Get ready for global location numbers

According to a recent Dark Daily story, hospitals, clinical labs and pathology groups will soon adopt location numbers and advise that pathologists and clinical laboratory managers take time to learn about GS1 Global Location Numbers

The GLN system was created by GS1, an international non-profit organization that works to standardize supply chain systems. Remember the familiar UPCs? Universal Product Code (UPC) bar codes were a product of GS1, as were other supply chain innovations.

The goal is to provide a uniform, global system that healthcare suppliers and healthcare purchasers can use to identify physical locations where goods are delivered or where bills and invoices are received. These numbers can help track medical supplies and devices through the supply chain, even to the patient bedside if needed. Another benefit is that GLNs will be used to ensure that invoices and payments go to the correct location.

This actually sounds like a good idea.  Anyone who has spent anytime in a hospital knows that often the signage is extremely poor and can be misguiding.  Good luck finding loading docks or the appropriate office for shipping or accounts receivable.  Ditto for mail rooms.  Somehow the gift shop and cashier one can always find.

For hospital based physicians such as pathologists and radiologists, the office address may be a floor designation or building number with little reference to a specific suite number or appropriate directory infomation. 

Managers of clinical and pathology laboratories that receive supplies directly from vendors should take steps now to be sure that their facilities are in compliance with the new system. For stand-alone laboratories, the first step is to contact GS1 USA for a prefix and information on how to use the system. For medical laboratories that are part of larger legal entity, such as a hospital, health system or corporation, now would be a good time to discuss with administration whether your laboratory needs a unique identifier.

Penn State Virtual Microscopy

Very nice collection of pathology images of many diseases and conditions from numerous organ systems at Penn State Hershey College of Medicine with searchable database. Scans up to 40x and one can compare different slides at the same time.

From the FAQ section of website:

What is Neuroinfo?

Neuroinfo is a software package which was developed by MicroBrightField, Inc. to provide digital microscopy to intranets and the Internet. It provides a web server, and image server, an embedded database as an integrated package which is easy to customize and extend. The images you see are very large. They were created using a microscope with a motorized mechanism which scans many fields of view, and combines them into a large montage which we call a digital slide. Images may represent as much as 80 Gigabytes of uncompressed image data. The system provides access to any field of view at any magnification from any web browser instantly. The web siteneuroinformatica.com is an example of the functionality that Neuroinfo provides.

Neuroinfo features include

  • Viewing and zooming of images that are too big to transfer efficiently across the Internet
  • Cataloging and grouping of slides. Categories can be user-defined and cover a broad range of data that is important in the interpretation of the microscopic material
  • Annotation and discussion of virtual slides. Bookmarks of specific regions of virtual slides can be saved Lines, text, contours and other labels can be drawn on the slide in the web browser. These labels do not modify the image
  • Permission to view or edit slides can be granted to specific authenticated users
  • Full text search of all textual data including annotations
  • Measurements of length, area and counts can be made using labels drawn over the image
  • Images can be white balanced and colors can be enhanced without modifying the entire image
  • Image Server Statistics provide graphs of image server load minute-by-minute and also chart slide popularity.
  • Strict adherence to open file formats and open data access

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How does the Neuroinfo viewer display huge slide files so quickly?

Neuroinfo acts as an image server, with a Java-based slide viewer technology to serve ultra-high-resolution images rapidly and interactively on the Web. The viewer requests image data from the server one field of view at a time. As the viewer pans and zooms, additional tiles of the image are transferred. Virtual slides can be extremely large; file sizes of tens, even hundreds of megabytes, are impractical to download for viewing. The Neuroinfo technology stores these large images in a pyramidal file format, which stores multiple resolutions from the original source resolution of the microscope lens used for acquisition, down to a macro view of the entire slide or a thumbnail only a few kb in size. Each resolution level is cut into many small tiles. This enables navigating to any region of the slide at any magnification quickly.

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Why is a system like Neuroinfo important?

The advent of virtual slide technology has allowed for the widespread sharing of information contained on glass microscope slides. This is a significant technological advance, as previously the only way to share information from slides was with photomicrographs that only contained a single field of view at a single magnification. Virtual slide technology allows remote viewers to examine slides with a functionality similar to that of a microscope; users can pan to regions of interest and zoom in and out freely. Advantages to virtual slides include remote access to slides, access to slides without a microscope, and the ability to see macro overviews of slides not attainable with a traditional microscope. However, the virtual slide cannot stand alone. Information about how the slide was prepared is essential to an understanding of the material; for example, information about the stain used, species, organ, scaling information, and orientation of the tissue section is germane to any information that is to be gleaned from examination of the slide. It is necessary is to present the digital slides along with enough detail about what the slide represents to give the viewer the feeling that they are in the 'presence of an expert'.

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How can Neuroinfo be used in teaching?

Neuroinfo can be used to set up teaching web sites for students of histology and pathology, providing not only virtual slides and an interactive web-based viewer, but also information about the slide, instructional notes, links to sources of further information, and annotations overlaid on the slide image.

