Marshall Makate, Oliver Waters, David Lim, James H Boyd, Suzanne Robinson
A comprehensive, longitudinal pathology platform was feasible to deploy and was associated with earlier treatment, more efficient workflows, lower costs, and less redundant testing. These benefits were more evident in specialist practice than in general practice, where the sample was small.Implications for health information management and practice:Interoperability delivers value only when clinicians can find, trust, and act on diagnostic data during a consultation. Storing results as discrete, searchable data points, rather than static documents, lets clinicians track trends and avoid duplicate tests. Delivering this at scale will require automated data exchange with providers and agreements that support clinically appropriate ordering.
BACKGROUND: In Australia, a patient's pathology results are held in separate provider systems, so clinicians often cannot see a full testing history during a consultation, which delays decisions and drives unnecessary repeat testing. Point-of-care access to a complete pathology record has been proposed as a remedy, but its feasibility and effect in routine outpatient practice remain poorly established.
OBJECTIVE: To evaluate whether point-of-care access to a patient's complete pathology history is feasible and whether it improves the efficiency of outpatient care and lowers costs.
METHOD: We piloted myPathology, a cloud-based application that integrates atomic pathology results from all major Western Australian providers from 2005 onward, across 4 outpatient settings over 12 months. Outcomes were assessed through clinician surveys, Medicare Benefits Schedule expenditure records, and an audit of tests normally performed once or rarely repeated. Changes in pathology spending were assessed using interrupted time series analysis.
RESULTS: All 21 participating doctors (3 general practitioners and 18 specialist physicians) used the application throughout and reported more efficient workflows. Specialist physicians saved an average of 16 minutes and ordered 8.3 fewer tests per clinic session, and 13 of 18 (72%) reported starting treatment earlier. Outpatient pathology spending fell by about 66%, equivalent to AUD 201,685. The time series analysis showed an immediate fall in spending (change in level, β = -0.473, p < 0.05) and a continued downward trend (change in trend, β = -0.132, p < 0.01). Unnecessary repeats of once-only tests accounted for 37.8% of the cost of those tests (AUD 41,781).
CONCLUSION: A comprehensive, longitudinal pathology platform was feasible to deploy and was associated with earlier treatment, more efficient workflows, lower costs, and less redundant testing. These benefits were more evident in specialist practice than in general practice, where the sample was small.Implications for health information management and practice:Interoperability delivers value only when clinicians can find, trust, and act on diagnostic data during a consultation. Storing results as discrete, searchable data points, rather than static documents, lets clinicians track trends and avoid duplicate tests. Delivering this at scale will require automated data exchange with providers and agreements that support clinically appropriate ordering.