December 2011

Stanley J. Robboy, MD

Aiming for the unrealistic

Recently, during a Laboratory Accreditation Program site visit, I got to thinking about my dad. When that happens, I always step back. Whatever brings him to mind is always worth a second look.

My father was a teenager when his Ukrainian shtetl, a small village, was destroyed in a pogrom. He and his brother trekked 1,000 miles to England and somehow found steerage on a ship bound for the United States. Like so many immigrants, they arrived here without money and speaking no English, yet found employment and pursued education. For my father, that meant a medical degree.

We had a handful of rules: work hard, know and do the right thing, and always have at least one unrealistic goal. Nobody ever got anywhere without a few unreasonable goals, my dad used to say, and he was right.

He didn’t tell us (but showed us) that “unrealistic” and “unachievable” were entirely different things, and the difference between the two would be hard work and a good plan. We could do anything if we took it one well-conceived step at a time.

The site visit that set me to thinking about this was at St. Francis Medical Center in Trenton, NJ, one of 33 hospitals in 11 states that are part of the Catholic Health East (CHE) system. Robert L. Moser, MD, is medical director of the Department of Pathology at St. Francis, a 350-bed community teaching hospital with more than 300 physicians on the medical staff.

The several pathologists at St. Francis are active learners and engaged participants in hospital patient care groups. They are readily available for consultation, provide timely diagnoses, and engender high praise from their clinicians. There is much on their plate but the practice was just fine.

I didn’t ask Dr. Moser about goals; I didn’t need to. He’s younger than I am, but we’re both old enough to remember when president John F. Kennedy said, “Ask not what your country can do for you. Ask what you can do for your country.” President Kennedy asked us to step up, not once or twice, but as a matter of course. For those who were listening, it became a habit of thought.

Dr. Moser has been chief medical informatics officer at St. Francis for 15 years. More recently, CHE appointed him co-chair of the Health Informatics Executive Group as well as chair of the Laboratory Standards Council for the entire system. He manages an outpatient therapeutic apheresis clinic and was part of an NCI research grant that established the breast cancer tissue biorepository at St. Francis. These are roles that make him more familiar to colleagues on the medical staff and more credible when he talks with them about how the electronic medical record and HIT in general will contribute to ever better patient outcomes.

His clinical colleagues are probably not aware of Dr. Moser’s longstanding interest in standardized nomenclature, but it did not go unnoticed in the CHE laboratory community. He has done seminal work over many years to organize and simplify the naming conventions, coordinate all of the laboratories within the system, develop common policies, practices, and procedures, and integrate multiple new technologies.

And the St. Francis pathologists are now involved with the Laboratory Interoperability Cooperative, a CDC-funded consortium composed of the CAP, American Hospital Association, and Surescripts. The cooperative is working to connect hospital laboratories to public health agencies via electronic data transmission of reportable laboratory results. (Electronic laboratory reporting is a meaningful-use objective for public health under the Affordable Care Act.) Another unrealistic goal made achievable.

Advances in health information technology are important factors enabling the increasing accessibility of precision medicine. Consider that the first whole genome sequence was initiated in 1990, took 13 years to complete, and cost $2.7 billion, yet the same procedure can now be done in about 10 days at a cost of about $10,000. The cost is expected to drop significantly in the coming years. Pathology affords a close-up view of medicine’s most unrealistic goals and access to the tools to reach them, intentionally, one step at a time.

As the St. Francis site visit made plain, transformational pathology is a natural evolution for our members. It is about seeing problems locally, acting on them, and being visible. The College will continue to provide cutting-edge education while fostering mentorship and collaborative engagement. Together, we will enable pathologists to grow their practices and pursue those all-important unrealistic goals, one step at a time.