The University of Iowa is using MicroBrightField Technology to present a student with a slide that does not contain any annotations and is asked to explore and interpret the material. The student makes their own annotations to indicate the locations of the diseased regions of the tissue (if there are any.) The teachers can later verify that the student caught all signs of disease.

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How can Neuroinfo be used in research?

Neuroinfo is also a powerful tool for scientific collaboration and cataloguing of slide materials. Remote workgroups can be set up allowing multiple researchers to simultaneously view slide material, add annotations to the slide, and write comments to one another. Using the bioinformatics database that is a part of Neuroinfo, slide material can be quantified, analyzed and compared to other sets of data as a means to support or negate hypotheses about the experimental results contained in the slides.

Neuroinfo can be used to create atlases that show the actual tissue at a cellular level, and demark regions that correspond to a controlled nomenclature. Atlases of many more species and variations will soon be available to the scientific community. These atlases can incorporate changes through the developmental stages of a species and side-by-side views of different developmental stages can easily be created.

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How is your technology any different than the online atlases that exist today?

Other atlasing web sites have a wealth of photomicrographs and descriptions. Neuroinfo is unique in the integration of the very-large-image digital microscopy, annotation features, group-oriented exploration and documentation of features and the ability to include additional information including controlled nomenclatures. Our technology can store images that have cellular detail. It doesn't just store one field of view, but an entire slide at full magnification. The contents of Neuroinfo are authored using the web interface by authorized collaborators anywhere on the Internet. Since the entire slide is available the microscopic material can be explored and features discovered in a manner analagous to a traditional microscope.

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Isn't it true that data, and not images lead to progress in science?

Traditionally, yes. A researcher's published data and conclusions are the cornerstone of scientific progress. Neuroinfo enables the sharing of primary data when it is required. A paper in the PDF or HTML format can be created which links from black and white images to the full color full resolution microscopic material. Any question that the researcher was measuring the appropriate cells in the correct region can be conclusively verified. Other researchers with other specialties may notice and quantify phenomena that they see on the slide, adding to the wealth of information in Neuroinfo, and available to the scientific community. The microscopic material becomes the gateway to a wealth of information about a specific region of a brain whether it's at the level of gross anatomy or at the cellular level. Back

How does sharing large image sets lead to new discoveries in neuroscience and other research?

Quoting the NIH Draft Statement on Sharing Research Data:

"There are many reasons to share data from NIH-supported studies. Sharing data reinforces open scientific inquiry, encourages diversity of analysis and opinion, promotes new research, makes possible the testing of new or alternative hypotheses and methods of analysis, supports studies on data collection methods and measurement, facilitates the education of new researchers, enables the exploration of topics not envisioned by the initial investigators, and permits the creation of new data sets when data from multiple sources are combined. By avoiding the duplication of expensive data collection activities, the NIH is able to support more investigators than it could if similar data had to be collected de novo by each applicant." (NIH 2002. NIH announces draft statement on sharing research data. http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-035.html.)

The Report on Neuroinformatics from the Global Science Forum Neuroinformatics Working Group of the Organization for Economic Co-operation and Development (June 2002) states:

"A very large number of researchers working on many thousands of projects world-wide are accumulating these data. But measurements made by individual groups in the context of distinct research projects are often difficult to share in a form easily exploited by the rest of the neuroscience community. Journal publications - the current method of sharing data - present results in a highly condensed format of representative data or average values. The community urgently needs a way of sharing primary data." (23. The Report on Neuroinformatics from the Global Science Forum Neuroinformatics Working Group of the Organization for Economic Co-operation and Development (June 2002))

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How are Virtual Slides created?

The partner technology to Neuroinfo is the Virtual Slice Module in the Neurolucida and Stereo Investigator software products from MicroBrightField. This Virtual Slice module allows for automated image acquisition of an entire microscope slide at any magnification available on the microscope. The software drives the motorized stage to acquire all fields-of-view contained in the region of interest, then seamlessly stitches the fields into a single image montage. Using innovative technology from Zoomify, the images are compressed and stored in the pyramidal format described above. If acquisition systems are not available, MicroBrightField offers slide scanning services. MicroBrightField does not use its own proprietary file formats for its virtual slides; all slide files are industry standard formats viewable by 3rd party software.

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Can permission to view slides be restricted?

Neuroinfo handles authentication and permissions. Permission groups let the designated administrators create groups of users that have permission to view and edit the virtual slides and database. These users can be granted permission on a view-only basis, or can be granted permission to view, edit, and make entries in the database.

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How is the Neuroinfo database organized?

Data about slides, groups of slides, and contributors is stored in a relational database. The database architecture scales to track new kinds of information easily. The information is stored as small chunks of data, each of which correspond to a carefully crafted Definition. The different small chunks of data can be linked to each other to form groups or to one another in any combination, allowing for the creation of rich sets of connected data. All textual data is also indexed for powerful text searching.

Example: Adding A Category In order to categorize slides by ethnicity of the subject, then a definition would be created using the web interface for "Ethnicity" and then this could be populated with all the different ethnic groups. Ethnicity would automatically show up on the search page as a filter, and each ethnic group would have a page that shows all of the corresponding slides. If one researcher enters "White" and later another enters "Caucasian", there is an administrative tool to remove the unwanted duplicate, and move all associations to the correct value.

