Dr. Sylvia Asa (University Health Network, Toronto), Mr. Dirk Soenksen (Aperio, Vista, CA) and myself will address cultural and strategic barriers to adoption of digital pathology.  Each one of these webinar series sessions will be moderated by Robert McGonnagle, publisher of CAP Today.  

Having been a part of the discussion and getting a quick look and the other speakers' slide decks in advance of our session in a couple of weeks, think this is going to be a good series on what the challenges and barriers are in digital pathology adoption in the clinical space and some insights as to how to overcome them.  

Join us May 9 by registering below.

BARRIERS TO ADOPTION OF DIGITAL PATHOLOGY

REGISTRATION IS FREE. REGISTER TODAY.

The Digital Pathology Association (DPA) in partnership with the Association of Pathology Informatics and CAP Today will host a series of four, one-hour webinars in 2012 focusing on the barriers to adoption of digital pathology. The topics to be addressed during the webinars include: a cultural and strategic perspective, regulatory issues, financial aspects of deployment, and technical considerations.

Each session will be moderated by Robert McGonnagle, publisher of CAP Today. Each of the four webinar sessions will include several experts in the field who will deliver short & focused presentations, and then will interact with McGonnagle and attendees about the major points presented.

These webinars will serve as a bridge between the recent, comprehensive article about regulatory aspects of digital pathology that appeared in CAP Today (see:Regulators Scanning the Digital Scanners) and the two most important, national conferences focusing on digital pathology, Pathology Visions 2012, the annual conference of the DPA, to be held October 28-31, 2012 and Pathology Informatics 2012 to be held October 9 – 12, 2012 in Chicago.

Mark your calendar from 11 AM EST to 12 Noon EST for the following dates: 

May 9| Cultural and Strategic Barriers to the adoption of Digital Pathology 

Featuring: Dr. Sylvia Asa, Dirk Soenksen of Aperio & Dr. Keith Kaplan 

July 25 | Financial Barriers to the Adoption of Digital Pathology

September 19 | Technical Barriers to the Adoption of Digital Pathology

November 14 | Regulatory Barriers to the Adoption of Digital Pathology

There will be no charge for participating in these webinars, however advance registration is required. Click HERE to register. The archived version of the webinars will be made available to DPA Members only. More details about these events will be published as they become available including the names of the participating faculty members.

SAN JOSE, Calif., April 25, 2012 /PRNewswire via COMTEX/ -- Telemedicine, once a specialty niche, is quickly becoming a new standard of care for hospitals and healthcare providers across America. Driven by patient demand and an imperative to improve healthcare quality and accessibility, telemedicine is now a near-requirement for modern medical institutions. Organizations not adopting these technologies expose themselves to declining clinical outcomes, loss of market-share and potential litigation.

"You can no longer afford to ignore telemedicine or offer it only as a peripheral service," said Jon Linkous, CEO of the American Telemedicine Association. "Providers that don't integrate telemedicine into their delivery models are limiting patient access to the best on-demand care possible. They are also losing out to their competitors who are using the technology to improve care, reduce costs and expand their markets."

The importance of telemedicine as a standard of care is evident in several areas:

Increased patient demand for telemedicine. According to ATA over 10 million Americans are now directly benefitting from telemedicine each year.

State mandates for insurance coverage of telehealth services. 15 states have now passed laws requiring private payers to cover services provided via telemedicine. The foundation for this legislation is that patients should receive the best care, regardless of whether an on-site provider is available.

A growing standard of care: Practically every hospital in the country uses telemedicine to assure 24/7 access to professional radiology services. Similar use is now growing for many other specialty services. So it is not surprising that patient and consumer groups are starting to expect such access everywhere. In fact, several recent lawsuits (that were later settled out of court) were filed against hospitals for not providing telemedicine services.

Organizations and individuals interested in learning more about telemedicine are encouraged to attend the ATA 2012 Annual Meeting, April 29-May 1, 2012 in San Jose, California. ATA 2012 is the world's largest telemedicine, telehealth and mHealth event, with 450 presentations and an exhibit hall with 200 product and service vendors. This year, over 4,500 healthcare professionals--clinicians, administrators, entrepreneurs, IT specialists, engineers and more--are expected to attend. Free passes for the ATA 2012 Exhibit Hall are available. For more information, visit http://www.ATA2012.com .

