Earlier this year vRad and San Diego-based XIFIN (pronounced zy-fin) began closely collaborating on an online workflow that will offer referring physicians a one-stop fusion of all diagnostic reports—from radiology, pathology and clinical labs. This summer, the companies are integrating platforms in a proof-of-concept project involving oncologists and their patients.
The new iteration of consolidated diagnostic reports (CDR) will allow pathologists and radiologists to root out clinical discordance and enable faster, yet more precise diagnoses.
It also will meld the XIFIN ProNet integrated diagnostic platform, a LinkedIn for several hundred pathologists around the globe, with vRad’s patented PACS workflow infrastructure, which allows several hundred radiologists to view 1.3 billion images per year.
Pointing to CDR results achieved in smaller but significant studies at UCLA and the University of Kansas, David Byrd, XIFIN’s vice president of business development, notes that when radiologists and pathologists collaborate, patients get better, more efficient care—and so does the healthcare system as a whole.
“The whole shift from fee-for-service to value-based pricing is where this comes into play,” Byrd told Medical Imaging Review. “Right now medicine is very much siloed. And the foundation of healthcare is diagnostics. Radiologists and pathologists should be working hand-in-hand and collaborating for the benefit of their shared patients.”
The university studies he references show discordance between radiology readings and pathology reports on the same tissues may range from 20% to as much as 40%, he says. In one analysis, modifications were made to 33% of the original diagnoses for breast cancer.
“The University of Kansas pilot confirmed that radiologists working together with pathologists achieve significantly higher concordance scores, leading to greater diagnostic accuracy and better patient outcomes,” Byrd says. “So the whole goal of the vRad-XIFIN CDR is to tear down the silos in diagnostics. The technology is there between the two of us. We just need to leverage it.”
XIFIN, which launched a decade and a half ago as a cloud-based financial system for large diagnostic labs, expanded into the clinical side of lab two years ago when it acquired PathCentral, originator of the ProNet pathologist network. The next logical step was to get more involved with imaging, recalls Byrd, and vRad was an attractive partner not just for its sheer size but also its similarly minded vision for diagnostics.
“We also have a technology that, to our knowledge, no one else has,” says Byrd. “We haven’t found anyone else out there who can put a radiology image and a digital pathology whole-slide image side-by-side in a cloud based viewer.” What vRad brings to the table are the client base, scale and patented workflow to facilitate proof of concept.
Both companies are simultaneously collaborating with SyTrue, a healthcare data-refinement company based in Chico, Calif., that specializes in natural language processing (NLP) solutions.
“Once you have the radiology and pathology data combined, you can leverage NLP to sift through and highlight components of the consolidated diagnostic report, perform intelligent semantic searches to identify similar cases and therefore images,” Byrd explains. “This keeps the physician from having to manually search for unique cases or read through the entire case. The technology highlights the important areas of the CDR, such as critical findings for important reference points.”
Only the beginning
Given the obvious advantages of collaboration among medicine’s top two diagnostic specialties, one might expect to find pent-up demand for CDR solutions. But old habits die hard and turf battles persist, Byrd says. Meanwhile CMIOs are tied up with EHR implementation and compliance projects, among other pressing IT issues, making it difficult to register a new solution—even a highly effective and cost-efficient one—on their radar.
Even so, XIFIN has received a steady stream of inquires in the weeks since a joint announcement from XIFIN and vRad went out in late March. “Hospitals are pinging our website and requesting more information,” Byrd says. “So it is intriguing to the market. As with any other proof of concept, interest should take off once we have proven outcomes and demonstrable ROIs.”
If anything, Byrd may be understating his confidence in the potential appeal of the new CDR.
“We think the proof of concept will last for a short period of time. That should give us a good window to show better outcomes with physician collaboration through a consolidated diagnostic report versus without,” he says. “Further down the road we see next-generation sequencing playing into this, with cross-specialty solutions to compare and contrast DNA strands through our imaging technology. When you look at it from that perspective, the floodgates are wide open for improving outcomes while reducing costs.”
For now the focus is on proving the vRad-XIFIN concept and quantifying its capacity to help produce better outcomes.
“I think a lot of people may be thinking, ‘Oh cool—a consolidated diagnostic report. That’s really neat that you can combine the data with the images. Nice bell and whistle.’ But the intent of this is not so much to create a data driver,” Byrd says. “It’s to improve the quality of care for the patient.”
Byrd is grateful to the university medical centers that have started down the CDR path, lending solid academic credence to the proof of concept’s clinical and financial hypotheses.
“They’ve seen some small, incremental improvements that we can reference,” he says. “But again, I don’t think they have the bandwidth that companies like XIFIN and vRad have when it comes to moving diagnostic images and data. The big thing here is that both our entities truly believe that there needs to be collaboration” among, between and within diagnostic specialties.
Byrd is quick to note that the two are not alone in recognizing the need. He cites comments made by Jeffery Immelt, the CEO of GE, several years ago—something to the effect of placing a bet on the consolidation of diagnostics within U.S. healthcare. Sure enough, soon after, GE proceeded to purchase several major, multimillion-dollar labs.
“As big as GE is, they really don’t have the infrastructure for this that vRad and XIFIN have, especially in combination, and they’re going about it in a different way,” Byrd says. “Still, looking at it from a holistic standpoint, the interest shows that vendors involved in diagnostics truly see radiology and pathology and lab in the future collaborating very, very tightly—if not in fact consolidating, to some extent. To my mind, that’s the big picture here.
“We believe the vRad-XIFIN CDR is going to spearhead the consolidation of diagnostics,” Byrd concludes. “We intend to bring our collective technology and corresponding expertise to bear in order to bring together pathology, radiology and clinical lab. That’s our goal.”