There are three distinct types of definitions that Neuroinfo uses for all contents and allows you to create.

  • Primary Data comprises the bulk of the experimental data. All Virtual Slides, paper abstracts, news items, experiments, personal journal entries, and experimental methods are stored as primary data.
  • Categories are defined to aid in grouping, filtering and otherwise categorizing your data. Any generalization that can be made about the data can be used to categorize your data. Modality, stain, species, tissue, organ, diagnosis, contributing lab or individual, etc. All categories show up on the search page as selectable options for filtering search results. They can also be used for navigation, "show me other slides that are also stained with Green Fluorescent Protein."
  • Particular details are used to add information about existing primary data. Virtual Slide Annotations are an example of data that is a particular detail of the existing Virtual Slide (which is primary data.) Measurements such as the "area of the putamen in this cross section" would also be stored this way. "Area measurements" cannot be a category, because each slide will have multiple unique measurements, and you wouldn't want the individual measurements (24.3 square microns) to show up on the search page. Particular details usually inherit the permissions of the associated Primary Data. If someone can see your slide, they are also allowed to see your annotations and measurements.

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What classification scheme do you use to index serial sections?

We support any indexing scheme by means of our innovative database structure. If the image represents pixels in an X,Y metric coordinate system, each slide also stores the Z position of the section. Additional stereotaxic parameters and relationship to gross structures are easily specified and immediately available for categorizing and searching.

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What curatorial mechanism exists to ensure data quality?

Every modification of the database updates a timestamp associated with the data. At the moment, we show recently modified database contents in a list on the home page. These can be reviewed and edited by a system administrator, or a collaborator who has editing privileges for the project the data belongs to. Mechanisms such as sending e-mail to a curator whenever data is edited can be provided.

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Can Neuroinfo provide for the Bioinformatics need for my entire project?

Definitions of bioinformatics and neuroinformatics are broad and varied. The central figure in bioinformatics is the biologist, and like a microscope the computer is now an essential tool for the biologist's understanding and research. Neuroinfo's unique capabilities will have a role in the inevitable revolution of access to microscopic material and the understanding of that material over the next decade.

Neuroinfo provides the foundation for a rich integration of digital microscopy, metadata necessary for the correct interpretation of the microscopic material, and all analysis results of the microscopic material. Resources from external databases and XML files can easily be incorporated and links to relevant genetics databases can be created. External web sites and mediator applications can be written in almost any programming language to query Neuroinfo using the XML-RPC protocol.

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What skills do I need to tailor Neuroinfo to my needs?

Changing the look of the web pages can be done easily with any html editor. We recommend Dreamweaver from Macromedia. Skills in graphic design are also desirable and can have a dramatic impact on the enthusiasm surrounding your site.

Since Neuroinfo provides a simple interface to the SQL database, no database expertise is needed. The Neuroinfo database is seeded with the most common categories likely to be used, including: staining technique, tissue, species, and section plane. New categories can be easily added from the administrative interface, and new items can be added to a category at any time. An innovative feature allows for the combination of redundant entries, so that a structure with several different names can be found with a single search of the database (for example, the word "putamen" can be combined with "lenticular nucleus" and "basal ganglia"). A basic facility with a computer is all that is needed to set up your own custom database.

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Can I use the Neuroinfo viewer in my own institutional or personal web page?

Yes. The viewer can be used with existing web sites. The viewer does require an image server, and there are several methods of integrating resources to enable virtual microscopy on your pages. We provide templates of database access from external web sites written in ASP, and PHP to do text searches, browsing contents by category, and virtual slide viewing and annotation.

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How do you handle the massive volume of data that these large slides require?

One of the largest sets of teaching material that is currently available to anyone in the world is the teaching collection at the University of Iowa. The collection consists of about 650 slides stored in the FlashPIX format which uses JPEG compression internally. The entire collection takes about 70 GB of hard drive space in it's compressed form. In just the last year, the price of a hard drive that can store 70GB of image information has dropped to about $80 US. A high performance web server that uses a RAID array to speed access and provide fault tolerance and salability might cost $3,000. Images are single files, and can be copied from computer to computer just like any other computer file.

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Is Neuroinfo actively being developed?

MicroBrightField, Inc. was recently awarded an NIH SBIR grant which will fund the continued development of Neuroinfo. MicroBrightField's customers drive the priority of new features and we will go out of our way to develop functionality necessary for a particular project.

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How much does Neuroinfo cost?

Neuroinfo is available from MicroBrightField, Inc. at a low one time cost plus a yearly maintenance contract. The cost is very low compared to the cost of having a software developer reinvent the technology. Day to day use of Neuroinfo does not require any technical support staff or programming skills. If you do have a programming staff and would like to extend Neuroinfo for your needs the Neuroinfo database layer makes complex modifications easy. Maintenance includes the customization of web page functionality for specific purposes by MicroBrightField's staff.

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What are the system requirements for Neuroinfo?

