Building an Effective DMT
How to assemble and manage the best team to accomplish your goals
The potential for the success of any group lies in its members, its leadership and everyone’s willingness to work together to achieve a common goal. A diagnostic management team is no exception.
What Is A DMT?
By definition, a diagnostic management team — or DMT — is a group of healthcare experts who meet on a regular basis while the patient is being evaluated as an inpatient or outpatient, to review individual patient histories and interpret clinical data and test results, and then generate a patient specific, expert driven diagnosis. These diagnostic summaries are added to the patients’ files to inform treatment decisions.
With literally thousands of tests at doctors’ disposal, it behooves healthcare organizations, staff and patients to utilize the most appropriate laboratory tests for each individual case. Yet, tests are over- and under-utilized all the time, leading to wasted resources and the possibility of diagnostic errors.
In 2015, the National Academy of Medicine endorsed DMT consultative services as a means of reducing medical errors in American healthcare. Dr. Michael Laposata, Professor and Chairman of the Department of Pathology at the University of Texas Medical Branch in Galveston, is a leading proponent of DMT use.
The DMT puts together the diagnostic puzzle to generate a diagnosis, or a short list of diagnostic options, and provides that information to the treating healthcare provider,” he explained. It’s my hope that everyone will soon appreciate that the goal of the DMT is to make complex clinical laboratory and anatomic pathology information understandable to every healthcare practitioner so that an accurate diagnosis is made rapidly."
If you want to start a DMT at your organization, here are some helpful items to keep in mind.
Contributing Lab Leaders
Dr. Michael Laposata
Pathology Department Chairman
Dr. Chad Botz
Assistant Professor of Pathology and Special Coagulation Laboratory Director at University of Texas Medical Branch in Galveston
Dr. Eric Walser
Chairman of Radiology at University of Texas Medical Branch in Galveston
Area Of Focus
When creating a DMT, the first question to ask yourself is —what are your professional strengths within the individual medical specialties?
The DMT concept can be put to use in practically any branch of medicine — teams have already generated positive clinical and financial results in coagulation, hematopathology, microbiology, surgical pathology, and endocrinology in organizations throughout the country.
Dr. Chad Botz, Assistant Professor of Pathology and Special Coagulation Laboratory Director at University of Texas Medical Branch in Galveston, participates on the coagulation DMT with Dr. Laposata to improve utilization of laboratory testing related to coagulation and thrombosis disorders. "The coagulation DMT meets daily Monday through Friday for 60 to 90 minutes to review all special coagulation tests performed for patients at UTMB,” Dr. Botz described. "A chart review by the resident on service is vital to incorporate the clinical picture regarding differential diagnosis and assessing which tests were most appropriate in that situation.” Thanks to a rather unconventional course of training that included two years in anesthesiology, board certification in clinical pathology and a one-year molecular genetic pathology fellowship, Dr. Botz is able to lend his own unique perspective to the group’s discussions. "Overall, it’s been a very valuable and rewarding experience implementing a project that has the potential for significant cross collaboration with all healthcare providers to ensure patients receive the quality care they deserve,” he said.
The big-picture goals of any DMT are shorter times to diagnosis, increased diagnostic accuracy and greater optimization of lab tests. How to go about accomplishing those goals in any specific field is an issue to be determined by the DMT leadership.
"Every laboratory director has some particular area which he or she knows better than virtually all other healthcare providers,” Dr. Laposata said. "This is why all doctoral-level laboratory directors should identify the area of their special knowledge and begin to provide expert-driven, patient-specific narratives of the laboratory tests used to help patients who may have a diagnosis within this area.”
Whether the scope is broad or specific, every DMT needs clear-cut guidelines in place for patient testing criteria, interpretation of those results and recommendations.
"I believe someone who’s familiar with optimization of all the steps that make a DMT efficient should review new DMTs and give helpful advice,” Dr. Laposata pointed out.
