1. Pathology

Category Archives: Pathology

Philips and Dako join forces in digital pathology

Posted on by

Eindhoven, the Netherland and Glostrup, Denmark – Royal Philips Electronics (NYSE: PHG, AEX: PHI) and Dako, yesterday announced that they have signed an agreement to integrate a selection of Dako’s image analysis applications into Philips’ future digital pathology solutions.

 http://www.research.philips.com/initiatives/digitalpathology/news/100721-dako.html

“Anatomic pathology is an essential element of virtually every cancer diagnosis and the demand for it is ever-increasing. Our goal is to develop integrated digital solutions that enhance the operational efficiency and productivity of pathology departments, as well as increasing diagnostic confidence,” says Bob van Gemen, General Manager of Philips Digital Pathology. “I am convinced that our partnership with Dako, with its leading market position and expert knowledge in detecting and quantifying specific biomarkers in cancer tissue, will significantly accelerate our clinical applications development program.”

“We are very pleased to announce this collaboration with Philips, a leading company in the healthcare industry that is committed to entering the digital pathology market,” says Lars Holmkvist, CEO of Dako. “By joining forces with Philips, we will be able to deliver highly competitive diagnostic tools based on Philips’ extensive clinical expertise and technology know-how and Dako’s expertise in advanced staining and image analysis in order to benefit pathology laboratories, pathologists and ultimately patients.”

Currently, anatomic pathology workflows to examine tissue samples are based on the microscope, through which pathologists examine tissue sections mounted on glass slides and treated with different stains. The staining enhances the contrast between, or reveals the presence of, cellular and molecular components such as cell nuclei or specific proteins. Accurate interpretation of the results is critical to the diagnosis and staging of each individual patient’s disease and requires a great deal of skill and experience.Digitizing the images that pathologists normally view through a microscope may enable the introduction of objective and quantitative image analysis tools.

Dr. Clive Taylor, MD, PhD, Professor at University of Southern California, USA, and a renowned expert in pathology, expresses about the collaboration: “Digital pathology has been long in gestation, in comparison to radiology, where images also are the currency of practice, and where image acquisition, transfer, interpretation and storage is almost entirely digital. In part, this lag is because acquisition of histopathology images is dependent upon a 100 year old technique of ‘tissue fixation’, sectioning and staining. In part, it is because, somewhat surprisingly, fully digitized histopathology images are much larger than CT files, and difficult to manage and analyze. Progress has been slow because there has been no single institution, or company, that embraces both of these areas. It is exciting that collaborations like that between Dako and Philips are now bringing diverse but appropriate expertise to bear on implementing a full digital pathology program.”

A fast pathology slide scanner and an associated image management system form the basis of Philips’ proposed integrated solutions for digitizing pathology workflows. The Philips-Dako collaboration will initially focus on leveraging Dako’s image analysis software for tissue-based breast cancer diagnosis using its reagents for staining HER2, Estrogen Receptor (ER), Progesterone Receptor (PR), p53 and Ki-67 proteins. The detection and quantification of these proteins in biopsy tissue are highly relevant for the classification of breast cancers and the selection of appropriate therapy. Philips and Dako will also explore the possibility of extending the collaboration to include image analysis software for immunohistology-based prostate and colon cancer diagnostics.

Pre-2005 Medical Residents Entitled to FICA Refund

Posted on by

I am late learning this apparently but a colleague recently told me if you were a resident between 1995 to 2005 you did not need to pay FICA. It was withheld in all cases, but most residencies/graduate medical education departments filed application for a refund based upon your status as a student.

Here is the IRS information on the issue:

http://www.irs.gov/newsroom/article/0,,id=219731,00.html

The Internal Revenue Service has made an administrative determination to accept the position that medical residents are excepted from FICA taxes based on the student exception for tax periods ending before April 1, 2005, when new IRS regulations went into effect.

The IRS has begun contacting hospitals and universities who filed FICA (social security and Medicare tax) refund claims for these periods with more information and procedures.

Medical residents with pending claims do not need to take any action at this time.  The IRS will send letters to medical residents after it it sends letters to all employers that filed claims.

Taxpayers with currently pending suits should contact the Department of Justice attorney assigned to the case.

Additional information:

What is to become of the general surgical pathologist?

Posted on by

There was a story in the New York Times yesterday entitled "Prone to Error: Earliest Steps to Find Cancer" (Tuesday, July 20, 2010) written by Stephanie Saul, a Pulitzer Prize winning investigative journalist.  There is also a 7 minute video that accompanies the article produced by Shayla Harris, an award winning video producer with the New York Times.  

CANCER-3-popup In short, the article deals with examples of errors in breast cancer diagnoses and personal stories of women affected including a case involving a misdiagnosis lawsuit.  

The video mentions the "American College of Pathology" I think referring to the College of American Pathologists, refers to pathologists "helping doctors diagnose cancer" while we "work in a lab rather than seeing patients".  It also says that the biopsy samples may be the size of a "few grains of salt".  

There are some excellent comments by Dr. Shahla Masood (note the clipboard and seeing a patient in her web profile picture) and reference to a certification program for breast pathology credited to Dr. James Connolly citing possible financial implications for referrals to "breast pathologists".