Neuroinfo will run on any machine running Windows 2000, Linux or Solaris. The power of the machine controls the number of simultaneous users you need to serve images to at one time. A 1GHz server with 256MB of RAM will handle about 12 simultaneous users all panning across virtual slides at once. Since users typically zoom in and examine the features of one location before moving on to another location, dozens of users can use a low end server at once. We highly recommend (and will configure and resell) Dell servers with 1GB of RAM, a 2.8GHz processor and a RAID array for fast disk access.

When a customer needs to handle hundreds of simultaneous viewers at once it will probably require more than one image server. For example, a class of 160 students needs to do some work just before (or during) exams. We want to ensure that the students can all see one field of view in two seconds. The server will have to be able to serve about four thousand tiles per minute. One high end server can service about 800 FlashPIX tiles per minute or about 1600 Zoomify tiles per minute. (Zoomify version 106 files are optimized for quick serving.) You will need three to five servers to handle the peak load. We provide the mechanism to delegate the image serving process to multiple machines. Since the peak load only happens a few times a semester, regular lab computers can be set up as supplemental image servers when necessary.

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Can I create 3D models of the serial sections on Neuroinfo?

Not Directly. MicroBrightField, Inc. also creates Neurolucida which has a 3D Solid Modeling module. You can see some of the results of the solid modeling module in the Neurolucida Gallery. Using Neurolucida in conjunction with virtual microscopy makes the 3D modeling process as well as quantification of your serial reconstruction very efficient.

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What aspects of Neuroinfo are open to the community and which are proprietary to MicroBrightField?

All data stored using Neuroinfo is available to anyone with sufficient permissions using a variety of data formats and software tools. The images that store the microscopic material are stored in formats that can always be converted to standard nonproprietary formats. In special cases, a source code escrow can be established in the event that MicroBrightField can no longer support the product. The only proprietary parts of Neuroinfo are the viewer, the image server and the database layer which make it easy to specialize and extend. Even the internals of Neuroinfo such as the embedded database and the tools which create the charts on the Image Server Statistics are all open source tools. The .jsp pages that format and present your data are also provided in full and we encourage you to modify them for your specialty.

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Can dial-up modem users access the digital microscope?

Yes-- if they are patient. A good modem connection gives about 48,000 bits per second. One tile of one image is typically 80,000 bits, and one field of view is about nine tiles... so a modem user might have to wait about 18 seconds for one small field of view. There is no technical problem to solve to support modem users, modems are simply limited in their transfer rate. Any viewer with DSL or cablemodem will load single fields of view within about two seconds. Using the technology on a Local Area Network gives lightening fast panning and zooming.

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How are annotations stored (what format?)

Annotations are stored in an XML-based format which describe the parameters specified when the label is drawn. Coordinates are stored in microns so that lengths and areas can be calculated without any conversion. When a boundary contour is drawn, there are several parameters which pertain not only to what is drawn, but what the region indicates, and how it behaves. Other labels such as arrows store the range of magnifications at which the arrow should be drawn. An arrow drawn at the low magnification gross view isn't useful when viewing the region at the cellular level. The architecture of the viewer allows any number of annotation tools to be added in the future. The annotation format is designed to grow as new annotation tools are needed.

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Can I use your annotation capabilities on my collection of JPEG files?

Yes. The viewer can load and pan around .jpg files by loading the entire image at once. The annotation and quantification tools are identical to those used for virtual slides. This enables researchers who already have large collections of photomicrographs to use the collaboration and quantification capabilities of Neuroinfo.

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Does it work with Zoomify?

Yes. We are completely compatible with Zoomify file formats, viewers and annotations systems. Neuroinfo provides a complete environment for people interested in Zoomify's flash-based viewer and annotation system. The annotator will even store annotations in our embedded database. We are continuing to use Java technology for our own web-based microscopy development. Neuroinfo would replace Tomcat in the zoomify instructions.

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Does it work on the Macintosh?

Yes and no. The Neuroinfo server software will run slowly on Mac OSX 10.2.2 w/ Java 1.4.1. The Java team at Apple are actively working on improving Java support, and we expect that OS X will make a good server someday, but it is not supported yet.

People who are viewing Neuroinfo content from a Macintosh will have no problems if they are running OS X version 10.2 (or later) with Java version 1.3 (or later) and the Mozilla 1.2 (or later) web browser. Mac users who are using Microsoft Internet Explorer will be able to view slides, but annotations will not control the viewer properly because IE does not support LiveConnect on the Macintosh. Viewers will see a yellow link at the top of every Neuroinfo page that encourages using the Mozilla browser for this reason.

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What if a Ritz-Carlton executive ran your hospital?

What if a Ritz-Carlton executive ran your hospital?

June 2nd, 2010

By Wendy Johnson

If you've ever been lucky enough to stay at the Ritz, you've experienced their first-rate customer service, attention to detail, inviting atmosphere, unique gift shops and scrumptious food. Could such luxurious pampering and quality translate over to the hospital environment?

It could, and it does. Bill Taylor, cofounder of Fast Company magazine, blogs for the Harvard Business Review about Henry Ford West Bloomfield, a suburban Detroit hospital that's run by former Ritz-Carlton executive Gerard van Grinsven.

