The new SPOT SprintPic turnkey macro imaging system makes it effortless to capture great images, increasing efficiency and saving photography time.   Including a scientific grade digital camera with a software-controlled motorized zoom lens on a lighted copy stand, the SprintPic system is preconfigured and ready to use so you can get up and running quickly.  Its large number of zoom levels accommodates a wide range of samples, from industrial parts to crime scene evidence to pathology grossing sections.  The SprintPic Software provides a monitor-sized live image preview with sliders for adjusting zoom level and iris aperture, so it’s easy to see when your sample is ready for capture.  Crosshair and grid reticles can be applied to the live preview to aid in counting or for visual inspection of part size.  When you snap a photo, it is immediately ready for adding annotations, measurements, or for saving to reports - no need to wait for images to download.   Images can be automatically transferred to laboratory information systems or saved to network file servers for archival.  Built-in high-output oblique and bottom lighting ensures true color reproduction and shadow removal.  The SprintPic macro imaging system takes the guesswork out of digital documentation.

SPOT Imaging Solutions

http://www.spotimaging.com/sprintpic

586-731-6000

Visiopharm A/S, a global leader in Quantitative Digital Pathology, announced today release of its novel CE-IVD module HER2-CONNECT for assessing Her2 status in breast cancer patients

Without any requirements for manual outlining of tumor cells, the level of automation is very high.

In summary, HER2-CONNECT™ showed 94% agreement with manual scoring and 95% diagnostic sensitivity and 99% diagnostic specificity.

Hoersholm, Denmark (PRWEB) August 07, 2012

As the first in a series of innovative CE-IVD diagnostic modules for cancer, Visiopharm is now releasing the HER2-CONNECT™ module in Europe for assessment of Her2 status in breast cancer patients.

In close collaboration with the NordiQC, the clinical performance of HER2-CONNECT has been determined by three studies comprising 796 tissue specimens prepared from breast carcinomas from 222 patients, using 6 expert reviewers/pathologists and representing 178 clinical pathology laboratories using DAKO, Roche-Ventana, Leica-Bond, and other HER2 IHC reagents. In summary, HER2-CONNECT™ showed 94% agreement with manual scoring and 95% diagnostic sensitivity and 99% diagnostic specificity.

Without any requirements for manual outlining of tumor cells, the level of automation is very high. Automation is achieved using a novel and patent pending principle of membrane connectivity for membranes detected in the tissue under examination [1,2 ].

Professor Mogens Vyberg, Director of the NordiQC, states: “Three requirements must be met in order for Digital Pathology to be useful in a routine diagnostic setting: It must be independent of reagent manufacturer and based on optimized and standardized staining procedures, exhibit high diagnostic performance in terms of sensitivity and specificity, and finally it must provide a high degree of automation. Our studies, of which some are still under preparation for publication, have demonstrated that the HER2-CONNECT™ module meet those requirements”.

"This is our first CE-IVD module in a series of modules coming out of our development pipeline. In our development, we are focusing on robustness, diagnostic quality, and last but not least automation. The critical step here is clinical validation and technical documentation. Visiopharm has invested significant resources in establishing the internal procedures and a quality system allowing us to develop, validate, and release CE-IVD modules for diagnostics in Europe", adds Johan Doré, CTO and co-founder of Visiopharm.

“We have now established the necessary platforms for rapid development of new image analysis algorithms and for providing comprehensive technical and clinical documentation. This will allow us to further accelerate an ambitious development program for new innovative techniques in diagnostics and companion diagnostics. We are doing that in collaboration with what we consider to be world-leaders in quality- and evidence based pathology”, says Michael Grunkin, CEO and co-founder of Visiopharm.

1. Brügmann, A., Eld, M., Lelkaitis, G., Nielsen, S., Grunkin, M., Hansen, J.D., Foged, N.T. & Vyberg, M., Digital image analysis of membrane connectivity is a robust measure of HER2 immunostains. Breast Cancer Res Treat. 2012; 132:41-9. 
2. Laurinaviciene, A., Dasevicius, D., Ostapenko, V., Jarmalaite, S., Lazutka, J. & Laurinavicius, A. Membrane connectivity estimated by digital image analysis of HER2 immunohistochemistry is concordant with visual scoring and fluorescence in situ hybridization results: algorithm evaluation on breast cancer tissue microarrays. Diagn Pathol, 2011, Vol. 6, pp. 87. 