There is no doubt this is a confusing area of pathology, even among experts as the story points out, and no one likes to hear about adverse outcomes and second and third opinions in some cases may be warranted.

This brings up a number of complex issues and the story is not favorable to pathology or pathologists.  The "American College of Pathology" and a "few grains of salt" and call out a pathologist who did obtain a second opinion?  Come on.  

Nonetheless, the story highlights errors made out of "hundreds of thousands of breast biopsies performed in this country a year", presumably from imaging guided biopsies detected from screening mammograms.  The debates continue about appropriate screening.

One mistake is too many but in my opinion the story puts pathology in a bad light and will only further undermine patients' confidence in the accuracy of their testing and diagnoses.  

I don't know which is worse the public thinking all pathologists are like "Quincy" or worse, like Dr. Kevorkian or have anything at all to do with the movie "Pathology" or this.   

Today, the CAP (aka "American College of Pathologists) sent a letter to the editor of the New York Times addressing pathologists’ commitment to continually improve the accuracy of diagnosing DCIS.

Having spent enough time in small community hospitals by myself for periods of time as a part-timer in doing so, I have a lot of respect for those folks who do it as a career without immediate "next door experts" or having renown "experts" in your department as I have enjoyed.  Add to that problems with classification and reproducibility and a drive towards one having their own "breast radiologist", "breast oncologist", "breast surgeon" and "breast pathologist" - what is the general pathologist to do?  And what happens when your "breast pathologist" is on vacation or at a "breast meeting" and these cases come across your microscope?

It is a delicate balance with significant push-pull involved with sub-specialty designations.  

And what are we as patients to do?  Go to cancer centers or specialty hospitals and seek out internal medical sub-specialists or surgical sub-specialists bypassing generalists and community hospitals? 

Answer to Case of the Week 55

Posted on by

Answer: Rhinosporidiosis (infection with Rhinosporidium seeberi)

Congratulations to Anonymous (x 3!), Kenneth, Chris, Victor, and Santoshpath who all got this correct! The keys to the diagnosis is the clinical history (location in nasal mucosa), exposure history (India), and histopathologic features of a polypoid mass containing mature sporangia (large, thick-walled spherical structures) and smaller internal sporangiospores (daughter cells). The sporangia stain with the fungal stains Gomori methenamine silver (GMS) and periodic acid-Schiff (PAS), and may mimic the appearance of similar appearing fungi such as Coccidiodes immitis (as one viewer suggested) and Chrysosporium spp. (the agent of adiaspiromycosis). Myospherulosis, a non-infectious entity, is also in the differential diagnosis. The difference between these entities is in the size of the spherule/sporangia and the internal structures.

This organism was previously considered to be a fungus, but it is now considered to be an aquatic protistan parasite (classified under Mesomycetozoea, which includes parasites of fish and amphibians). Rhinosporidiosis is endemic in India, Sri Lanka, South America, and Africa.

Although the disease most commonly involves the mucosa of the nose, mouth, and conjunctiva, involvement of the skin, ear, genitals, and rectum has also been described. Disseminated infection has been described in 3 individuals.

Thank you all for viewing and writing in!

Arizona Telemedicine Program Receive State Medical Association Award

Posted on by

Congratulations to Drs. Weinstein and Lopez and their colleagues at teh University of Arizona and Arizona Telemedicine Program. The scale of this program and the number served as part of a public health initiative is an example for other states and universities.

Ronald S. Weinstein, MD, FCAP, director, and Ana Maria López, MD, MPH, FACP, medical director, of the Arizona Telemedicine Program (ATP) at the University of Arizona College of Medicine, have been honored with Distinguished Service Awards by the Arizona Medical Association (ArMA).

 
Distingsvcawards The ArMA Distinguished Service Awards are given to individuals or organizations providing outstanding service to the community individually or collectively.
 
“In the last 15 years, Arizona has seen the development of a robust telemedicine program in our state, and these two physicians have been vital to its development and success,” notes ArMA president Gary R. Figge, MD, who presented the awards on June 4 at the ArMA 2010 President’s Banquet. “The work of these two physicians has indisputably demonstrated their service and dedication to the Arizona community.”
 
Telemedicine is the use of telecommunications technology to provide health-care services to patients who are geographically separated from a physician or other health-care providers. Since Drs. Weinstein and López began their work, the ATP has emerged as one of the largest telemedicine programs in the world and has received numerous national and international awards for its patient services, distance education programs, research and innovations. Patients in 70 communities statewide have received more than one million teleconsultations facilitated by the ATP. This year, 500 hours of continuing medical education and continuing education will be delivered to 34 communities using bi-directional video conferencing.
 
Dr. Weinstein is foundingdirector of the ATP and UA professor of pathology and public health. In 1996, he and Arizona state Rep. Robert “Bob” Burns (now state senate President Burns) established a pilot telemedicine program in Arizona. This initially consisted of eight pilot sites and included the establishment of telemedicine clinics in underserved rural communities, several Indian Health Service hospitals, and at an Arizona State Prison in Yuma. Since then, the ATP has created a large statewide broadband health-care telecommunications network, which it operates, linking dozens of health-care organizations in Arizona for the first time.
 