It "truly must be seen to be believed," Taylor writes. The newly built hospital has 300 private patient rooms to which patients are immediately assigned upon admission. Why waste their time in the lobby filling out forms?

It also features an atrium with 2,000 live trees; a menu designed by a hot-shot chef; a concierge to assist frazzled loved ones; weekly classical concerts and a 90-seat demonstration kitchen where patients and family members can learn tips on preparing healthy meals.

It's so glam, in fact, that the hospital is hosting its first wedding next month.

If your first reaction is skepticism and even a bit of eye-rolling, you're not alone. Grinsven's ideas weren't exactly welcomed by Motor City's healthcare establishment. Sure, private rooms are great in theory, but how can a hospital maximize revenue that way? What the heck did this guy know about running a hospital?

Turns out, Grinsven's experience was more applicable to healthcare than most folks imagined. Though private rooms appear to be a fancy luxury, they actually save money in the long run: "They significantly reduce rates of infection in the hospital and add to the personal privacy of patients," he told Taylor.

You can read the full interview and article at the HBR Blog.

Wendy Johnson is the publisher of FierceHealthcare and a longtime healthcare journalist. She can be reached at wjohnson@fiercemarkets.com.

A CEO’s Guide to Molecular Diagnostic Reimbursement: Navigating the Many Challenges of Reimbursement and Commercialization

FREE Special Edition White Paper

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CEO's Guide to Molecular FREE White Paper

Reimbursement and commercialization are significant challenges in this era of personalized medicine and comparative effectiveness. Many traditional clinical laboratories and early stage startup companies are trying to enter this space and are struggling to evaluate both the market and its offerings. According to Gene Tests, a publicly funded medical genetics information resource, the availability of new diagnostic tests increases 10% annually. However, there is a 20% increase in the utilization of genetic tests per year versus a 1% to 3% increase in non-genetic diagnostic tests per year.

In 2007, for example, genetic tests cost Aetna 70 cents per member per month as an aggregate. These numbers are increasing. In 2005/2006 genetic testing comprised 17% of Aetna’s testing dollars; in 2006/2007 it was 21%.

Some view genetic testing technologies as disruptive to traditional physician practice patterns as well as to pharmaceutical companies, who may now have patient criteria limitations on their next potential blockbuster. Depending upon the source, it is believed that only between 9% and 21% of physicians use genetic tests. Many physicians say they don’t understand genetic tests well enough to use them effectively. It is imperative, therefore, that the molecular diagnostic industry improves its messaging and ability to educate physicians. There are many misperceptions regarding the capabilities of well validated genetic tests. Because genetic testing has proven to be valuable for the prognosis, diagnosis and management of many diseases, the commercial potential is quite significant.

The Dark Report is happy to offer our readers a chance to download our recently published White Paper “A CEO’s Guide to Molecular Diagnostic Reimbursement: Navigating the Many Challenges of Reimbursement and Commercialization” at absolutely no charge.

Download Your Report Now!

The following are some of the questions to consider when creating a business plan for commercialization of a genetic test:

  • How can clinical utility be established prior to launch?
  • What is the current environment in your targeted diagnostic area?
  • What is the fully loaded cost of goods?
  • What will your billing capabilities be?
  • What will your billing policies and rules include?
  • Diagnostic Kit or Laboratory Developed Test?

Download Your Report Now!

Table of Contents:

Preface - Page 3

Chapter 1. Considerations for Commercialization and Reimbursement of a New Molecular Diagnostic - Page 5

Chapter 2. The Road to Coverage - Page 10

Chapter 3. Reimbursement Options for Molecular Tests - Page 15

Chapter 4. Coverage and Contracting for Molecular Tests - Page 18

Chapter 5. Conclusions - Page 23

Appendices:

A-1 About Rina Wolf - Page 25

A-2 About XIFIN Inc. - Page 26 A-3 About DARK Daily - Page 27

A-4 About The Dark Intelligence Group, Inc., and THE DARK REPORT - Page 28

A-5 About the Executive War College on Laboratory Pathology Management - Page 29

A-6 About Karen Appold - Page 31

Terms of Use - Page 35 

 

Register here to download the White Paper NOW! Simply complete the form below and click on SUBMIT! If you have any problems please call: 512-264-7103 or email us

Diagnostic Kit or Laboratory Developed Test?

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Abstracts Solicited for the Pathology Informatics 2010 Conference in Boston on 19-22 Septembe

Courtesy of labsoftnews.com:

The Pathology Informatics 2010 (PI-2010) conference will take place in Boston. MA, on 19-22 September, 2010. Abstracts for scientific sessions and e-posters are being solicited in connection with the conference with a firm deadline of July 30 for both categories. PI-2010 is the largest and most comprehensive pathology informatics CME event in the country and has been created by the merger of two predecessor conferences of long standing, APIII in Pittsburgh and Lab InfoTech Summit in Pittsburgh. The former has a 14 year history in Pittsburgh and the latter was presented for 21 years and Las Vegas and Ann Arbor. The latter event was known as AIMCL. The conference web site is now up-and-running. Details about the three content tracks (applied informatics, imaging informatics, and advanced/experimental informatics), plenary lectures, and workshops are availableas well as on-line registration.