According to the The Pathology Blawg this matter I first talked about in October 2010 has been settled by Mayo Clinic for $1.26 million.

Suit Alleges Mayo Overbilled for Pathology Services, Justice Department Joins Suit (Originally posted October 2010)

The below news item has been circulating for a couple of weeks following a suit originally filed about 3 years ago.  Several folks have asked me what I know about this.  

Did Mayo intentionally defraud the government of potentially millions of dollars for frozen sections not performed?

It is a difficult question to answer and I really do not know how strong the lawsuit claim is. 

I do not think Mayo intentionally would do this but it is a complicated issue.

The story actually begins about 100 years ago when Dr. Louis B. Wilson, credited with being the Father of Research at Mayo Clinic, developed the first techniques to rapidly fix tissue for sectioning during surgery at the request of Dr. William Mayo or what we recognize in pathology as the "frozen section". His techniques live on at Mayo today much like they did over 100 years ago.  The history of the procedure has recently been reviewed with reference to the original article by Dr. Wilson.

• Gal AA. The centennial anniversary of the frozen section technique at the Mayo Clinic. Arch Pathol Lab Med. 2005 Dec;129(12):1532-5.
• Gal AA, Cagle PT. The 100-year anniversary of the description of the frozen section procedure. JAMA 2005;294:3135-7.
• Wilson LB. A method for the rapid preparation of fresh tissues for the microscope. J Am Med Assoc 1905;45:1737.

Enough history.  Fast forward about 100 years and according to Mayo's GME FAQ's on the frozen section practice it mentions: "The frozen section rotation is probably best thought of as neither a frozen section rotation nor a general surgical pathology rotation, and perhaps that is why residents have come to refer to it as the “sink” rotation. The volume and variety of specimen material seen by residents while on the sink is comparable to what would be seen during a general surgical pathology rotation at a large medical center, yet the workflow is that of a frozen section laboratory. " The site goes on to mention " In the Mayo frozen section labs, a single-color toluidine stain is used because it produces a fast and easily readable stain. The toluidine blue stain produces a slightly different staining pattern compared to H&E, but the morphologic features are inherent to the tissue."

I never understood "morphologic features are inherent to the tissue".  Histology is artifact.  We create it with dyes - a chemical process creates purple nuclei and pink cytoplasm.  In the case of toluidine blue stain, as above, it is largely monochromatic with less contrast than traditional H&E stains, whether frozen or fixed.  

Until recently, with increasing pressure from CAP inspectors, slides reviewed at frozen may not have had a corresponding H&E permanent slide to review for frozen-final correlation.  The tissue used in the frozen section was "blocked" without making an H&E slide.  Again, the practice is unique and would be difficult to validate in many other labs if one takes an objective view.

It also turns out that given the water based nature of the stain and the stain itself it was difficult to make a "permanent" slide for later review as the stain may continue to permeate the tissue.

Given the unique practice, essentially a general surgical pathology practice with final diagnosis made on frozens at the time of surgery rather than "permanent" sections,  issues related to frozen section slides, blocks and permanent slides could all potentially complicate billing algorithms as the suit alleges.  

While the parties bringing forth the suit and the Justice Department are looking at the letter of the law, a persistent question will remain whether whatever may have happened here in regards to billing was justifiable (i.e. cost effective) given potential lack of need for second surgeries, immediate intraoperative staging and overall costs to the system for additional laboratory technical and professional resources to generate additional slides, reviews and reports as compared to outcomes in a "frozen section = final diagnosis" practice alone.  This practice is highlighted on Mayo's breast cancer website:

"Mayo Clinic physicians may use frozen section evaluation of tissue during breast cancer surgery to determine whether all of the cancer has been removed. Mayo Clinic's unique frozen section pathology laboratory provides rapid, accurate microscopic analysis of tissue while the patient is in surgery. Mayo surgeons know if they have achieved negative margins (removed all the cancer) while the patient is still in the operating room. Frozen section analysis may prevent the need for patients to undergo additional surgery."