Dr. Weinstein also has been recognized for his innovations in the fields of pathology and telepathology and for creating a number of innovative education programs and courses. A Massachusetts General Hospital-trained pathologist and Harvard-trained cancer scientist, he served for 32 years as an academic pathology department chairman. While chairman of the Department of Pathology at Rush Medical College in Chicago (1975-1990), he developed robotic telepathology, introduced the word “telepathology” into the English language and authored a stream of scientific papers and books on telepathology. As chair of the Department of Pathology at the UA (1990-2007), he established an international telepathology diagnostic network and validated the diagnostic accuracy of telepathology. He is known as the “father of telepathology” and recently received the Eliphalet Nott Medal from Union College (Schenectady, New York), which recognizes “the perseverance of alumni who have attained great distinction in their field.” Previous Nott Medal Awardees have included a Nobel Laureate and the inventor of the laser. Dr. Weinstein has had a career-long interest in organized medicine and has had many leadership roles. He is past president of five national professional societies, including the United States and Canadian Academy of Pathology, the International Society for Urologic Pathology (ISUP) and the American Telemedicine Association (ATA). He has received Distinguished Service Awards from both the ATA and the ISUP. Dr. Weinstein also has been an innovator in other areas. He and Richard A. McNeely, former director of Biomedical Communications at the Arizona Health Sciences Center, co-designed the T-Health amphitheater in Phoenix. The T-Health amphitheater received the 21st Century Achievement Award, Education and Academia, from the Computerworld Honors Program. Dr. Weinstein is the author or co-author of more than 500 scientific articles, book chapters, monographs and published abstracts. A popular teacher, Dr. Weinstein is a recipient of the UA Basic Science Teacher-of-the-Year Lifetime Teaching Award and has been honored at five UA College of Medicine graduation ceremonies.
 
Dr. López is founding medical director for the ATP. She also is associate dean for outreach and multicultural affairs at the UA College of Medicine, UA professor of medicine and pathology, and a member of the Arizona Cancer Center and the UA BIO5 Institute. She serves on the board of directors of University Physicians Healthcare, the non-profit corporation created in 1985 as the medical practice of the physicians of the UA College of Medicine. She also serves as elected governor of the Arizona chapter of the American College of Physicians. In 2005, the National Library of Medicine recognized her as a Local Legend as part of a program highlighting the positive, enduring contributions of women physicians nationally to the health care of their communities.
 
Drs. Weinstein and López have continuously collaborated on developing and managing innovative academic programs since 1990, when Dr. López was chief resident in medicine at University Medical Center.
 
About the Arizona Telemedicine Program
 
Established in 1996, the Arizona Telemedicine Program (ATP) is a large, multidisciplinary, university-based program that provides telemedicine services, distance learning, informatics training and telemedicine technology assessment capabilities to communities throughout Arizona and in neighboring states. A division of the ATP, the Institute for Advanced Telemedicine and Telehealth (T-Health), is housed in the historic Phoenix Union High School building on the campus of the University of Arizona College of Medicine – Phoenix. One of the nation’s first regional demonstration learning centers, T-Health incorporates both telemedicine and telehealth – distance learning and health care delivery – using a wide range of technologies, including real-time videoconferencing, electronic transmission of digital medical images and data and the Internet. For more information, visit the website, http://www.telemedicine.arizona.edu
 
About the Arizona Medical Association
 
The Arizona Medical Association is a voluntary membership organization for Arizona physicians. The mission of the Arizona Medical Association is to promote and provide leadership in the art and science of medicine; to preserve and improve the health of all people in Arizona by developing and maintaining the highest standards; to represent the physician and the profession in the public forum; and to defend the freedom and ability of the physician to practice medicine in the best interests of the patient.
 

Digital Pathology Consultants Launches a Digital Pathology Webinar Series

Posted on by

Digital Pathology Consultants, a leader in digital pathology consulting services has launched a free webinar series provided by http://www.thedigitalpathologywiki.com and its sponsors; established to arm adopters and users with the information necessary to be successful with digital pathology.

Broomfield, CO (PRWEB) July 12, 2010

Digital Pathology Consultants, a leader in digital pathology consulting services announced today the start of a free webinar series provided byhttp://www.thedigitalpathologywiki.com and its sponsors; established to arm adopters and users with the information necessary to be successful with digital pathology.

The series will kick off with "Digital Pathology: How to Put The Pieces Together" presented by Amanda Lowe, President of Digital Pathology Consultants on July 20, 2010 at 12 PM EST. Amanda will provide an overview of the key pieces of digital pathology including acquisition, integration, data management, and interpretation and how to efficiently put the pieces together. This is an excellent webinar for individuals who are planning to adopt a digital pathology solution, or who have a solution and want to know how to maximize the investment and use the technology to its full potential.

The series will continue with a monthly one-hour webinar presented by industry leaders to educate the community, share best practices, keep current on industry advancements, and to cultivate healthy discussions about digital pathology.

