevent the occurrence of a variety of diseases and to improve patients’ overall health, assuming that doctors are willing to authorize the tests in the first place. Fortunately, in India, a doctor’s “legal” authorization is not required for every aspect of healthcare; so, just as one may buy most types of pharmaceuticals without a prescription and may schedule diagnostic imaging procedures without a referral, most medical laboratory testing can be accessed privately without the invasion of a third party. The same now holds true for some types of genetic testing, with companies like EasyDNA and other private genetic testing laboratories appearing on the scene. This means Indian patients are somewhat more empowered, instead of being completely at the mercy of physicians like those patients in the U.S. and U.K.
Take for instance the case of a U.S. company known as 23andMe that was providing ancestral and health related genetic testing to American patients. 23andMe has now been forced by the U.S. Food and Drug Administration to stop providing health related genetic testing, leaving patients in the lurch once again. Before the FDA got involved, one could simply order the test kit online, privately, without anyone’s permission or interference. The customer would receive their kit, swab a cheek and mail the sample back to 23andMe, then the company would send the test results to the customer. Now an American patient who would have enjoyed a relatively private and hassle free testing experience with 23andMe must endure an unnecessarily embarrassing, time consuming and expensive clinic visit that will require equally expensive insurance.
In addition to genomics, pathology informatics also has the potential to protect patients from incompetence, to some degree, by reducing instances of misdiagnosis, pharmacy errors, mistaken patient identity and other life threatening mistakes. According to Leica Microsystems, a very common cause of misdiagnosis is the incorrect labeling of patients’ tissue samples. Leica has stated on its website, “Alarmingly, it is estimated that up to 98,000 people die in hospitals each year from preventable medical errors, making misdiagnosis the eighth leading cause of death in the US, ahead of motor vehicle accidents, breast cancer and AIDS.” Leica suggests using technology to track specimens, as this can reduce the chances of improper labeling. Sample tracking, as it’s called, is now being successfully carried out with barcode technology in many facilities. On its website, Leica has mentioned, “The bar coding system ensures that only one patient’s samples are handled at a time to prevent any confusion of slides between patients. Every time a sample is scanned, the laboratory can track its process, where it is and who handled it, providing full traceability. According to the Department of Pathology University Hospitals Case Medical Centre in Cleveland, Ohio, the use of bar coding and tracking in surgical pathology has significantly decreased the hospital’s number of errors from 11-14 slides out of 10,000 to 0-1 out of 10,000.” The company predicts that as sample tracking technology evolves, scanners will one day be able to differentiate one entire specimen cassette from another.
Aside from reducing errors, pathology informatics technologies may also expedite the turn around time, meaning that if a patient has a biopsy peformed she might get an accurate diagnosis faster and be able to start treatment sooner. The Philips Digital Pathology System appears to be an ideal all in one solution to accurately speed up the diagnostic process. On their website, Philips says their system can “scan standard pathology slides at a speed of one slide every 50 seconds (total scanning and handling time).” Philips says its system’s image viewing/storage component includes image analysis software for feature recognition and quantification and the company claims its system can retrieve a patient’s information, case notes and radiology images to be viewed alongside pathology images, and also contains report generation tools to facilitate data sharing between medical professionals.
While it’s heartening to know these life saving technologies exist, corrupt government agencies like the FDA, along with some morally bankrupt physicians, seem determined to stop the majority of patients from gaining access to them. This is why patient education, autonomy and empowerment is the need of the hour, because all the technology in the world can’t fix a healthcare system run by sick bureaucrats.