"There’s much to be learned about identifying patients who should be discussed in a DMT, how to formulate the expert-driven narrative and how to bill for the report that’s generated, just to name a few aspects.”
Who To Include
Once you’ve clarified your DMT goals, it’s time to start assembling a team of participants. The DMT’s purpose will help determine who to include, but each member of the group must have specialized knowledge in the specific field. Observers can include students and trainers of all kinds. A diverse group will offer the broadest range of expertise when drafting narrative interpretations.
"A DMT requires a minimum of two people,” Dr. Laposata said. "There must be an attending lab expert (often a pathologist or Ph.D. laboratorian) who can review a tentative diagnostic narrative created by a person who has investigated the case and has medical knowledge. This person can be a pathology resident, a fellow from a medical service, a Ph.D. specializing in a clinical laboratory discipline, or doctoral candidates for the newly created doctorate in clinical laboratory sciences.”
Other prospective participants to consider inviting might include Ph.D. fellows, clinical lab scientists, medical students, attending physicians from other disciplines and pathology residents. Keeping the total number of participants to around 6 keeps managing the group from becoming unwieldy and gives everyone a fair chance to participate in discussions.
How To Structure Meetings
After determining your goals and assembling your team of participants, your DMT is ready to start meeting. To be most effective, a DMT needs to gather on a frequent, regular basis and create comprehensive patient-specific reports to be entered into the patients’ medical records. As with most medical matters, timing is everything.nicating with a manager, or accessing the Internet to find a solution to a problem.
"The key timing issue is to organize the DMT so that the output of the team is provided when clinical decisions are being made about the patient,” Dr. Laposata stressed. "The DMT is not a case conference that’s organized long after the patient has been treated. In a DMT role, laboratory directors are providing support for healthcare providers who will immediately benefit from expert recommendations to establish a definitive diagnosis for a current patient.”
How long DMT meetings should be, and how often they should be held, depends on the number of cases to be evaluated and the goals of the group.
"The DMT concludes when all of the cases are reviewed, not just when the hour is up,” Dr. Laposata mentioned. "The leader can regulate the extent of the discussion to make sure the session doesn’t extend beyond member’s attention spans.”
If physically assembling DMT members in the same room at the same time isn’t possible, meetings can be coordinated remotely via video conferencing.
Dr. Eric Walser, Chairman of Radiology at University of Texas Medical Branch in Galveston, participates in DMT case meetings several times each week via online conferencing services such as Skype or GoToMeeting, and includes patients to discuss their own cases in what he calls a "real-time tumor board.”
"Traditionally, doctors meet once a week and go over all the cases at once; this is much faster and more immediate,” he said. "We can go over all the findings and options in one electronic visit. This allows us to treat patients from afar, and the follow-up for patients with chronic conditions can be done more frequently without travel and time constraints. It gives patients more continuity, and more information.”
An initial face-to-face meeting with the patient is required for billing purposes, but Dr. Walser says that after that, it’s often more convenient to gather the DMT members online so the patient can simultaneously communicate with their doctor, a surgeon, a radiologist, a pathologist and a patient navigator.
"They usually just see their primary care doctor and then maybe a surgeon,” he continued. "They may never see a radiologist or pathologist in person. This allows the patient to see all those doctors at one time and gives them a more global assessment.”
Another benefit of virtual meetings — experts can be looped in from organizations outside of your own network, giving patients the reassurance that they’re consulting with the top doctors in the field about their individual cases.
Dr. Walser says the most important aspect of planning a virtual meeting is making sure the organizer is on time.
"Being on time is crucial,” he said. "And you’ve got to get confirmed attendance from everyone participating, especially the patient.”
Time is a precious commodity for everyone, of course, but those who’ve committed to being part of a DMT, whether in person or electronically, find it well worth the investment.
We still have room to grow and optimize Diagnostic Management Teams, yet the important foundation has been set in place,” Dr. Botz. said I look forward to seeing the continued positive progression in the years to come."
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