Traditionally, medicine was practiced in silos. A general practitioner would send an order to a radiologist. The radiologist would send it back. If something suspicious was identified, then the general practitioner would send the order for a biopsy to be diagnosed by a pathologist, who would also send it back. This cycle continued until the patient’s treatment was complete.
In this model, the general practitioner is like an air traffic controller, managing all the pieces and people that combine to form patient care. Specialists are isolated, and delivery—from the patient’s perspective—is linear. There was a time when this was the most practical way to incorporate specialists into the cycle of care, especially if these specialists were not easily accessible in terms of physical proximity.
Healthcare is evolving. Professionals are finding that the siloed model of medicine limits their ability to collaborate and effectively practice medicine. Patients are demanding more insight and are becoming active participants in their care. In this new model, patients are the center of a web, surrounded by the specialists that make up their care team. These specialists are all at once engaged with the patient and with each other, sharing, deliberating, and collaborating.
Advances in digital technology have facilitated this new care model, allowing specialists to collaborate remotely and asynchronously with real-time access to key case files. When specialists more engaged with each other and with their patients, the quality of care has the potential to improve. Studies have shown that additional opinions lead to changes in diagnosis and treatment up to 9 percent of the time after multi-disciplinary team meetings1. The more specialists collaborate, the greater the potential to impact care.
We have seen the potential benefits of collaboration play out in multi-disciplinary team meetings (or tumor boards) time and time again. Despite this opportunity to better serve patients, industry-wide adoption of a more integrated model of care is stunted by a few barriers. They are surmountable barriers but only if care teams and healthcare leaders agree to conquer them.
When it comes to sharing patient files in today’s world, sharing information is relatively easy. The hard part is marrying the relevant information with the individual work flows of each specialist involved in a care team. Specialists may be working from different buildings, different networks, and use a range of software applications. These are remnants of the siloed model of care, where each member of the care team made their contribution in isolation. As enterprise solutions evolve, these constraints are becoming less and less limiting, but it takes a deliberate directional choice on the part of healthcare leaders to adopt systems and practices that support more open collaboration in medicine.
If you, as a medical professional, are not in the open digital world, you are just not as involved in care as you could be. This statement rings true for many specialists who are still separated from care teams because the technology is not available to them.
Even as more care teams move away from the siloed model of care, the lack of investment in technology is still isolating pathologists. The analog approach to viewing slides and managing case files makes it difficult for pathologists to share their findings with other specialists. Where radiologists are emailing digital images, many pathologists are still physically packing and mailing slides if a patient requests a second opinion. For as much as we know about the power of collaboration and the benefits of connecting specialists with specialists, we are clearly missing an opportunity when we relegate pathologists to their offices. Like all specialists, pathologists should be engaged and involved with the patient and the whole of the care team.
The need for a unified platform—or for a variety of platforms intentionally designed to accommodate and facilitate collaboration—is great. Silos are artifacts from the past. The sooner we can leave them behind, the sooner we can deliver a new standard of care for patients.
1. Newman EA, et al. Cancer. 2006;107:2346-2351