Here is an overview of the scientific sessions:

The Scientific Sessions will consist of a series of 15 minute talks, each of which is immediately followed by questions which are posed by the audience. Researchers interested in presenting as part of these sessions should submit a 350 word abstract. There is particular interest in submissions that focus on three main areas of sub-specialization: pathology informatics, biomedical informatics, molecular pathology and imaging. 

Here is a summary of the e-posters being solicited:

E-poster presentations are similar to traditional poster presentations but are presented directly from the Internet using a PC. E-posters may take several forms including a PC-driven PowerPoint presentation, a live demonstration of a Web site, or other Web-based media. 

A total of 36 exhibitor have now committed to participation in PI-2010 and it is anticipated that more that 40 or more will be present by the time of the event. Make your plans now to submit an abstract or register for this mega-event. I am a member of the conference planning group and am sure that you won't be disappointed.

Telecytopathology for immediate evaluation of fine-needle aspiration specimens

I was recently asked to write an editorial for Cancer Cytopathology on "Telecytopathology for immediate evaluation of fine-needle aspiration specimens" for an upcoming edition of the journal when an article looking at implementing a solution for this purpose will be published.

This article has been published in electronic form ahead of print.  If you can access the journal the DOI is 10.1002/cncy.20079.

In the course of writing the editorial, I reference an article written by multiple authors about 10 years ago as part of a consensus panel with guideline for the practice of cytology with "new" technologies that existed then.  The questions raised by that group involved field selection, resolution, focus, z-stack focusing, liability concerns with diagnoses made at a distance, reporting requirements, etc...

While the technology is no longer "new" many of these issues and concerns persist unfortunately for the cytology community in particular.  The article the editorial is based on reviews nearly 500 FNA cases reviewed remotely with very high diagnostic concordance that is important for several reasons.  Namely, the inexpensive nature of the system, ease of use, and clear situations where false negative cases may be encountered. 

If I am able to do so, will provide copies of the articles when they are published.

Definiens Digital Pathology Webinar Announcement: SOX2 Evaluation in NSCLC using Definiens Tissue Studio

From Digital Pathology Insights

Date: June 10th, 2010

Time: 11am EDT / 4pm GMT

Join us for a webinar: SOX2 Evaluation in Non-small Cell Lung Cancer using Definiens Tissue Studio.

In this talk, a study on SOX2 amplification in non-small cell lung cancer with a special focus on IHC assessment using Definiens Tissue Studio image analysis software will be presented.

The aim of the study was to verify SOX2 amplification and protein over-expression in non-small cell lung cancers (NSCLC) and to compare these results with patient and tumor characteristics. A total of 940 NSCLCs from two independent population-based cohorts containing predominantly adenocarcinomas of the lung and squamous cell lung carcinomas, were assessed by fluorescence in-situ hybridization (FISH) and immunohistochemistry (IHC) to study SOX2 amplification and expression level. For protein expression analysis, the expression level was explored by utilizing Definiens Tissue Studio.

Speakers:

  • Sven Perner: Assistant Professor – Institute of Pathology, Comprehensive Cancer Center, University Hospital Tuebingen
  • Theresia Wilbertz: PhD Candidate – Institute of Pathology, Comprehensive Cancer Center, University Hospital Tuebingen
  • Peter Duncan: Director of Marketing and Business Development – Definiens

Space is limited. Reserve your webinar seat now at:

https://www2.gotomeeting.com/register/654854170

Who is on your “A team”?

During a recent discussion with one of my colleagues he asked me if I could think of 5 people who I have worked with, done business with, worked for or supervised that would constitute my "A team".

He then gave me a couple of names on his "A team".  Among them was a former chairman, former hospital administrator and a couple of pathologists, past and current that would make up the team.

5 names quickly came to mind from my perspective that would be solid leaders, administrators, managers and diagnosticians whose ethics and integrity were beyond reproach.

One of the key people on my dream "A team" was also a former chairman and prior chair of anatomic pathology in the same department many years ago while I was at Walter Reed.  

One of the many important lessons I learned from her was the ability to work with people you many not normally choose to work with in an environment where there was little control regarding new hires, transfers and folks moving to other assignments when their time came.

Important lessons for any organization, particularly one on a large scale, but equally valuable or more valuable even in smaller organizations.

A few of her key attributes among many was also the ability to know what she did not know, delegate when necessary and know when certain goals were not going to be measurable or achievable.   She was also wiling to listen to any idea or criticism but you needed the data to back it up for anything to move forward. If you had strong justifications, the support would be there.  If anything appeared misleading, she could detect it.  

Who is on your "A team"?

PATHOLOGY VISIONS ABSTRACT DEADLINE EXTENDED TO JUNE 15

The deadline to submit abstracts for oral and poster presentations has been extended to June 15! To submit your abstract, click here.

Poster presenters will be given a two-day display opportunity. Outstanding posters will be eligible to receive complimentary conference registration.

