Dr Glenn Edwards is consultant chemical pathologist, and an experienced healthcare executive.
Glenn has practiced pathology in both public and private sectors in Australia. He is currently Head of Chemical Pathology in WA, and National Medical Director, for St John of God Pathology.
Dr Edwards is co-inventor and founder, and former Medical Director and CEO of Pacific Knowledge Systems. PKS is an Australian software company which commercialised the LabWizard and RippleDown suite of pathology decision support products.
His interests centre on clinical knowledge management, decision support systems, and the clinical pathologists’ role in improving the clinical and commercial value of laboratory practice.
Title: Challenges for Clinical Pathologists in the Decision Support Era
Abstract
The automation revolution in clinical laboratories is mature. These highly sophisticated and efficient organisations have transformed the diagnostic process.
However we now face new issues. Engaging reliably with stakeholders in a visible and meaningful way can be a challenge for clinical pathologists in the context of large, high throughput laboratories. Increasing demands to demonstrate value coincide with an urgent need to maintain relevance – as multi-stakeholder networks design a future based around electronic records, personalised medicine, clinical decision support (CDS) and consumer engagement.
Our experience with a pathologist-managed decision support tool has shown that clinical pathologists can improve clinical care processes – within the context of a high volume automated pathology service. For example, patient- and context-specific interventions significantly improved specialist referral rates for suspected Familial Hypercholesterolaemia. This work marks the first report of the benefit of clinical pathologists’ report interpretation in a prospective case-control study. Context–specific intervention by clinical pathologists also caused a significant fall in LDL-cholesterol, a key marker for coronary heart disease risk. Applied broadly within our laboratory, this approach is mitigating against clinical pathologists’ loss of visibility and relevance. Feedback from clinicians shows a strong preference for greater patient-specific guidance from pathologists.
However, new issues arise which require further investigation. The nature and sources of pathologists’ knowledge, and the way these are reliably and transparently captured in a knowledge-based DS tool, remain poorly examined. As with CDS in patient-care domains, clinical pathologists face an important issue of dealing with decision error. While there seems growing acceptance of decision error as an inevitable concomitant to improved patient outcomes, the implications for system design, validation, audit and professional responsibility for pathologists remain poorly understood.