The American Telemedicine Association is the leading resource and advocate promoting the use of advanced remote medical technologies. ATA and its diverse membership work to fully integrate telemedicine into healthcare systems to improve quality, equity and affordability of healthcare throughout the world. Established in 1993, ATA is headquartered in Washington, D.C. For more information, visit http://www.americantelemed.org .

Source: American Telemedicine Association

Frequent readers know I am a fan of cloud computing, hosted services and/or software or SAAS, IAAS, PAAS, web-based computing, etc...

Of course, cloud computing or any of the other acronyms or names is not new. The idea of utilizing remote servers or applications is as old as the most primitive networks. That is the premise for networks.

More recently, remote services, technology, applications that are maintained and served have become increasingly common for everything from enterprise e-mail solutions through Microsoft, for example, to image analysis applications.

As a consumer, I can get the latest version without the hassles of updates, upgrades or routine support that may normally be necessary with local applications or installations.

As a healthcare provider, particularly for organizations without a deep IT bench, the ability to outsource functionality to another provider can often mean lower costs without sacrificing reliability, support, security or access.

Digital pathology allows for "anytime, anywhere" review of pathology images (slides, cases) that can be viewed by the right person at the right time.  These images themselves can be locally served or hosted to be viewed but in order to report the diagnosis/findings in order to create a final surgical pathology report and a legal document requires access to the appropriate laboratory infromation system in order to do so.

This can be accomplished with remote services such as Citrix connectivity, remote desktop protocols, terminal server configurations or a host of others to allow for secure remote access.

Or we can leverage the power of the cloud and hosted functionality that provides a platform for remote signout over the web.  

Many laboratory information system vendors offer web-based signout to facilitate shared access regardless of where a particular individual may be, as mentioned previously on this blog, including a post about signing out cases from 35,000 feet, above the cloud(s).

Recently I had a chance to take a look at a hosted LIS available as a mobile application on my 4G iPad 3 from PathX.

A little skeptical of actually signing out cases from my iPhone or iPad, I assumed a very rudimentary experience that would look nothing like a conventional worklist-driven solution to present cases for review and signature.  Instead what I saw was just that - worklist of cases pending signature and release in the palm of my hand.  

Once you launch the application, you are presented with your worklist of completed cases which you can select, preview and verify.

Within the application is some other functionality including a Twitter feed from the vendor as well as Dark Daily updates, ability for clients to order supplies and some setting controls that are user defined.

Considering the value proposition of digital pathology, that one is no longer tethered to their microscope, their histology laboratory, and now their LIS, the added functionality of mobile review and signout facilitates a critical component of "anytime, anywhere" review AND signout.

This technology raises a major question in my mind, namely, what/where constitutes the point of service, a critical component of CLIA regulations in terms of "where the pathologist was sitting when he/she made the diagnosis".  Legitimately, this could still have been in a professional office setting with a CLIA license when the diagnosis was rendered, dictated and transcribed.  The act of verifying/certifying that report as accurate may or may not be another matter.  More on this in a subsequent post. 

In the meantime, if you are in the market for an LIS solution and considering a hosted solution, consider PathX, with the added functionality of mobile sign-out.

http://www.definiens.com/community/symposium.html

Researchers at the University of Leeds say their digital scanning system produces high-res images that can be rotated.

Today, pathologists and researchers must cut super-thin slices of tissue samples to view them on a microscope -- a labor-intensive process that renders 3D images created from hundreds of 2D sections prohibitively expensive.

Not to mention tedious to construct. Imagine if a single scene in Halo was presented as a series of 2D images one must perfectly align before getting the lay of, say, a single battleground.

A 3D rendering of cirrhotic human liver tissue infected with hepatitis C.

(Credit: University of Leeds)

Now, computer scientists and medical researchers at the University of Leeds in the United Kingdom say they've devised a novel workaround in the form of a digital scanning system that produces 3D views of tissue samples with almost no extra labor.

Read more.

Source: CNET (by Elizabeth Armstrong Moore)

Hoersholm, Denmark - April 23, 2012 -- Visiopharm A/S, a global leader in Quantitative Digital Pathology, announced today that the United States patent and Trademark office will issue the patent “Feature-based registration of sectional images” (Application No. 12/514,918).