As a presenter, you can share your experiences and discuss potential uses for digital pathology in the future. Submission topics include:

  • Business Case/Reimbursements
  • Cytology
  • Diagnostic Pathology
  • Disease-Specific
  • Drug Development
  • Education
  • Frozen Sections
  • Hematopathology
  • Image Analysis
  • Immunohistochemistry (IHC)
  • Informatics
  • IT
  • Personalized Medicine
  • Research Applications
  • Telepathology
  • Toxicologic Pathology
  • Validating Algorithms

To submit your abstract, click here.

ABOUT PATHOLOGY VISIONS

Pathology Visions is the annual meeting of the Digital Pathology Association, held October 24-27, 2010, at the Sheraton San Diego Hotel and Marina on the beautiful San Diego bay. Enjoy thought-provoking discussions on digital pathology applications and enrich your conference experience through the following:

  • Exciting presentations on new applications
  • Peer-to-peer discussions on digital pathology
  • Hands-on workshops
  • Scientific poster sessions
  • Digital pathology demonstrations
  • Networking events

ABOUT THE DIGITAL PATHOLOGY ASSOCIATION (DPA)
The mission of the DPA is to facilitate awareness of digital pathology applications in healthcare. Members are encouraged to share best practices and promote the
use of the technology among colleagues in order to demonstrate efficiencies, awareness, and its ultimate benefits to patient care. To learn more or apply for membership, visit http://www.digitalpathologyassociation.org
 
 
 
For more information, visit
http://www.pathologyvisions.com

First edition of Journal of Pathology Informatics has been published!

The first edition of JPI has been published. Congratulations again to Liron Pantanowitz and Anil Parwani for making this happen as quickly as they did.

Please open the following link to view it:
 
http://www.jpathinformatics.org/browse.asp

Stepwise approach to establishing multiple outreach laboratory information system-electronic medical record interfaces
Pantanowitz Liron, LaBranche Wayne, Lareau William
J Pathol Inform 2010, 1:5 (26 May 2010)
Cytologic evaluation of image-guided fine needle aspiration biopsies via robotic microscopy: A validation study
Cai Guoping, Teot Lisa A, Khalbuss Walid E, Yu Jing, Monaco Sara E, Jukic Drazen M, Parwani Anil V
J Pathol Inform 2010, 1:4 (26 May 2010)
Overview of laboratory data tools available in a single electronic medical record
Kudler Neil R, Pantanowitz Liron
J Pathol Inform 2010, 1:3 (26 May 2010)
Development and use of a genitourinary pathology digital teaching set for trainee education
Li Li, Dangott Bryan J, Parwani Anil V
J Pathol Inform 2010, 1:2 (26 May 2010)
Introducing the Journal of Pathology Informatics
Pantanowitz Liron, Parwani Anil V
J Pathol Inform 2010, 1:1 (26 May 2010)

BioImagene to show its digital pathology solutions at European Congress

Comany sees increasing European demand for BioImagene solutions prompts expansion

Berlin, Germany,  May 27, 2010 – BioImagene, Inc., the leading provider of end-to-end digital pathology solutions, launched its suite of digital pathology solutions in Europe. The company will showcase these digital pathology solutions at the Woche der Pathologie Congress in Berlin, which takes place from May 27-30, 2010.

The solutions can also be viewed at the 10th European Congress on Telepathology and 4th International Congress on Virtual Microscopy, that will be held in Vilnius, Lithuania from July 1 – 3, 2010.

 to read the full press release.

Hastings Center Report – Medical Tourism

Came across this interesting article from The Hastings Center Report © 2010 The Hastings Center by I. Glenn Cohen reprinted on Medscape. The numbers and scenarios are staggering.  Its worth the read.

Medical Tourism: The View from Ten Thousand Feet

Medical tourism—the travel of patients from their home country to another for the primary purpose of seeking medical treatment—is already big business. In 2005, Bumrungrad International Hospital in Bangkok, Thailand, saw 400,000 foreign patients, 55,000 of whom were Americans, and centers in India, Malaysia, Singapore, Mexico, and elsewhere also attract significant foreign patient populations. Some of these patients are seeking care that is unavailable at home, such as surrogacy services or stem cell treatments. Others are uninsured or underinsured Americans looking for price savings (in some cases upwards of 80 percent) compared to what they would pay out of pocket in the United States. 

Governments, too, have taken interest. The U.S. Senate held a hearing, "The Globalization of Health Care: Can Medical Tourism Reduce Health Care Costs?" West Virginia considered (but ultimately rejected) a bill that would have given its public employees financial incentives to get treatment abroad (something many self-insured U.S. firms already do). Texas has taken steps to ban insurers from making their covered populations use health care services abroad. 

Medical tourism raises a panoply of legal and ethical questions. In this short space I offer only the view from ten thousand feet, setting out the different types of medical tourism and the kinds of concerns they can pose. Consider this as a statement of a kind of research agenda, one that I hope readers will join me and other scholars in developing. 

One can usefully distinguish three kinds of medical tourism.

