Improving Medical Opinions

The old adage “Two heads are better than one” clearly applies to the complex world of medical diagnosis. While the original phrase is attributed as far back in time as Ecclesiastes, perhaps C.S. Lewis, the Irish-born novelist, had it right when he was quoted as saying: “Two heads are better than one, not because either is infallible, but because they are unlikely to go wrong in the same direction.”

Seeking Opinions

As the practice of medicine continues to become more specialized, it’s more compelling than ever for a patient, physician or veterinarian to seek out a second head, someone with expert knowledge to review a particularly complex case. This has often been referred to as a Second Opinion.However, it’s becoming even more common to seek this specialized expert knowledge for an initial consult, in addition to a second and third opinion. This increase in collaboration among referring physicians, the expert, and the patient requires intelligent and efficient technology that will support collaborative case communications.

In the world of human medicine, insurance reimbursement often drives patient behavior. Unfortunately, health insurers may limit the patient’s access to care to within their own network. However, the reality that an additional opinion might prevent greater costs down the road puts pressure on insurance companies to reimburse patients who seek a second or third opinion. Getting an additional expert’s opinion could prevent an incorrect or incomplete diagnosis or confirm a diagnosis, either way helping to ensure the patient receives the correct treatment plan. In the U.S., Medicare Part B now includes reimbursement for second or even third opinions if the second opinion differs from the first.1 

It may be astounding to learn that many, if not most, initial diagnoses for critical medical conditions are incorrect. A 2017 study from the Mayo Clinic in Rochester, MN (USA) found initial diagnoses to be incomplete or incorrect in the vast majority (88%) of cases. With data like this, there is little doubt that payers will begin to reimburse patients more frequently to ensure they receive appropriate treatment plans, thus saving all parties from incurring additional costs down the road. This data also suggests that patients who can afford it will seek additional medical opinions on their diagnosis, even if it means paying out of pocket. 

Advances in technology, including electronic access to medical information, make it more common to be referred to a specialist who may be geographically distant from the patient. Thanks to web-based case management platforms, this remote expert collaboration is becoming a common piece of the diagnosis and treatment process. Rather than wade into areas outside of their own level of expertise, internists and general practice veterinarians and physicians refer their patients to specialized colleagues to collaborate on providing more informed answers. And while two heads are better than one, ultimately, coordinated teamwork will likely serve patients even more effectively.

Physicians and veterinarians have notoriously busy schedules; so finding multiple experts available to review a case at the same time can be difficult. Ensuring they have easy access to the right information wherever they might be when they have the time to review it, is key to capturing their attention. This process begs for an efficient, geographically agnostic, clear and concise method to access, review, and report on a patient case.

Hospitals with reputations for expertise in certain specializations, such as the Mayo Clinic, Memorial Sloan Kettering, and Partners Healthcare, have already institutionalized access to their expert physicians to provide opinions. Offering this type of service both extends their brand as well as expands their sources of incremental revenue.

Regional hospitals serving wide geographic communities can establish centers of expertise to serve their wider community. Individual physicians and veterinarians, also with specialized expertise, will find that establishing a process for receiving case information and responding to these with an online opinion can be a lucrative addition to their established practices.

The Case Sharing Process

Creating a Case Presentation

The mathematician Blaise Pascal is likely the originator of the idea that when creating a written document, in this case a letter to a colleague,shorter requires more time.3 A quote attributed to Pascal in the language of his day says: “Je n’ai fait celle-ci plus longue que parce que je n’ai pas eu le loisir de la faire plus courte.” In today’s English, that would roughly translate as: “I have made this longer than usual because I have not had time to make it shorter.”

Electronic Health Records fall into this category. In general, EHR documents may be a great way to accumulate a complete record of patient data in an electronic compendium. Unfortunately, though, the larger these records get, the more difficult and time consuming it is to identify the key pieces that are relevant to the patient’s current case. It would simply take too much time to organize an EHR to highlight these key pieces.

Finding a way to sift through the relevant parts of the patient record and present only these essential pieces, avoiding the reams of other information in the patient’s record that may be important, but not for this purpose, requires an effort beyond your standard EHR system.

In fact, the volume of data can impede a proper diagnosis according to an article in Fortune Magazine:

“EHRs promised to put all of a patient’s records in one place, but often that’s the problem. Critical or time-sensitive information routinely gets buried in an endless scroll of data, where in the rush of medical decision- making — and amid the maze of pulldown menus — it can be missed.” 

There’s a clear need for a more efficient way of extracting the relevant information from an EHR, PACS or other health data repository for an important, perhaps even life-saving, diagnosis.

Including Medical Images

According to the New England Journal of Medicine, medical imaging is one of the top medical developments over the past 1,000 years. It’s not a surprise that its use as a diagnostic tool is ever increasing. Including a medical image along with the relevant case information is clearly helpful. Medical imaging has improved the medical diagnostic process in a much less invasive manner, according to the European Society of Radiology, causing imaging to be used extensively and routinely in almost every subspecialty.

But accessing medical images in a location other than where they originated often requires delivering a CD or DVD to the expert physician orveterinarian. CDs are cumbersome, often faulty, create delays in the delivery of this important information, and generally are not the optimal viewing medium. Going beyond CDs and getting medical images into the hands of the expert, immediately, is critical to enabling expertopinions.

Enabling Expert Access Wherever and Whenever It’s Available

While physicians and veterinarians are busy professionals, specialists are even more so. In order to get their attention in a timely manner, it’s critical to present a clear and succinct set of information in a way that they can access it wherever and whenever

is convenient for them. For physicians working in institutional environments, access to data coming from outside their facility can often be frustrated by a firewall or similar cybersecurity defense. It’s imperative that whatever system the referring physician uses enables them to access the diagnostic data no matter where they are geographically. Whether they’re in a firewall-protected institution, traveling, at home, at aconference or even on vacation, they must be able to access the case information whenever they have a window of time to review it.

Clearly Articulate the Issues

The best expert opinions come in response to clear presentations and thoughtful questions. With a system that enables a succinct presentation of the case data coupled with relevant questions, experts become focused on the specific issues that matter to the patient and his or her referring physician. Rather than being distracted by concerns that may not be germane to this patient’s current case, experts can be efficient and focused.

Collaboration

Back to our two (or more) heads being better than one, the ability to share diagnostic information, thoughts and opinions among several professionals withdifferent areas of expertise can often lead to an improved result. Picture the patient presenting symptoms that may turn out to be bile duct cancer. A team ofphysicians from oncologists, to urologists to gastroenterologists, and more, may all need access to the same information concurrently. Being able to distribute this information efficiently, in a collaborative environment, among experts in different regions, can lead to faster and better collective judgment.

The Bottom (and Top) Line

There is clearly a need to present relevant case information to expert physicians and veterinarians in a collaborative environment in order to improve healthcare results. This process, which may require teams of geographically diverse experts, needs to enable the presentation of pathology, radiology and test results in any location, at any time, wherever and whenever the required experts have availability to review them and provide an opinion. Systems must avoid presenting reams of irrelevant data. The more concise and directed, the better the chance the expert team will have the time and ability to focus on what is important to this patient’s diagnosis.

Experts and institutions can participate in this process without changing their location or their technology. And while the process will likely lead to better patient outcomes, it is an efficient way to generate much needed additional revenue in this reduced reimbursement environment.