As long as it’s not the Assassin chip….

Philip

From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Reynolds Tim (RJF) BHFT
Sent: 06 February 2013 09:55
To: [log in to unmask]
Subject: Re: "A Step Forward In The Transformation Of Pathology Services"

The compassion chip will be enforced as a design criterion [although it will probably be called the Assisi chip as a result of terminology confusion].

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Prof. Tim Reynolds
Consultant Chemical Pathologist / Associate Clinical Director - Diagnostics / R&D Lead,
Burton Hospitals NHS Foundation Trust
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From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Mike Toop
Sent: 06 February 2013 9:42 AM
To: [log in to unmask]
Subject: Re: "A Step Forward In The Transformation Of Pathology Services"

I am sure you are right Tim. Once the algorithms have learnt to be caring, compassionate, and interested in the well-being of human beings. The nearest thing I’ve seen for that is the holographic Doctor on Star Trek Voyager.

http://en.wikipedia.org/wiki/Doctor_(Star_Trek:_Voyager). Perhaps you should start designing him? J.

From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Reynolds Tim (RJF) BHFT
Sent: 06 February 2013 09:18
To: [log in to unmask]
Subject: Re: "A Step Forward In The Transformation Of Pathology Services"

It's not just pathology which is one of the last unregulated / unstandardised industries. The whole of medical care comes into that category. Once the power of the artisan doctors is codified into computer algorithms the cost of health care [or at least the medical bit] will plummet because we will no longer need highly trained individuals...

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From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Mike Toop
Sent: 02 February 2013 5:24 PM
To: [log in to unmask]
Subject: Re: "A Step Forward In The Transformation Of Pathology Services"

I have read this thread with some interest. With nearly years post retirement study of politics and economics and in my new incarnation as a non-executive director for an acute hospital trust, I can see this issue from a number of angles.

In this post I will stick to the industry structure of analytical (not interpretative) pathology and look at it form a microeconomic viewpoint. Whilst it gives no solutions it helps explain what is happening

Pathology is not a single service or even discipline. Its divisions into disciplines are historical, conceptual and academic rather than scientific or economic.

This heterogeneity od service leads to:

a). Different parts of the analytical service are at different parts of their industry life cycle. Thus genetics, POCT and parts of immunology are at the start of their life cycle. Many different tests and methodologies are being tried out, no real standards have yet emerged and economies of scale await standardisation.

Routine biochemistry and haematology testing are beginning to require standardisation, methodology is mature and economies of scale have become important and major developments are in production development and service delivery rather than product innovation. Other parts of pathology such as histopathology are mature, with little innovation in either product design or delivery.

b). Some parts of the service have large minimum economies of scale (MES) (the point at which production costs are at am minimum). For automated tests this is well above the size of the average acute unit. For POCT, acute work, and histopathology where throughput is due to the work of a single individual, the MES is small, well within the size of most provider units. tests in the early part of their development cycle. Test in development, or highly complex tests although not requiring large volume site, do require an academic and R&D function, most easily found in production units attached to universities.

If we look at the East of England tendering outcome we see that these two factors alone would explain how pathology has split with complex and development work gong to a university department, Volume, mature work going to a unit able to produce the necessary production to reach MES and work not able gain economies of scale.

The big losers here are small acute trusts. The implicit subsidy from volume work subsidising acute 24 hour services has gone. As an essential service, trusts will have to subsidise this service in the short term. The pressure to drive efficiency in this sector will however be enormous. As we have seen this service is not suitable for efficiencies scale of change so the current model providing it will face huge evolutionary pressure. That may be for on-call to be multi-disciplinary, POCT or other novel approaches.

In other industries, at this phase of development two things usually happen. Firstly the number of providers falls dramatically and secondly the industry adopts industry wide standards. Although the speed of change of these economic forces can be politically slowed, they cannot be resisted forever.

The development of interpretive services knowledge management and integrated care systems design is however a wide open and new field at the start of its product cycle, but thereby hangs another tale…

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