Future webinars include "Pathology 2.0" presented by Keith J. Kaplan, MD a surgical pathologist and CIO at Carolinas Pathology Group, on August 10, 2010 at 12 PM EST and "Image Analysis In A Regulated Environment" by Steve Potts, PhD, CEO of Flagship Biosciences on September 23, 2010 at 12 PM EST.

The webinar series is free to all registered attendees, however space is limited. Register today for this unique opportunity where the information you learn can be applied immediately.

About Digital Pathology Consultants, LLC

Digital Pathology Consultants, founded by Amanda Lowe, is the leading provider of digital pathology consulting services for the biopharma and healthcare industries. Our services help clients research, plan, select, implement, and validate digital pathology solutions. Knowledge, trust, and an open exchange forum shape the foundation of Digital Pathology Consultants. Delivering results is our promise, exceeding your expectations is our guarantee.

Leica Microsystems Wins European Scanner Contest

Posted on by

First Prizes for Scan Speed and Best-Focused Images

Leica Microsystems‘ Slide Scanner Leica SCN400 and Autoloader Leica SL801 have come first in two categories of the first European Scanner Contest (ESC). The prizes were awarded in the “Scan Speed and Best-Focused Images” category, each at 20x and 40x magnification.

The jury was convinced by the digital pathology system by Leica Microsystems: Thanks to the patented “Dynamic Focus”, the Slide Scanner Leica SCN400 produces virtual images of exceptional quality at unprecedented speed. Another product designed for high throughput in the pathology lab is the Autoloader Leica SL801, which is capable of scanning up to 384 samples at a time. “By winning first prize, Leica Microsystems has again asserted its market position. We will continue to play a key role in shaping the future of virtual microscopy and digital pathology,” said Dr. Bodo Falke, Sales Manager Central Europe for Leica Microsystems, at the award presentation in Vilnius, which hosted the 10th European Congress on Telepathology and the 4th International Conference on Virtual Microscopy last week.

The European Scanner Contest was held within the framework of “Pathology Week“, a joint event of the German Society of Pathology and the Association of German Pathologists. With this competition, the organizers have created the first opportunity to compare the speed and imaging quality of different scanners using identical samples. The contest is also intended to promote the development of virtual microscopy products.

Source: Leica Microsystems

http://www.leica-microsystems.com/news-media/press-releases/press-releases-details/article/leica-microsystems-wins-european-scanner-contest/


Olympus America Licenses Digital Pathology Patents to BioImagene

Posted on by

Olympus continues to enter into nonexclusive licensing agreements with other whole slide vendors.  The latest announcement is with BioImagene.  While the terms were not made public and often are not clearly one can see the value of this rich suite of patents that several vendors have entered into agreements with Olympus for imaging and data handling.  I gather more companies will also follow given what Olympus owns in order to continue to move the field. 

 

CENTER VALLEY, Pa., July 12 /PRNewswire/ -- Olympus America Inc. has signed a nonexclusive worldwide licensing agreement with BioImagene, Inc. of Sunnyvale, California, allowing BioImagene to access an extensive portfolio of Olympus patents in the field of digital pathology and virtual microscopy. This is the most recent of several licenses that Olympus has granted for the technologies, which are considered critical for developing future digital imaging and data handling systems for pathology.  

Digital pathology technology has the potential to change the way doctors review and manage millions of biopsy slides and other pathology specimens now handled using glass slides and traditional optical microscopes.  The patents included in the licensing deal cover methods and equipment for creating, storing and delivering virtual microscopy slides. The technology enables pathologists to view and share high-resolution virtual microscopy images over the Internet.

"The digital pathology field is evolving rapidly," said F. Mark Gumz, President and CEO of Olympus Corporation of the Americas, the parent company of Olympus America Inc., "and allowing other companies in this field like BioImagene to license these important patents will help advance the field of pathology, and ultimately promote better access to healthcare for patients around the world."

"Digital pathology is at an important inflexion point, moving very rapidly towards broad-based adoption. We believe that our relationship with Olympus will be a catalyst for this trend," said Ajit Singh, Ph.D., President and CEO of BioImagene. "Olympus has been a pioneer in this field, and their patent portfolio will complement BioImagene's innovations in end-to-end digital pathology."

In the United States alone, $13.2 billion was spent in anatomic pathology testing during 2008, according to a 2010 Laboratory Economics report. The Olympus portfolio enables development of solutions that can streamline the review of pathology slides and improve the speed of reporting, while saving costs and enhancing patient care. Virtual microscope slide technology also has the potential to aid hospitals in moving to comprehensive patient Electronic Medical Record (EMR) systems – a transition that is already beginning in some parts of the world.

The companies are not making specific terms and conditions of the agreement public.

About Olympus Scientific Equipment Group

Olympus America Scientific Equipment Group provides innovative microscope imaging solutions for researchers, doctors, clinicians and educators. Olympus microscope systems offer unsurpassed optics, superior construction and system versatility to meet the ever-changing needs of microscopists, paving the way for future advances in life science.

About Olympus

Olympus is a precision technology leader, designing and delivering innovative solutions in its core business areas: Medical and Surgical Products, Life Science Imaging Systems, Industrial Testing Instruments and Cameras and Audio Products.