It should be noted from a similar story out of Minneapolis -- "The Justice Departmentindicated in a September 21 court filing that it intends to intervene in the allegation that the Mayo Clinic billed for services that were not performed. The department will not become involved, however, in the claims that the Mayo Clinic improperly obtained laboratory accreditation and failed to retain histopathology slides for the appropriate time period.

Courtesy of genomeweb.com:

The Justice Department has joined a lawsuit against the Mayo Clinic alleging it submitted fraudulent claims to Medicare and Medicaid for thousands of surgical pathology tests over 10 years that its labs never performed.

The government's position, filed this week under the federal False Claims Act in a US District Court in Minneapolis, said that "over the course of the last 10 years, Mayo has routinely billed Medicare, Medicaid and other federally sponsored health care programs for surgical pathology services that have not been performed," according to the Pittsburgh Tribune-Review.

The suit, which was originally filed in November 2007 by attorney and neurologist David Ketroser, accuses Mayo of billing Medicare for permanent specimen slides and for examining the slides, "even though no slides were prepared or examined," the paper says. "Instead, the suit charges, Mayo routinely prepared only frozen section slides, which were not retained."

The suit also claims Mayo failed to comply with federal regulations that require clinical lab to retain pathology slides for 10 years.

The plaintiffs in the suit include former Mayo patients, survivors of deceased Mayo patients, and Minnesota attorney David Ketroser.

Mayo officials did not respond to a request for comment, according to the Tribune-Review.

A few days after its original report, the paper wrote that Mayo officials said the Clinic reimbursed the government for what the paper called "billing errors" on the pathology tests.

Mayo spokesman Bryan Anderson said Minnesota-based Mayo discovered the errors three years ago — "long before Mayo became aware that the sealed complaint [against it] had been filed" — and "voluntarily" refunded $242,711, the paper said.

The total amount of Mayo's alleged fraudulent billing was not immediately clear.

Courtesy of DarkDaily:

23andMe executives want the credibility that FDA clearance provides for its DNA tests and declared their intent to eventually support more clinical laboratory test applications

Offering genetic tests directly to consumers is a controversial subject among some pathologists and healthcare ethics experts, who question both the science of these tests and whether consumers will do the right thing with the information.

Read more from the source.

August 3, 2012 | By Susan D. Hall FierceHealthIT

Researchers claimed success using an SAS-based natural-language processing (NLP) tool to detect breast and prostate cancers from pathology reports, according to a study published this week in the Journal of the American Medical Informatics Association.

Results from the SAS-based coding, extraction, and nomenclature tool (SCENT) were compared with a random sample of 400 breast and 400 prostate cancer patients diagnosed at Kaiser Permanente Southern California whose results were classified manually.

SCENT successfully identified 51 of 54 primary and 60 of 61 recurrent cancers. It flagged only three false positives from 793 known benign results. Measures of sensitivity, specificity, positive predictive value, and negative predictive value exceeded 94 percent in both cancer groups.

White Paper: Improving Patient Outcomes Through a More Effective Electronic Medical Record

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Using Electronic Medical Records (EMR) instead of paper files has the potential to improve care for patients by boosting communication. Despite positive results related to EMR usage, questions remain. How can physician practices best use EMRs to focus business and clinical operations, improve outcomes and engage patients in healthcare decision making? Learn more.

The authors noted that previous research has found natural language processing tools useful in coding and extracting information from clinical text. Indeed a recent paper published in Radiology cited success with a tool to parse data from records to build a repository of data to improve dosing recommendations.

They attributed the slow rate of adoption, however, to difficulty in integration with clinical data systems, technical complexity, and habitual use of medical claims data.

