Best Case Scenarios for DMTs
Which medical fields and cases are most appropriate for DMT input and intervention?
In 2015, the National Academy of Medicine endorsed Diagnostic Management Team consultative services as a means of reducing medical errors in the American healthcare system. Composed of a multi-disciplinary group of healthcare experts, a DMT meets on a regular basis to evaluate individual patient histories and interpret clinical data, in turn generating an expert-driven narrative that helps inform treatment with the goal of improved outcomes.
With so many opportunities out there for DMTs to weigh in with valuable input, figuring out where to start may feel a bit overwhelming. First steps include determining which medical fields — and specifically, which cases — lend themselves most readily to reaping the benefits of DMT intervention.
DMT input is most valuable in diagnostic areas where there is uncertainty about test selection.
DMTs offer advice on a diagnostic evaluation that has a great clinical and financial impact.
Examples of how the DMT approach is being used in Coag, Radiology, and Anatomic Pathology are shared.
Contributing Lab Leaders
Dr. Michael Laposata
Professor and Chairman of the Department of Pathology at the University of Texas
Medical Branch in Galveston
Dr. Joshua Kish
Anatomic and Clinical pathologist at Greensboro Pathology Associates
Medical Director for the Aurora Research Institute
Dr. Eric Walser
Chairman of Radiology
University of Texas Medical Branch in Galveston
“Any diagnostic area where there’s uncertainty about laboratory test selection and interpretation of laboratory test results lends itself to a DMT,”
“Any diagnostic area where there’s uncertainty about laboratory test selection and interpretation of laboratory test results lends itself to a DMT,” said Dr. Michael Laposata, Professor and Chairman of the Department of Pathology at the University of Texas Medical Branch in Galveston. “The more complex and poorly understood a diagnostic area happens to be, the greater the need for advice. If they’re being thoughtful in their responses, most doctors would agree that virtually all clinical testing beyond a complete blood count and a comprehensive chemistry panel benefits from expert input.”
While DMTs can be assembled and put into practice within nearly any medical area of study, they may prove to be more helpful in some fields than others.
“DMT input would be most valuable in areas where the advice on a diagnostic evaluation has great clinical and financial impact,”
“DMT input would be most valuable in areas where the advice on a diagnostic evaluation has great clinical and financial impact,” Dr. Laposata noted. “In some cases, the experts can provide lifesaving advice; in other areas, they can regulate inappropriate overutilization and underutilization of testing to allow a diagnosis to be made at a much reduced cost to the institution.”
On the flip side of the coin, are there any medical fields or cases where DMT input would not have the potential to be valuable or appropriate? Dr. Laposata says no.
“Some of the simplest and most common test results, such as hemoglobin and hematocrit, don’t require experts to provide advice to the physicians and providers who ordered them,” he pointed out. “However, hemoglobin and hematocrit are important components of a DMT that’s focused on a related area, such as diagnosis of hemoglobinopathy. While there are many clinical cases where a diagnosis is made without the need for expert input, I don’t believe there are any specific tests where a DMT doesn’t help in some way.”
Here’s a closer look at how several DMTs are being put to use in different areas with positive effects.
For the past few years, Dr. Eric Walser, Chairman of Radiology at the University of Texas Medical Branch in Galveston, has been assembling a DMT group of experts online — and including the patient — to address complex prostate cancer cases two to five times each week in real-time.
“I was noticing that my patients would come to Galveston to have their treatment and imaging, then go home,” Dr. Walser said. “About 60 percent were traveling here from outside the state. Now, they can see a radiologist, a urologist, a pathologist and a scheduler during one 15-minute meeting. Before, it would take them three or four days to schedule and attend all those individual appointments.”
Dr. Walser finds conducting his DMT meetings online to be more convenient for everyone, saving time and improving the participants’ ability to communicate quickly and effectively with patients not just in Texas, but all over the world.
Patients love the DMT approach, not to mention the time savings and lower out-of-pocket travel costs.
Although some doctors may not be on board with the idea of fewer billable visits and tests, Dr. Walser says his patients love the DMT approach, not to mention the time savings and lower out-of-pocket travel costs.
“We’re moving in the direction of digital, patient-controlled healthcare,” he said. “We have a really large state, and UTMB has historically treated people from counties throughout Texas, as well as a widely scattered prison population. Prisoners would sit in front of a camera with a nurse who would examine them and report online, that’s how this all started. What we use now is an enhancement of that system; the technology grew up as a way to deliver expedited healthcare anywhere at an affordable price.”
In 2004, Dr. Joshua Kish, Anatomic and Clinical Pathologist at Greensboro Pathology Associates and Medical Director for the Aurora Research Institute, participated in a coagulation DMT led by Dr. Laposata as part of a two-month coagulation/blood bank rotation during his residency at Massachusetts General Hospital. When Dr. Kish joined the group, it had already been ongoing for several years, and it still continues operating to this day.
Having a broad spectrum of disciplines represented among the team members was relevant to the group’s goal of being able to interpret a wide range of varying coagulation results.
“The DMT format works well with coagulation cases because it’s such a complex biologic system to begin with, and it entails so many available testing options,” Dr. Kish said. “Instead of just providing a set of numbers and values, we were able to offer actual verbiage about what those values mean for the patient, allowing the group’s members to share opinions with clinicians who might not have been as familiar with coagulation results.”
Dr. Kish’s DMT group assembled daily in a conference room at 4 p.m. to start rounds, which could last up until 6 p.m. depending on the volume of cases.
“It was a big time commitment, but definitely worth it,”
“It was a big time commitment, but definitely worth it,” he attested.
Over time, Dr. Kish said the Mass General coag DMT has proven its value through measurable results such as shorter length of stays, more focused follow-up testing and more appropriate use of blood products, points that haven’t gone unnoticed by the C-suite.
“Shorter hospital stays are a big gain for the healthcare system, and one of the more compelling arguments for DMT intervention,” Dr. Kish said. “No hospital administrator is going to scoff at the chance to lower costs.”
Other successful DMTs are currently hard at work to improve outcomes in transfusion medicine, microbiology, liver disease, neuropathology, primary hyperaldosteronism and other medical fields of study. Looking ahead, Dr. Laposata predicts more widespread DMT utilization to come in plenty of areas beyond those already in place.
“There are many more in the pipeline, such as evaluation for opioid management and anemia evaluation to determine underlying cause,” he added.
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