Olympus works collaboratively with its customers and affiliates worldwide to leverage R&D investment in precision technology and manufacturing processes across diverse business lines. These include:

  • Gastrointestinal endoscopes, accessories, and minimally invasive surgical products;
  • Advanced research, clinical and educational microscopes and research and educational digital imaging systems;
  • Industrial research, engineering, test, inspection and measuring instruments; and
  • Digital cameras and voice recorders.

Olympus serves the healthcare field with integrated product solutions and financial, educational and consulting services that help customers to efficiently, reliably and more easily achieve exceptional results. Olympus develops breakthrough technologies with revolutionary product design and functionality for the consumer and professional photography markets, and also is the leader in gastrointestinal endoscopy and clinical and educational microscopes.  For more information, visit http://www.olympusamerica.com.

About BioImagene

BioImagene (http://www.bioimagene.com) is the leading provider of innovative and scalable digital pathology solutions for diagnostics. The company's total digital pathology solution is comprised of the Virtuoso™ digital pathology application software, iScan™ family of automated digital slide scanners, and a rich menu of Companion Algorithms™. BioImagene's innovative product line includes a unique image viewing input device called the iSlide™, and a high-performance pathology workstation called Crescendo™. BioImagene is also the platinum sponsor of PathXchange™, a vendor neutral, not-for-profit website for the pathology community.

SOURCE Olympus America Inc.

Webinar Announcement – Introducing: Definiens Tissue Studio 2.0

Posted on by

IF_TS2_Box_blogTitle: Introducing: Definiens Tissue Studio 2.0™
Date: Wednesday, August 4, 2010
Time: 11:00 AM – 12:00 PM EDT / 4:00 PM – 5:00 PM GMT

Register Here:
https://www2.gotomeeting.com/register/738419971

The most advanced digital pathology image analysis solution for biomarker translational research – just got better.

New in Definiens Tissue Studio 2.0:

? Full immunofluorescence support: Nuclear, membrane & cell detection; Cell simulation; Biomarker co-localization; Tissue microarray core detection; Full multiparametric quantification of all objects (cells or sub-cellular compartments); 12-color channel support.
? Improved nucleus detection for bright field images
? User Defined Feature Selection for Definiens Composer Technology
? And – still simple to use!

Speakers:

Dr. Kai Hartmann - Product Manager, Definiens
Peter Duncan - Director, Marketing and Business Development, Definiens

Beth Israel Pathologists Press for Personalized Medicine Training

Posted on by
Leading pathologists from Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School are among those advocating for making genomic and personalized medicine training part of all pathology residency training programs in North America over the next two years, according to “A Call to Action” published in the June issue of the American Journal of Clinical Pathology.

“No field of medicine has really taken this on, but there is a clear need for pathology to be out in front of this type of analysis in medical practice,” said Jeffrey Saffitz, M.D., Ph.D., BIDMC’s chief of pathology.

The suggested training curriculum would be modeled on that offered by the Genomic Medicine Initiative (GMI), which was launched by the BIDMC pathology department in 2009. “By July 2012, we want every pathology training program in the United States and Canada to have this program in place,” said Saffitz, adding that GMI officials have had discussions with CAP leaders about developing standards, as well as a funding model, for these programs. 

The curriculum includes lectures on current genomic testing technology, including next generation sequencing, as well as analyzing what the results mean—both for patients and other medical providers. Pathology residents also have the opportunity to analyze their own genome.

An important component of the training program is to understand what current genomic technology can offer in terms of information. “We want the residents to have a clear sense of what the current limits of this testing are, even though this is changing daily,” said Saffitz. “But overall, the goal of the training is to demystify personalized and genomic medicine to our residents.”



CAP Virtual Management Conference Now in Webinar Format

Posted on by
  http://www.cap.org/apps/docs/education/vmc_brochure_2010.pdf

The CAP Virtual Management College offers a new presentation format, redesigned from the ground up to give you a richer, more interesting learning environment. You’ll still get the valuable practice management topics you need and enjoy the first-rate faculty, but now VMC comes to you via the Web for a rich, new interactive experience.

• Supplement your curriculum with this practical series designed expressly for residents and new-in-practice pathologists.

• Benefit from a convenient, one-hour listen-and-learn format (perfect for busy schedules!).

• New! Chat with the speaker and ask questions during the session.

• Provide outstanding learning opportunities from leading faculty.

• Hear the recorded webinar online any time after the session.

• New! No need to manually advance slides—just log in.

• Register additional locations for a nominal fee.

Enroll in the Virtual Management College for your site and invite your entire lab/residency program to a conference room to listen and learn. Or register as a single user and participate from your desk or at home.

http://www.cap.org/apps/docs/education/vmc_brochure_2010.pdf

 

Update on Rules for Telemedicine Privileges

Posted on by

In the midst of The Joint Commission’s revisions to its telemedicine privileges standards, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule in May that would revise the current conditions of participation (“CoPs”) for both hospitals and critical access hospitals regarding telemedicine services.    