Creating a common dictionary of terms can be painstaking work as illustrated in a study on the use of NLP in breast cancer research published recently in theJournal of Pathology Informatics. It reported 124 ways of saying "invasive ductal carcinoma" and 95 ways of saying "invasive lobular carcinoma" and more than 4,000 ways of saying invasive ductal carcinoma was not present.

The authors noted the system probably would require tweaking to work with clinical text in other medical areas and outside of Kaiser Permanente, but the system "has the potential to provide significant value to clinical and epidemiologic researchers, particularly when statistical NLP is infeasible due to resource or other constraints."

A second article on natural language processing in JAMIA found the technology effective for de-identifying clinical health data for research, promising relief from the tedium of manually coding records from which personal information had been scrubbed.

While much data for research remains outside machine-readable formats, platforms enabling comparative-effectiveness research too often lack natural- language processing capabilities, according to a Medical Care study.

To learn more:
- read the research
- check out the Journal of Pathology Informatics study

Related Articles:
Studies show data mining's promise for radiology dose monitoring
Natural-language processing effective for de-identifying clinical health data
Platforms for comparative effectiveness research still evolving

Read more: Natural-language processing tool flags breast, prostate cancer - FierceHealthIT http://www.fiercehealthit.com/story/natural-language-processing-tool-flags-breast-prostate-cancer/2012-08-03#ixzz22jOsB2kk 

Subscribe: http://www.fiercehealthit.com/signup?sourceform=Viral-Tynt-FierceHealthIT-FierceHealthIT

Came across this as a CAP Today commercial message from Cleveland Clinic entitled "Diagnose Patients Faster with Cleveland Clinic Labs"

eIHC solutions similar to Clarient it appears with Ventana images and Aperio scanning platform
Additional Materials  eIHC Brochure  AP Special Stains  IHC Requisition Leveraging Digital Image Technology for Rapid Interpretation of Immunohistochemical (IHC) Stained Slides Incorporating technological advances in digital imaging (eSlides) enhances research, education, and patient care across the street and around the world. Cleveland Clinic Laboratories now offers web-based eSlides of IHC-stained slides to help optimize clinical workflow for IHC. In collaboration with Aperio, a provider and global leader of ePathology Solutions, a secure internet site provides access for clients to read immunohistochemically stained eSlides on a computer monitor anytime, anywhere. When a case is opened, all case, specimen and slide information, as well as controls are conveniently at your fingertips. The service provides access to eSlide conferencing and secure messaging allowing the pathology community to engage in dialog and exchange information. The opportunity to view stained eSlides within 24 hours after the blocks arrive at Cleveland Clinic may help clients follow a staining algorithm rather than requesting batches of stains, some of which may ultimately be unnecessary. For more information, please contact: Cleveland Clinic Laboratories Client Services 216.444.5755 or 800.628.6816 (toll-free) ClientServices@ccf.org

A new analysis has found that doing away with PSA (prostate specific antigen) testing for prostate cancer would likely cause three times as many men to develop advanced disease that has spread to other parts of the body before being diagnosed. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the study suggests that PSAtesting and early detection may prevent approximately 17,000 men each year from having such advanced prostate cancer at diagnosis.

PSA testing has come under fire recently as a potentially ineffective screen for prostate cancer. Last year a government panel reviewed the available evidence and concluded that PSAtesting has little or no benefit and that doctors are finding and treating non-aggressive cancers that are not likely to cause symptoms or be lethal. Therefore, many men may be experiencing serious treatment side effects such as incontinence and erectile dysfunction for no reason.

To see what might happen if PSA testing were abandoned, Edward Messing, MD, of the University of Rochester Medical Center, and his team looked at information from the years immediately before routine PSA testing was done (1983-1985) and compared it to the current era of widespread PSA testing (2006 to 2008). The information for the analysis came from the nation’s largest cancer registry, the Surveillance, Epidemiology, and End Results (SEER) database. The researchers were particularly interested in the records of patients who had advanced prostate cancer that had already spread to other parts of the body at the time of diagnosis. These cases are generally incurable and always cause significant symptoms very quickly if left untreated.

