Stanley J. Robboy, MD

November 2012

Stanley J. Robboy, MD

For pathology, promising new steps

Typically, the first purpose of an annual meeting is to highlight progress during the previous year. CAP ’12 certainly did that. But maybe, just maybe, we might more appropriately view our meeting as a launch—a burst of momentum that is just starting to carry us to promising new beginnings. I wish in this month’s column to feature four initiatives and creative partnerships that have been part of this launch, each now coming to fruition.

Earlier this year, the CAP commissioned G2 Intelligence, a firm that studies and advises diagnostic testing laboratories and related medical providers, to conduct a focused analysis of emerging pathology practice models as part of our transformation program. Eleanor Herriman, MD, MBA, a pathologist who is the director of research and advisory services for G2, has taken the lead in that undertaking.

Dr. Herriman shared initial findings at the CAP ’12 national member conversation, a highly rated special session at the annual meeting that is just what it sounds like. The final report will be available shortly and surely will take center stage. We will have something tangible to work with to help secure our future as a profession.

Dr. Herriman has identified several professional but business-supported scenarios useful for our specialty—what the CAP calls Promising Practice Pathways. To start the ball rolling, she considered four value-based services (meaning services whose value is measured in terms of big-picture clinical impact). We will outline this work further in future columns, but for now, let me share just one statement (in this case, tied to personalized medicine for oncology treatment) that captures the gestalt: [Together with] molecular testing and informatics capabilities, as well as access to clinical data, this pathway can be navigated from a number of starting points, with variable speeds and using either buy, build, or borrow resourcing.

We begin with where we are and use the resources at hand to construct the path to where we want to be. I like the way she thinks.

While the pathways can be employed individually, they have even more power at the practice level and in the greater environment. They are designed to add clinical value outside the laboratory by improving quality and outcomes, and they should also generate significant cost savings. Please visit the new Promising Practice Pathways landing page (yourpathyour choice.org) to order the document. Stay tuned in 2013.

Another highlight of CAP ’12—one that married perfectly with the practice pathways research—was a scientific plenary on molecular testing for lung cancer organized by Philip T. Cagle, MD, director of pulmonary pathology at The Methodist Hospital in Houston and a professor of pathology at Weill Medical College of Cornell University. Recruited as panelists were Marc Ladanyi, MD, of Memorial Sloan-Kettering and Kim Norris, a UCLA Lung SPORE patient advocate and president of the Lung Cancer Foundation of America. Dr. Ladanyi’s front-line work in molecular testing for lung cancer and Kim Norris’ personal story—her husband died of the disease—made a powerful case for pathologists in direct patient care. Their messages were clear and memorable.

Dr. Cagle is also editor-in-chief of the Archives of Pathology & Laboratory Medicine. His seven-year tenure in that post has been one of continuing innovation, creativity, and steady recruitment of outstanding subspecialty experts to the editorial advisory board. The January issue will introduce four new editorial board sections in emergent fields that will affect our future: precision medicine, digital pathology, advanced imaging in pathology, and clinical effectiveness and economics. It will also introduce expanded clinical pathology sections that will put new emphasis on personalized health care. These exciting changes within the Archives reflect a sophisticated appreciation of our diverse and complex personal and educational challenges.

My fourth topic relates to a similarly forward-looking initiative that involves the Association of Pathology Chairs with which we recently signed a Memorandum of Understanding that will allow collaborative development of educational initiatives and derivative products focused on emerging areas of pathology practice and research. Ann D. Thor, MD, professor and chair of the Department of Pathology, University of Colorado, is the current APC president. Our joint philosophy is simple: Together, we can achieve more than either can alone, and in a more cost-effective manner.

The agreement formalizes our intentions to work together to address revolutionary changes in health science and the economy. We will develop programs for use at all levels of education and will encourage better alignment between undergraduate, graduate, and continuing education initiatives and competency requirements. We will collaborate on educational products and training for experienced pathologists that can be offered at CAP or APC meetings, within academic departments and through online offerings. These interactions and joint initiatives will foster communication and allow us to be more responsive to critical professional needs, including those of academic and community-based practices. In leveraging combined resources, we can better advocate on behalf of our patients and specialty at the institutional, state, and national levels. One of our first joint projects will provide education in health information technology and laboratory information systems, which provide critical database and interface support for pathology’s role in new health care delivery models, including accountable care organizations and other coordinated care initiatives.

Collectively, Dr. Herriman’s business-case approach, Dr. Cagle’s management of the scientific plenary at CAP ’12 and vision for transforming the Archives and execution of that vision, and our exciting partnership with the APC are indicators of a promising future for our specialty. We know where we want to go: toward more integrated practices as physicians on patient care teams. And we know how we’ll get there: plan the work, work the plan, choose our individual paths and follow them, one step at a time.

My take-home message from CAP ’12 is that our specialty is robust, thriving, learning, and fully committed to finding, and creating, meaningful opportunities for pathologists in the changing world of health care. We are now engaged in a persistent, collaborative process to become more ready, better known, and more distinctly linked to innovations that will protect and improve patient well-being and foster a sustainable and economically sound future for our specialty.