The Joint Commission (“TJC”) had previously issued new changes to TJC Standards MS.13.01.01 (Telemedicine) and LD.04.03.09 (Oversight of Care, Treatment and Services Provided Through Contractual Agreement) that were to become effective July 15, 2010, for Medicare-participating hospitals. However, after CMS issued its proposed rule, TJC on June 9, 2010, announced the effective date of these changes was being delayed until March 2011.

CMS regulations currently require hospitals and critical access hospitals to privilege practitioners providing telemedicine services as if the practitioner were on-site. In the present CoPs there is no mechanism for “privileging by proxy,” such as is permitted by the TJC telemedicine standard. In the preamble to the newly proposed regulations, CMS notes that, “One TJC policy that has been in direct conflict with the CoPs has been TJC’s practice of permitting ‘privileging by proxy’ … In short, TJC privileging by proxy standards allowed for one TJC-accredited facility to accept the privileging decisions of another TJC-accredited facility.

Hospitals that have used this method to privilege distant-site medical staff technically did not meet CMS requirements that applied to other hospitals even though they were TJC-accredited.” The proposed rule would address this issue by making changes to 42 CFR 482.12 and 42 CFR 482.221 that would make it permissible for the medical staff to “rely upon information furnished by the distant-site hospital when making recommendations on privileges” for individual distant-site practitioners providing telemedicine services if:

  1. The distant-site is a Medicare participating hospital.  
  2. The practitioner has privileges at the distant-site hospital and the distant-site provides a current list of the practitioner’s privileges to the originating-site.  
  3. The practitioner holds an appropriate state license in the state of the originating-site hospital.  
  4. The originating-site hospital conducts reviews of the practitioner’s performance in the exercise of telemedicine privileges and sends the distant-site hospital such performance information for use in the periodic appraisal of the practitioner. At a minimum, this information must include all adverse events that result from the telemedicine services provided by the practitioner to patients at the originating-site and all complaints received by the originating-site about the practitioner.

Additionally, for the forgoing to apply under the proposed rule, the telemedicine services would need to be furnished under an agreement with a Medicare-certified hospital and that agreement must specify that it is the distant-site hospital’s responsibility to conduct credentialing of the telemedicine practitioners in accordance with the CoPs.

It should be noted that unlike the TJC standards, CMS makes no distinction between telemedicine and tele- interpretive services. Also, note that the rule only permits the use of information from Medicare-certified hospitals, it does not permit hospitals to rely on information from non-hospital entities, such as teleradiology companies. However, the proposed CMS rule does not appear to affect the ability to use a credentialing verification organization when appropriate. The new rule is still only proposed, but if it is finalized Medicare- participating hospitals will be required to follow this rule.

Laboratory Automation White Paper:Achieving Best Practices with Total Laboratory Automation

Posted on by

FREE Special Edition White Paper

download your report now!

Download Your FREE Special Report Today!
Simply Complete The Form Below

Making the Most of Clinical Laboratory Automation: Achieving Best Practices with Total Laboratory Automation in Your LaboratoryEvolution of the clinical pathology laboratory has been one long progression of advances in technology. These improvements have transformed pathology and laboratory medicine from the manual performance of individual chemistries or hematology tests to sophisticated diagnostic analyzers that perform multiple laboratory tests in an automated format. This review discusses the methods currently available to improve medical laboratory process efficiencies. It ends with discussion of the merits of “closed” versus “open” total laboratory automation applications.

The Dark Report is happy to offer our readers a chance to download our recently published White Paper “Making the Most of Clinical Laboratory Automation: Achieving Best Practices with Total Laboratory Automation in Your Laboratory” at absolutely no charge. This free download will provide readers with a detailed overview of the increase in clinical lab efficiency and flexibility dictate that medical laboratories will need to automate to achieve the cost savings, elimination of labeling errors and optimize use and safety of skilled medical technologists.

A key point in the laboratory automation design is to quantify the savings. This calculation is referred to as return on investment (ROI) or “pay-back” period. Essentially this is the reduction in laboratory personnel resulting from the application of a lab automation system. Our experience is that 20-30% fewer FTE’s are required after automation. In turn, improved staff productivity is a key element which is the key in calculating the ROI.

download your report now!

Steps that are recommended for choosing an automation system include:

  1. A thorough evaluation of your laboratory work flow to understand each step of your current processes.
  2. Evaluate each vendors approach to provide the optimum most efficient solution to satisfy your laboratories needs.
  3. Determine whether an open or closed system provides the best solution for decreasing costs and improving efficiency including flexibility for future expansion or other changes.
  4. For more steps please CLICK HERE...

download your report now!

Table of Contents

Introduction - Page 3

Chapter 1. Continuous Flow Automation - Page 6

Chapter 2. Pre-Analytical and Post Analytical - Page 8

Chapter 3. Planning For The Automated Laboratory - Page 12

Chapter 4. Open versus Closed Continuous Automation Systems - Page 15

Chapter 5. Determine Return On Investment - Page 18

Summary - Page 19 A Case Study of iLAS’ System at Work - Page 20

Appendices

A-1 About Jon Crissman, MD - Page 26

A-2 About DARK Daily - Page 27

A-3 About The Dark Intelligence Group, Inc., and The Dark Report - Page 28

A-4 About the Executive War College on Laboratory and Pathology Management - Page 29

Terms of Use - Page 32

download your report now!