The investigators found that approximately 8,000 cases of prostate cancer had already spread to distant sites (i.e. – metastases) at the time of diagnosis in the United States in 2008 (the most recent SEER year). Next, they designed a mathematical model that used pre-PSA incidence rates of metastatic disease from the mid-1980s to estimate the number of such advanced cases that would be expected to occur in 2008 if PSA screening had not been done. They predicted the number would be approximately 25,000, which is about three times greater than the number actually observed.

“Our findings are very important in light of the recent controversy over PSA testing,” said Dr. Messing. “Although there are trade-offs associated with the PSA test and many factors influence the disease outcome, our data clearly indicate that not doing the PSA test will result in many more men presenting with far advanced prostate cancer. Almost all men with clinically apparent metastases at initial diagnosis will die from prostate cancer,” he added.

Prostate cancer is the second leading cause of cancer death in the male population. In 2012 an estimated 241,740 new cases will be diagnosed and 28,000 deaths will occur. Prognosis depends on whether the cancer has spread, and the degree to which the cancer cells are abnormal.

Roper Industries Buys Sunquest for $1.4B, Reports 8% Leap in 2Q Profit
 

After reporting stronger year-over-year quarterly earnings, Roper Industries (ROP: 99.45, -0.19, -0.19%) said it is buying privately-held diagnostic and laboratory software maker Sunquest Information Systems for $1.4 billion in cash.

The Sarasota, Fla.-based medical and scientific imaging software developer said the acquisition of Tucson, Okla.-based Sunquest, a leader in labs software, will help its medical software platforms benefit from an aging population and expansion of anatomic pathology.

"We continue to transform the enterprise with the addition of Sunquest," Roper CEO Brian Jellison said in a statement. “We expect Sunquest to benefit in all economic environments from very favorable market forces.”

Sunquest and its products will continue to operate under current brand names. The deal, subject to customary closing conditions, is expected to close within 30 days.

Roper, meanwhile, reported on Monday net earnings of $115 million, or $1.15 a share, up 8% from a year ago. Revenue climbed 4% to $725 million, led by an 8% increase in orders to $763 million.

Analysts in a Thomson Reuters poll were looking for earnings of $1.15 a share on higher sales of $747 million.

"We achieved record second quarter revenue and earnings, as our businesses continued to execute well in the current uncertain economic environment,” Jellison said.

Shares of Roper ticked 7% higher Monday to a new all-time high

Read more: http://www.foxbusiness.com/industries/2012/07/30/roper-industries-buys-sunquest-for-14b-reports-8-leap-in-2q-profit/#ixzz22Ffklq6Z

(Reuters) Jul 23 - A former lab technician faces charges in connection with a hepatitis C outbreak that reportedly infected dozens of patients at a New Hampshire hospital, authorities said.

David Michael Kwiatkowski, 32, is charged with obtaining controlled substances by fraud and tampering with a consumer product, U.S. Attorney John P. Kacavas said this week.

The outbreak at the Exeter Hospital Cardiac Catheterization Unit is believed to have infected some 30 people with the disease, considered the most serious of hepatitis strains, authorities said. Hepatitis C can lead to liver cancer and cirrhosis, and kills more people each year than HIV, according to the Centers for Disease Control and Prevention.

"The evidence gathered to date points irrefutably to Kwiatkowski as the source of the hepatitis C outbreak at Exeter Hospital," Kacavas said. "With his arrest, we have eliminated the menace this 'serial infector' posed to public health and safety."

Kwiatkowski, who worked in the lab until the investigation launched in May, has hepatitis C and is accused of stealing syringes of the pain medication Fentanyl intended for patients. Authorities say he would then inject himself with the drug, then replace it in the tainted syringe with saline solution, which would then be injected into the patient, Kacavas said.

The investigation included testing some 1,100 patients from as far back as October 2010 before Kwiatkowski was identified as a suspect.

"It is deeply disturbing that the alleged callous acts of one individual can have such an impact on so many innocent lives. As a result of his alleged actions, people in our community, who in many cases are the friends and neighbors of the 2,300 people who work here, now face the challenge of a potentially chronic disease," said Kevin Callahan, President and CEO of Exeter Hospital.