The patented technology, which is now protected in both Europe and in the United States, enables perfect alignment of whole slide images at any magnification, independently of tissue type and staining. This is a central capability for the next generation of quantitative bio-marker analysis, and for time- and cost efficient Whole Slide stereology

Next generation of quantitative bio-marker analysis: High-precision alignment of digital slides has direct application for automating the analysis of biomarkers. The rate limiting step for the application of Quantitative Digital pathology in research and diagnostics has been robust and reliable tumor identification and classification. With this technology, it is now possible to implement automated Virtual Double Staining. This is done by aligning two serial sections stained for different markers by immunohistochemistry; any nuclear, membrane, or cytoplasmic biomarker of interest may be stained for in each of the slides. Advanced analysis software is used for automated alignment of slides; the tumor cells are found in one slide, e.g., by means of a cytoplasmic marker, and the expression of the bio-marker of interest, such as Estrogen receptor or Ki67, is quantified in the other slide, within the cells identified with the cytoplasmic marker.

“With the Virtual double staining approach, we can use standardized and optimized staining protocols for both of the markers used without the difficulties that we experience with physical double staining due to, e.g., conflicting protocol requirements and overlapping chromogenes. This could be an important step towards deploying automated and standardized image analysis in clinical pathology. We are currently involved in a number of collaborative studies where this technology is applied and refined for different markers, different reagent vendors, different scanners, and different tumor types. We are basing the development of these methods on our standardized and optimized staining protocols, and expect to publish some of this work later in 2012”, stated Professor Mogens Vyberg, Director of NordiQC.

The technology is fully integrated as part of Visiopharm image analysis and stereology solutions. 

“This patent is very important to Visiopharm. We strongly believe this will become central to improve quality and automation, while at the same time reducing the costs associated with tissue based diagnostics and research. The results we are obtaining with our collaborators are very encouraging in terms of developing fully automated diagnostic tests and validating the value of this approach.”, adds Michael Grunkin, CEO of Visiopharm.

Time- and cost efficient Stereology: For the vast majority of scientific applications, highly automated Whole Slide Stereology can now replace Classical labor-intensive, manual, and high-maintenance complex hardware configurations for microscope-based stereology systems. The ability to automatically align Whole Slide Images of serial sections for an entire study is essential to automating the physical disector, and the sampling of perfectly aligned disector pairs. The technology is implemented in the Autodisector™, which is making Whole Slide Stereology a time- and cost-efficient option also in high-throughput environments.

According to Johnnie B. Andersen, Honorary Associate Professor at the Stereological Research Lab, and Stereology expert at Visiopharm, “Apart from automation, Whole Slide Stereology has demonstrated numerous significant advantages to researchers. Based on thin sections, the classical problems with lack of staining penetration in thick tissue sections are completely eliminated. Working with thin sections also eliminates practical problems that frequently originate from shrinkage and collapse of thick sections. Eliminating these critical issues will save researchers countless hours of futile lab work, when preparing tissue sections for important scientific studies. Loss of critical study data for those reasons can be very expensive. Finally, the combination of slide scanning and Whole Slide Stereology makes stereological data fully traceable, which is mission-critical in highly regulated environments”.

About Visiopharm

Over the past 10 years, Visiopharm image analysis and stereology software has become the preferred Quantitative Digital Pathology solution for leading biopharmaceutical companies, clinical researchers, and academic researchers all over the world. Visiopharm has more than 300 deployed systems worldwide and a large network of distribution and support partners, and is featured in over 400 scientific publications.

Source: Visiopharm

University College London (UCL) showcases their digital pathology offerings, examples using Slidepath viewing software over the web from Lecia SCN400F scanner and costs for slide scanning and storing services.  Great images and reasonable prices for high resolution scanning and storage.

From their website:

High Resolution Digital Pathology

Archiving Slides

We can archive precious bright field and fluorescent  research and diagnostic pathology samples at high resolution. Our slide scanner (LEICA SCN400F) digitises entire histological slides. 

We can simply scan your slides and make the files available to you or we can store them on a secure, password-protected server

Comparison of multiple slides

The system is ideal for comparison of slides, for permanent archiving of entire fluorescent slides simply or for taking snapshots of your slides, in perfect contrast, white balance and in vivid colours. Images can be accessed at any time with any web browser, platform-independent or with an app on your iPad . 

Remote Access

We can give researchers exclusive access to their selection of slides. 

Researchers and Pathologists can get a login to access the slide collection on our server. 

Examples:

• Human Glioblastoma Xenograft; H&E
• Mouse Brain Tumour (Glioma); Olig2 IHC
• Appendix; H&E
• Cerebral Amyloid Angiopathy & Alzheimer's Disease; Beta A4
• Tauopathy (Pick's Disease) Courtesy of Prof Revesz, QSBB.  
• Mouse cerebellum, coronal section (H&E)

Price List: High resolution scanning and digital archive

http://www.ucl.ac.uk/ion/divisions/neuropathology/ion-histology/DigitalPathology

The micturition contest (no pun intended) in regards to self-referral practices, particularly within urology groups continues.