Aurora Interactive and PLUS Diagnostics Enters Into a Deal to Power Pathology Labs With Digital Communications Technology

Posted on by
MONTREAL, QUEBEC, Jun 29, 2010 (Marketwire via COMTEX) --

Aurora Interactive, a world leader in digital pathology communications announced today the company has signed a sales agreement for its mScope Clinical communication platform and viewer with U.S.-based PLUS Diagnostics Inc. The platform has many applications; including the Aurora Interactive mScope Clinical platform and viewer to support PLUS Diagnostics laboratories and their professional staff to continually exceed their clients' quality expectations.

"Our company is dedicated to providing our clients with outstanding service supported by state-of-the-art technology. Our goal is to ensure they have the latest advancements in technology that will help them achieve better outcomes on behalf of their patients. The addition of the mScope to our laboratory infrastructure supports us in achieving this goal," said David Pauluzzi, President and Chief Operating Officer of PLUS Diagnostics.

Pierre Le Fevre, President and CEO or Aurora Interactive stated: "We are proud to have been chosen by PLUS Diagnostics, a laboratory industry technology leader to boost their online connectivity solutions utilizing leading-edge technologies that deliver anywhere, anytime, access to information that healthcare professionals require to make decisions about patient care." Since 2008, Aurora Interactive has broadened its market penetration to Austria, France, Portugal and Spain for its mScope Education platform; and Canada, Holland and the United States for its Clinical platform.

About Aurora Interactive Ltd.

Aurora Interactive has developed the leading web based software platform (mScope) for simplification, productivity and ease of communications. mScope's Universal Web Viewer has collaborative tools to view medical slides and images anytime, anywhere, regardless of file format. The software has three applications to aid digital pathology web based communications needs: mScope Education, mScope Clinical, and mScope Universal Viewer. Aurora's mission is to improve patient outcomes and help members of the medical community achieve their full potential by eliminating the learning, diagnostic and collaborative restrictions imposed by time and space. http://www.aurorainteractive.com

About PLUS Diagnostics

PLUS Diagnostics is a leading national anatomic pathology company that provides a full range of multi-specialty services, including extensive diagnostic procedures and specialist consultations. Accredited by the College of American Pathologists, PLUS Diagnostics has long been recognized for exceptional service and quality. The company currently focuses on a broad base of specialty pathology services, including urology, gastroenterology and hematology/oncology. For more information, visit, http://www.plusdx.com.

SOURCE: Aurora Interactive Ltd.

Online Pathology: Moving Forward, Standing Still

Posted on by

This post marks the 1000th for the Digital Pathology Blog in about 3 years time.  It is hard to imagine I would still be at this 3 years later on a nearly daily basis with the goal of informing and educating fellow pathologists and the laboratory community on issues related to digital pathology, telehealth, image analysis, industry news, research and development and topics related to the practice of and pathology and laboratory medicine mixed in with some general health news, current affairs and humor.

For post #1000 I have asked Dr. Ed Uthman who has embraced online pathology or Pathology 2.0 as I refer to it for more than a decade.  I asked him to provide his thoughts and opinions on where we have been and what we need to do as a community.  I have shared some of Ed's thoughts on this blog from the PATHO-L listserv he mentions as well as video from his YouTube channel.  He also regularly uploads high quality gross and microscopic images on Flickr and can be found on Twitter and Facebook.

Thank you Ed for your thoughts and insights and to the beginning of the next 1000 posts.

------------------------------------------------------------------------------------------------------------------------------

In 1999, I wrote an article for Clinics in Laboratory Medicine, in which I presented an optimistic view of the future of online pathology. I predicted a paradigm shift from the ancien regime--a top-down flow of scientific knowledge--to a fully interactive network, where investigators who create most of the knowledge would have ready access to the pathologists in the field. The latter would provide valuable feedback that would help guide future research in the direction of efficiency and pragmatism. Eventually, the entire specialty could evolve into a worldwide colloquium of scientists and practitioners. At the time, I had been online (initially with a 300-baud modem) since around 1987. I started with GEnie, the information service run by General Electric. There was a "Medical Roundtable" in which I could discuss issues with other physicians, including the occasional pathologist. The medium was strictly plain text; data transmission speeds made the sharing of images impractical, video impossible. As we all know, steady progress in bandwidth availability, data storage, and client processing power led to the multimedia online paradise we enjoy today. So, just as those of us who grew up with the Jetsons might ask where the flying cars are, I have to ask, where is the online pathology paradise? Consider:

  • Medical publishers, which used to be our major source of useful information, are now a clogged bottleneck for same. Although most journals have online editions, access to full text is prohibitively expensive. Just to view a single article, I have to pay almost as much as Medicare pays me to examine and report on a biopsy specimen. The other day, an academic pathologist told me that a publisher had complained when he made a PDF of one of his own articles available free for downloading. Keep in mind that these publishers do no scientific research, write no manuscripts, rely extensively on volunteer editors, and pay no royalties. Yet, one has the chutzpah to enforce its copyright agreement against its own contributor. All this in the era of Wikipedia, where you can find detailed information on the most obscure of topics, all free of charge.
  • Traditional leaders in organized pathology have fallen far short of their potential. The American Society for Clinical Pathology has mutated into a retail storefront for (mostly mediocre) educational materials. The College of American Pathologists, which initially dragged its feet in meeting the challenge of the World Wide Web, finally sprang forth with an extensive Web presence. Unfortunately it has the most byzantine user interface imaginable, courtesy of third party vendors with apparently no understanding of the needs of pathologists. Fortunately, there is a bright shining star in this arena, the US and Canadian Academy of Pathology (USCAP), which makes all the educational materials for its annual meetings freely available for downloading, by anyone, with no password required. I will have to grant kudos with oak leaf clusters to USCAP executive director Fred Silva, who throughout his career has been three steps ahead of everyone else.
  • The medieval academic system soldiers on. Hieratic figures, the published experts, remain confined to expensive journals, textbooks, and seminars. They are rarely or never seen in demotic online venues, such as PATHO-L, a free mailing list for pathologists, now with about 800 subscribers, which has enjoyed continuous vigorous traffic since 1994. Universities continue to use the same old-fashioned models in deciding faculty promotion and tenure, concentrating on publications accepted by paper journals. Any young assistant professor who would undertake an ambitious online project, such as a pathology-oriented Wikipedia (or even an immunostain Wikipedia), would have to weigh the likelihood that all that work would be ignored by a promotions committee.

By posting my complaints to a blog, I realize I am preaching to the choir. Still I would take this opportunity to entreat my colleagues to use their bully pulpits to shake up the status quo and move our specialty into the Information Age. We are way behind.

Ed Uthman, MD
Pathologist, Houston/Richmond, Texas, USA
Website: http://web2.airmail.net/uthman
Photos: http://www.flickr.com/photos/euthman
YouTube Channel: http://www.youtube.com/user/euthman
Downloads: http://public.me.com/euthman
Twitter: http://twitter.com/euthman

S.C. Medical Board considers anatomic pathology services arrangements

Posted on by

An issue was recently brought to the attention of the SC Board of Medical Examiners on behalf of the South Carolina Society of Pathologists dealing with certain anatomic pathology business practices that have ethical and legal considerations that practicing pathologists should be aware of.  The matter was presented to the Board by Jane Pine Wood, Esq. and Steven M. Harris, Esq. and recently responded to by the Board.  Documents of the request and response are available on the SC Board of Medical Examiners website (links below correct - wrong on source page).


The documents are worth reading for background and the types of business models that may be occurring and what it means for our specialty.  Welcome your comments.


"At its May 2010 meeting, the SC Board of Medical Examiners considered the legal and ethical issues related to certain anatomic pathology services arrangements. The board concluded that the arrangements in question may constitute misconduct under the medical practice act. While it has not received a complaint and has not investigated any specific arrangement, based on the facts outlined in the presentation made at the May meeting these relationships raise serious legal and ethical concerns. Accordingly, the board cannot advise that they are permissible under the medical practice act at this time.


May 13, 2010 letter to the SC Board of Medical Examiners requesting advice from the Board about certain anatomic pathology services click here.


June 9, 2010 letter of response from the Board click here."

http://www.llr.state.sc.us/pol/medical/PDF/pathology%20final.pdf

http://www.llr.state.sc.us/pol/medical/PDF/PathologyWoodRequest.pdf

http://www.llr.state.sc.us/pol/medical/PDF/PathologyWoodResponse.pdf

Case of the Week 55

Posted on by

Here’s a challenge for all of you: Nasal polyp removed from a 50 year old Indian man with complaints of chronic nasal obstruction. Histologic exam reveals the following:

Hematoxylin and Eosin, 40x final magnification

Hematoxylin and Eosin, 100x final magnification

Hematoxylin and Eosin, 200x final magnification

Hematoxylin and Eosin, 600x final magnification

Hematoxylin and Eosin, 600x final magnification

www.GoPathDx.com

Posted on by

http://Www.GoPathDx.com is a new premier interactive pathology web portal founded by a group of pathologists in Indianapolis, Indiana, USA. The site serves as a pathology resource center where pathologists around the world can access information related to pathology learning, training, ongoing practice, continuing education and job opportunities. Additionally, the site also provides a place for social networking amongst professional colleagues. Featured function tabs include top news, pathology journals, lectures, a case of the week, telepathology, research updates, jobs and conferences. The site is very user-friendly and interactive, where pathologists can write their own diagnosis for a case of the week, post cases themselves to initiate a discussion, or make a comment about certain products they use. It is a great place to find information and place your advertisements as well.

 

Simply register with your e-mail, tell us where you are from (optional) and create a user name and password, then you can enjoy all the information of the site. The only reason we need your e-mail address is to be able to update you with upcoming events that may interest you, such as new lectures, new CME courses, new job opportunities and even new IHC Abs info that may be useful for your practice. We will not share your e-mail address with any third party.

 

Should you have any questions, comments or even complaints, please feel free to let us know. GoPathDx.com is here for you and your local pathology community.

 

Come and Join GoPath Global Community!

 


  1. Pathology