Kwiatkowski worked at the hospital in Exeter, New Hampshire, since April 2011 and had been diagnosed with hepatitis C for a year before that, according to a statement by the U.S. Attorney's Office in New Hampshire.

Originally from Michigan, Kwiatkowski worked as a traveling contract medical technician in six other states, which has prompted CDC officials and the U.S. Attorney's office to check into potential public health threats in those states.

Kwiatkowski was arrested on Thursday at a hospital in Massachusetts, where he was being treated for an undisclosed illness. He was expected to be taken into federal custody in New Hampshire upon his discharge from the hospital, authorities said.

The tampering charge carries a 20-year prison sentence, and the controlled substance charge carries up to four years.

Hepatitis C afflicts more than 4 million Americans. Up to 85% will develop chronic infection. Of those, 75% will get chronic liver disease, according to the National Institutes of Health.

I received some feedback, e-mails, questions, comment and death threats about my recent posting entitled  "94% of Pathologists Agree Digital Pathology Will Become Common Practice"

One in particular I have extracted from a LinkedIn message board in response to my feed to the group. If you are a member of this particular group you may have seen this.  If not, to protect the innocent, I will leave the respondents name anonymous. His comments are in plain text with my opinion in italics and/or bold. 

"This is a very interesting, yet misleading headline.
This is not one-size-fits all.
I think that when one reads this headline, it is our impression that digital pathology will replace the standard microscope and H&E slides. Not a chance, in my opinion, in the next few years. I have replied on this topic many times before. This is NOT, however, stating that digital pathology will not be adopted."

-- Of course the title is misleading.  And interesting. Not as misleading as "Dewey Defeats Truman", "Mission Accomplished" or "New Coke Better Than Old Coke" but I appreciate you calling my little blog post title a "Headline" nonetheless.  Trying to promote content here so I used this title as opposed to "6% of those surveyed say chances of digital pathology adoption equal to Cubs chances of winning the World Series (NEVER)".  After Steve Bartman I may lose some friends on da North Side. Anyways, you read the piece and commented so the headline had some attraction which is what a blogger needs - catch those 2 or 3 minutes out of your day to read what I write among all the other things you want and have to do including reading legitimate news sources.

If the headline read "Digital Pathology to Replace Microscope in 10 years" that might be misleading and completely inaccurate, in my opinion.  I actually think it will become part of common practice but not replace common practice.  Perhaps 20 or 40% of work will integrate or involve digital pathology but not selling my stock in wax, glass or microscope companies just yet so I think we can agree on this.

"One has to look at the APPLICATION of digital pathology. Let's look first at routine pathology. Digital is a LONG way off. Why?....here are some thoughts.
1. It can't compete with routine H&E for in expense. Digitizing slides just adds expense.
2. Digital can't replace the routine H&E. The slide still has to be produced. (unlike radiology which eliminated the need for film)
3. The "look and feel" of a slide still has not been replicated by digital.
4. It's still more reliable to store a physical glass slide for 10 years than a digital file.
5. I still can look at an H&E slide with a microscope that uses a mirror for illumination, and it won't take any power to run a computer (the ULTIMATE green solution)."

-- I agree with many points made here.  Scanning adds costs.  A nickel H&E may result in a 90 cent image that has to be acquired, labelled, archived, stored, backed up and eventually perhaps disposed of.  Have made this argument before - unlike radiology which starts with digital CT and MR images that initially were printed on pieces of plastic for viewing on light boxes and "hot lamps" analagous to those used by Roentgen himself, pathology, tissue, histology is well founded in physical analogs as mentioned above in terms of wax, glass and stain after the tissue have been collected, heated, cooled, baked, fried and stained.  The cost issue I think does go out the window a bit if we speak to the points you make below about looking at something 1000 miles away.  This helps costs:benefit ratio business case argument.  More below on this.

