BIDMC Pathology Grand Rounds: Building a Center for Precision Diagnostics Driven by Expert Pathologists and AI

Michael Laposata, MD, PhD, professor and chair of the Pathology Department at University of Texas Medical Branch (UTMB), and adjunct professor at the School of Health Professions, Galveston, Texas, presented Building a diagnostic center for all healthcare in America, at the Dec. 5 Grand Rounds, sponsored by the Department of Pathology at Beth Israel Deaconess Medical Center (BIDMC). Given that there are more than 10,000 available diagnostic tests, Laposata has focused most of his career on improving patient access to quick and accurate diagnoses.

“Patients all undergo laboratory testing, and often think their doctors know all the laboratory tests,” said Laposata. However, lack of medical school training in test selection and result interpretation, coupled with the challenge of keeping up with medical literature, creates knowledge gaps that can lead to diagnostic error. “The largest contributor to preventable death from medical error is diagnostic error, not procedural or pharmaceutical error,” he said. The National Academy of Medicine estimates that there are more than 60,000 of these preventable deaths in the US annually.

Clinical laboratory leaders, anatomic pathologists, and radiologists, have an opportunity to fill this knowledge gap and cross what he called the “divide in medicine” between diagnostic experts and treatment experts.

While Laposata has piloted versions of a Diagnostic Center at previous institutions, a recent donation helped launch the John Sealy Diagnostic Center at UTMB (the Center), which consists of a team of pathologists and experts in informatics, genetics, regulatory matters, and billing. The Center provides physicians with expert test interpretation by pathologists and laboratory physicians that is patient-specific, automated for fast delivery, and includes recommendations that physicians can use to tailor treatment to each patient.

How does the Center do this? They have created a knowledge base combining the strengths of pathologists’ expertise and AI. They define the disease scope, create a structure of the information for AI and humans, populate the knowledge base, and integrate a large language model. When they enter patient details, the knowledge base quickly interprets results and outputs a likely diagnosis and what tests to run for the patient. Laposata and his team have tested and validated about 500 diagnoses to date. They continue to add diagnoses, and update and refine the knowledge, using new literature and medical advances.

Having thought of this idea 30 years ago, Laposata concludes “now all the pieces are in place for this work to have a significant impact on patient care and healthcare delivery.”

Michael H. Roehrl, MD, PhD, MBA, Chair of BIDMC Pathology, says: “Pathologists are the expert physicians who perform and interpret increasingly complex multi-parameter diagnostic testing that directly determine patient care. Dr. Laposata’s excellent talk fully embodies BIDMC Pathology’s vision for BIDMC Precision Diagnostics that leverages both our world-class subspecialized diagnostic physician faculty in Pathology and cutting-edge technologies such as multi-omics and artificial intelligence.”

The BIDMC Department of Pathology is hiring pathologists in all areas. Learn more about joining Harvard Medical Faculty physicians, view jobs, and apply.