In the latest diaglogue between The Pathology Blawg and In-Office Pathology co-founder, Mr. Bernie Ness, Mr. Ness writes that "I have never met a pathologist in my 10 years of private consulting before IOP who knw what the positivity rate was for their lab.  NEVER. Pathology is the absolute dumbest profession I have ever seen in my life.  I have never seen a group of professionals so clueless as to the rules and regs that govern them."

Someone told me many years ago never to send an e-mail to someone you wouldn't want forwarded or put on a website.  I learned that lesson the hard way years ago as a senior resident/junior staff pathologist in the Army.  Even if you are right and have the data that you think supports your point, think about who may or can see this.

Many years ago, while head coach of the New York Jets, Herman Edwards once said "You play to win the game. Hello? You play to win the game."  In more recent years, when referring, specifically to athletes texting or posting content online, ESPN plays a soundbite of him saying "Think before you hit send!" 

Think about that message being forwarded and think before you hit send.  Good advice. 

Confident Mr. Ness was aware of the risks sharing his innermost thoughts with a blogger and put them in writing.  Probably the first time I have seen pathology called "the absolute dumbest profession" but perhaps I am not reading the right material.  

He is welcome to his opinion.  Or a second opinion for that matter.  Of course he will defend his business practices as being sound clinical business practices but I wouldn't expect to hear or see this kind of rhetoric from someone who has spent over 30 years in sales and marketing within the laboratory industry, even if he/she thought it were true.  

According to the In-Office Pathology website (see below), it claims that Mr. Ness has helped with such innovations as client electronic interfaces, image enhanced reporting and of course, in-sourcing of pathology services in physician office practices.  

If an expert in sales and marketing within the pathology and laboratory industry mentions "Pathology is the absolute dumbest profession I have ever seen in my life", what does that say about our profession?  

From In-Office Pathology:

Bernie Ness has distinguished himself over the past 30 years as one of the experts in sales and marketing within the laboratory industry. His experience encompasses both large national lab companies as well as private, venture capital funded, startup companies. He is a recognized expert in the field of anatomic pathology sales and marketing.

He is well known for his expertise in revamping troubled sales organizations, adding innovation, marketing new technology and organizing and training sales forces. Bernie established one of the first computer-to-computer links for client order entry and lab results reporting. He launched several technologies that have become standards in oncology, infectious disease, pathology, and genetics, including color digital image anatomic pathology reporting. Bernie is often quoted in lab industry publications such as The Dark Report, Small Business Reports and Advance. 

He is a graduate of Southern Illinois University with a degree in biology and a minor in microbiology. He was a board member of BioDiagnostics Laboratory, Inc.,Torrance (CA), a member of Biomedical Marketing Association and The Medical Marketing Association. Bernie formed BJ Ness Consulting Group that specialized in pathology business management. He also started several medical ventures, including a revolutionary new logistics product to keep medical specimens frozen for four days without dry ice. He is co-founder of the predecessor company of recently renamed In-Office Pathology, the market leader for in-sourcing pathology referrals from specialty medical practices in urology, gastroenterolgy, and dermatology. 

MAKE YOUR HOTEL RESERVATION TODAY FOR PATHOLOGY VISIONS 2012

The DPA has secured a special group rate for attendees of Pathology Visions at the Hilton Baltimore, $189 + tax per night for a single and double occupancy room. For overnight guest room accommodations, please make reservations here or by contacting the Hilton Baltimore directly by phone at (443) 573-8700. Be sure to mention that you are with the group Pathology Visions in order to receive the contracted group rate.

Room Rate:

$189 Single/Double + tax
Check-in: 3:00 PM
Check-out: Noon

Self Parking: $28, In/Out privilege

Valet parking: $40, In/Out privilege

Room Guarantee Information:

Hotel reservations must be received prior to October 1, 2011. All hotel reservations must be guaranteed with a credit card. You must be registered to attend Pathology Visions to receive the special rate.