-- "Look and feel" best used by interior decorators, not physicians.  As far as imaging is concerned, Kodak use to make film, lots of film and now they don't and they are still bankrupt.  I still try to shoot some hobby photos with film.  Takes weeks to get it ordered and longer to get it developed.  Have to send to Atlanta.  Nearest place from Charlotte to send film to be developed.  Doesn't anyone use 110 or 35 mm anymore? Anyways, look and feel overrated and this will be improved.  I like the grainy nature too of good old black and white film and a long f/stop but I can do some much more with digital.

-- And this is the analogy (no pun intended), like radiology, we are going to see so many more deliverables with digital, just as radiology has with 3D imaging and the like that we can do with 2-dimensional pink and blue stained images (or bichrome IHCs).  

-- "Slide storage" and "reliable" are not usually words I put in the same sentence.  Take the case from last week the patient wants sent to a medical school pathology department and the slides "are not in file".  Or the slides are in the file room, but misfiled.  Or the slides are not filed.  Granted, most of the time it works.  Digital would be no less reliable, perhaps more secure and perhaps most importantly, not only stored, but sharable, to your points below.  Rent and expense of slide file room versus 100 TB of server space in terms of costs over 3 or 5 years?  With wind and solar energy running the factories and powering our homes and businesses, costs of either would be very low.

"Now....for specialty uses....Digital beats glass...

1. Send an image a 1000 miles away for a consultation.
2. Send an image of an IHC or FISH for analysis from a 1000 miles away.
3. any permutation of the above."

 --  Could not agree more. One of the two most tangible ROIs for digital pathology, today, remain, tele-pathology, tele-consultation, tele-IHC, virtual consultation, virtual IHC, tele-peer review, tele-whatever, remote screen share, image host, same slide, same time.  No substitute for this in medicine and pathology.  And with Pathology 2.0 - the power of the cloud to harness collective intelligence.  The other tangible use case/application for digital pathology is image analysis.  FDA cleared algorithms and CPT codes for reimbursement.

"There are also some other applications that simply cannot be done on an old H&E slide that is easy with digital (if there are any companies out there interested...let me know). At this point, they will remain un-published."

-- When the times comes I welcome you to publish your thoughts here.

"Let me know where you think I am going wrong. I would like to hear your thoughts..."

-- Thanks for the thoughtful comments and dialogue.

In the mid-1960s, a new slogan was introduced for Trident: "4 out of 5 dentists surveyed would recommend sugarless gum to their patients who chew gum." The phrase is believed to have been based on the results of a survey of practicing dentists with either D.D.S. or D.M.D. degrees, apparently conducted in the early 1960s, whose patients included frequent users of chewing gums; the percentage of respondents to the survey whose responses indicated they would make such references to their patients is believed to have been approximately 80%, rounded off to the nearest full percentage point, of the total number of respondents. It became strongly associated with the Trident brand. As of the last days of May 2010, however, Kraft Foods's Cadbury Adams group was not known to have made any public disclosures of any details about the survey, presumably citing the proprietary nature of the survey data and conclusions as its rationale.

Anyways, didn't you ever wonder who that 1 in 5 or 20% of dentists did not recommend Trident gum to their patients who chew gum?  

Now comes real data from real pathologists in a wide variety of practice settings courtesy of Laboratory Economics recent Digital Pathology Survey Summary.

A survey was e-mailed to approximately 5,000 hospital labs, independent labs and pathology groups this month.  A total of 174 surveys were judged usable, yielding a rate of 3.5%. Survey participants included 58 hospital labs, 18 academic medical centers, 52 independent labs, 14 esoteric reference labs and 32 pathology groups.

31% of respondents claim having a digital pathology system in place with another 20% claiming adding a system within 2 years.  Aperio has a 44% share with Ventana representing 29% of users and 27% claiming "Other". (Click on images to enlarge)

The main uses for digital pathology cited included HER2 scoring, education/training, second opinions/consultations, ER/PR scoring, primary clinical diagnosis, archiving specimens, clinical trials and autopsies.

Note the 20% (with multiple answers allowed by respondents) for Primary clinical diagnosis. A full 1 in 5 current users claim, among other uses, primary clinical diagnosis.  Bravo.  

Reasons respondents cited for lack of adoption and barriers to adoption included cost, microscope meets needs, data/storage concerns, speed, LIS integration (or perhaps lack thereof), reimbursement, limited test menu and time/patience to learn.  Not much new here.  Answers would have been identical 10 years ago. (Click on images to enlarge)

Last, but not least, when asked when will digital pathology become mainstream, specifically "How long before it becomes common practice for primary diagnosis of cancer?" 61% of respondents thought it would be within 10 years.  Another third thinks it will take more than 10 years.  Only 6% think Never.  

Mixed news here.  10 years ago people were saying "10 years" and nearly 2/3 of those people who responded to this survey who are using an Aperio or Ventana already or another system for HER2, ER/PR, education/training/archiving, consults or primary readers, by any account - adopters are thinking 5-10 years for "common practice" and another 33% think longer than that.

I guess I am in the minority if I chose less than 5 years as a pure percentage of repsondents.  The question did not tackle specific use cases but I think 5 years is an easily attainable number for a large number of hospitals, laboratories and groups to adopt the technology with tangible ROI for certain uses, tests or applications.  (Click on image to enlarge)

Someday I think we will wonder who these 6% of pathologists/laboratorians were...

Source (and thanks to): Laboratory Economics for permission to reuse survey information and graphs/images.

For as long as I can remember I have done the quarterly performance improvement program in surgical pathology offered by CAP.

Essentially, the surgical pathology committee puts together an offering composed of 10 cases with questions, summaries and of course answers to the questions to test your knowledge.  

The slides are mailed during regular intervals, you review the slides, take the self-tests and review the write-ups and answers.

Attempts have been made over the years to convert all or parts of this highly analog experience to digital.  

At one time I recall getting a CD with some whole slide images for a set of cases.  I do not think this was marketable and most members did not support.  While perhaps less expensive to scan 10 slides each set than recuts dozens or hundreds and review for consistency, they did not take off back then.

Increasingly with the CAP Case of the Month I often highlight on this site as well as with their PIP program, whole slide imaging is increasingly used.

This last set offered Case 10 as a digital slide with questions/answers.  

Fantastic images, highly navigable, fast image refresh and view, zoom and focus speeds second to none.

And I got the right answer by looking at the image!

When will the entire PIP program be this good and fast?

With the knowledge that major changes in healthcare are hovering just over horizon, one of the “fixes” to what is “broken” in our current system is the prospect of Accountable Care Organizations (ACOs)—organizations of providers that can potentially improve the way medicine is practiced and reduce costs.

In an effort to stay abreast of the healthcare changes, Orchard Software has put together some information to share on ACOs, including what they are and how they may impact the laboratory. There are five parts with the first three being ACOs 101, Measures and Meaningful Use, and Three Types of Accountable Care Organizations. Each part has its own focus and by the end of the series the reader will have a foundation for constructive conversation about ACOs.

The first part is called ACOs 101 due to its focus on the basics of ACOs. After reading this post, a reader should under- stand what an ACO is by definition and the three core principles that define all ACOs. The post also gives a history of how of the ACO movement started. Finally, ACOs 101 shares the requirements to become an ACO and what processes an ACO must define.

In the second part, Measures and Meaningful Use, the post introduces the 33 measures in the Final Rule on ACOs published by the Centers for Medicare and Medicaid Services. The post gives several examples of the four domains, which are patient experience, care coordination, preventive health, and at-risk population/chronic care. The post also shares how the ACO movement and Meaningful Use measures overlap.

In the third post regarding The Three Types of ACOs, the three models of ACOs are highlighted, which are the Medicare Shared Savings Program, Advance Payment Model, and Pioneer ACOs. Each model has its own benefits and advantages depending on a facility’s risk desire and immediate participation in the ACO movement.

This post was also released on the day that the Supreme Court upheld the Affordable Care Act. With this ruling, many of the ACO initiatives remain unchanged.

Check out the full blog at http://www.orchardsoft.com/blog and stay up to date on my issues impacting the laboratory industry.

Published: Monday, July 23, 2012, 9:00 AM

 By Jeff Hansen -- The Birmingham News