Hilton Baltimore

The Hilton Baltimore hotel is ideally located in the exciting Baltimore Inner Harbor district downtown, a prime business, historic and cultural district in Baltimore, Maryland. We’re directly connected to the Baltimore Convention Center, adjacent to Camden Yards, and across from M&T Stadium, home of the Baltimore Ravens. The Connie Award winning Hilton Baltimore, MD hotel is a property designed to impress and accommodate every need of today's traveler

Guest Accommodations: 
As one of the premier hotels in Baltimore, the Hilton Baltimore offers luxurious accommodations in the downtown Baltimore area. Pamper yourself with our Hilton Serenity Collection™ bedding while you enjoy a luxurious guest room that features today’s latest technology - large, plasma high-def televisions, high speed Internet access and MP3 player clock radios. 
  
Hotel Address:

Hilton Balitmore

401 West Pratt Street

Baltimore, Maryland, United States 21201

Tel: 1-443-573-8700   

Fax:  1-443-683-8841

The College of American Pathologists recently mentioned, as I discussed last week a study looking at the number of specimen containers collected (and billed to Medicare) for prostate biopsies for self-referring (in-office laboratories) versus non self-referring urologists (send specimens to a lab to be processed and read).  There has been some concern that urologists, who have a stake in a lab they may own, would have financial incentive to do more biopsies, generate more cups and generate more 88305 codes than if they simply sent the work to a lab to be done.  

The null hypothesis for the study by a noted public policy economist at Georgetown University was that there would be no difference in number of specimens between those who owned their labs versus those who referred to laboratories.

The study found otherwise, that self-referring labs generate more cups for themselves than those who sent the specimens to another laboratory.  If you make more, you do more.  Simple economics.

Sadly, despite doing more biopsies, the cancer detection rate did not increase.  It actually decreased.  I don't think a multivariate analysis was done, based on how study was contructed (Medicare claims for these specimens from 2005 - 2007), but nevertheless, doing more biopsies did not yield more cancer.  

So, what does the CAP do with this information?  Essentially nothing in the course of the past week.

There was a Statline release with a link to the study by Dr. Mitchell last Monday and a members-only Webinar on the matter last Friday.  Dr. Mitchell reviewed her design study, methods, results and conclusions for about 30 minutes and then a member-driven Q&A followed for the remaining time.  

The session was moderated by Dr. George Kwass, a practicing pathologist in Massachusetts and CAP Board of Governors member.  

The member generated questions that were read by staff to Dr. Kwass and Dr. Mitchell ranged from design characteristics to what the College plans to do with the information.

This perhaps was the most disappointing part of the webinar.  Dr. Kwass specifically responded to the question of what does the College plan to do with "It is a work in progress".

On April 12th, the AUA fired off this letter, applauding the Journal which published the Mitchell Study and mentioned the "turf war" between pathology and urology on this matter and defended their practice of 12 cores versus less.

An organization called LUGPA which stands for The Large Urology Group Practice Association had a press release on Friday, hours before the CAP Webinar to its members.

The press release states: "This study simply furthers the political agenda of its sponsors to recapture lost market share and does not deserve credible recognition," states Dr. Deepak A. Kapoor, President of LUGPA and Chairman and CEO of Integrated Medical Professionals, PLLC. "To suggest that certain practices are performing extra and unnecessary pathology work for their own remuneration when they are working within rational clinical guidelines is offensive. It shows a total lack of understanding of proper prostate cancer diagnosis."

The College of American Pathologists published an alert, link to study, information on its advocacy site which I mentioned last week and holds a members-only webinar.  

Assuming the College did not know the results when the study was completed or during the peer-review process, it should have had 4 or 5 action items and more talking points ready to go, whether the results were favorable or unfavorable to the College's interests in this "turf war" as mentioned by our urology colleagues.  

Instead, we get "It is a work in progress".  A work in progress, strictly defined is "Material that has entered the production process but is not yet a finished product."  

Work in progress (WIP) therefore refers to all materials and partly finished products that are at various stages of the production process. WIP excludes inventory of raw materials at the start of the production cycle and finished products inventory at the end of the production cycle.

The term could also be used to ongoing projects, as I have used it, for example, months-long software implementations, home contruction or contract negotiations where everyone is working towards a common goal and end desired product.  

If the study was, say started in 2010 and in part, funded by the CAP, why is that an organization called LUGPA is firing their bullets and we are still having only, as far as I can tell members-only calls?

What is the College, its board, advocacy groups, political action committee or PR engine going to do before the likes of LUGPA, AUA or IOP continue to put their own spin on this?

Pathologists are data driven.  We have the data now.  Why don't we have a succint plan to use the data after many years?

>PRWEB.COM Newswire

Read more: http://www.digitaljournal.com/pr/664835#ixzz1sAfUOgEw