Medical tourism for services that are illegal in both the patient's home and destination countries. Organ sale, which is illegal in all countries except Iran, is a good example. While in such cases both the patient's home and destination countries have decided to ban the practice, medical tourism raises a set of questions about extraterritoriality and the coordination of domestic and foreign regimes of criminal law. If a foreign country criminalizes organ sales but has a lax enforcement regime that essentially tolerates a gray market, should the United States use also its own criminal law against its citizens that purchase organs abroad? One model here would be the Protect Act of 2003, which levies either a fine or thirty years in prison or both in the United Statesfor any U.S. citizen or permanent resident "who travels in foreign commerce, and engages in any illicit sexual conduct" including "any commercial sex act … with a person under 18 years of age." Another possible approach (that is potentially even more draconian) currently in place to curb organ tourism is sketched in Medicare regulations requiring that physicians inform patients seeking organ transplantation that transplantation by an unapproved center "could affect the transplant recipient's ability to have his or her immunosuppressive drugs"—required to avoid tissue rejection—"paid for under Medicare Part B."

One set of ethical questions is whether these approaches go too far in their penalties; perhaps we should defer to the level of enforcement and penalties in the destination country. A corresponding set of pragmatic questions asks how we can do a better job of detecting this kind of medical tourism if we decide to penalize it through domestic criminal sanction.

Another set of questions focuses on the duties of U.S. doctors. If a patient is waiting for an organ and appears unlikely to get it, does his doctor have a duty if asked to inform the patient of better versus worse transplant centers dealing with such purchased organs abroad, or at least to refer the patient to a colleague who will? May a physician faced with a patient she determines has purchased an organ abroad and who now requires follow-up care decline to provide that care? Can she decline only if she finds another physician willing to provide care?

Medical tourism for services that are illegal in the patient's home country but legal in the destination country. Let me give three quite different examples of what might fall within this second category: (1) A same-sex married couple has difficulty in securing a traditional surrogate in their home state of Massachusetts (where surrogacy agreements involving compensation to traditional surrogates are unenforceable) and turns to a clinic in the village of Anand, India, where many women serve as surrogates and a clinic offers surrogacy services at one-third of the cost in the United States. (2) A patient with squamous cell carcinoma has run out of treatment options approved by the Food and Drug Administration and is also barred from joining a clinical trial of the experimental drug Erbitux because she does not meet the inclusion criteria, but travels to France, where the drug is available for purchase. (3) A patient travels abroad for physician-assisted suicide, which is illegal in her home country. 

These cases raise many interesting questions: for the surrogacy case, should we respect a country's sovereignty in deciding that this form of "exploitation" is not worthy of legal condemnation, and does the answer depend on our views about whether the exploited group was sufficiently enfranchised and able to participate in the democratic process? Should we view the development of fertility tourism markets as a welcome "safety valve" to our domestic prohibition, or should we instead view ourselves as responsible for creating the market through our domestic prohibition and thus complicit in whatever exploitation occurs?

For the assisted suicide or surrogacy case, if the fear is "corruption"—if we fear that the practice will change moral attitudes and lead to disrespect of the female body or those at the end of life then is the corruption likely to be contagious across cultures? For the drug case, will medical tourism make it more difficult to recruit people for randomized, double-blind clinical trials of experimental drugs in the United States? Does medical tourism produce problematic socioeconomic status inequalities in access to experimental drugs, in that the wealthy can travel abroad, while the poor cannot?

If, based on any of these concerns, we decide we want to try to reign in our citizens' activities abroad, then we face difficult challenges in designing regulation. Detection can be difficult if the activity is sanctioned—and, therefore, not policed—in the destination country (although our control of immigration may allow us to detect cases of fertility tourism).

Medical tourism for services legal in both the home and destination countries. Traveling to India for cardiac bypass or to Thailand for hip replacement is paradigmatic of this kind of medical tourism, which may result from purchasing care either out of pocket (sometimes via an intermediary) or through an insurer that gives incentive to seek treatment abroad. For example, the West Virginia bill discussed above would not only have covered travel, lodging, and sick leave for the employee using medical tourism but would also have waived all deductibles and copayments, as well as offering the employee a "rebate" of up to 20 percent of the cost savings realized by undergoing treatment in a foreign facility. We can usefully divide the issues raised by this kind of medical tourism into three categories.

The first category, patient-protective concerns, focuses on the welfare of the tourist-patient. The concerns are both about the quality of care and, should medical error occur, about medical malpractice recovery. Here we face both theoretical and practical difficulties in trying to provide patients with the kind of information needed to make informed choices. We also face questions about the limits of justified paternalism, and whether a laissez-faire approach to medical tourism can be squared with our domestic practice of prohibiting the contractual waiver of medical malpractice or the protections of state licensure statutes. The answers to these questions (and our policy options for intervention) differ depending on whether medical services abroad are purchased out of pocket or are prompted by an insurer.

A second category, concerns about others in the home country, looks at the possible effect of medical tourism on the cost and availability of health care in the home country. If patients frequently seek care abroad, will that fact dampen or promote efforts to secure universal access to health care? Will increased competition from global providers have salutary or destructive effects on the U.S. health care industry? Would regulatory competition give legislators incentives to weaken or strengthen parts of health care law, and would those changes be beneficial? Would it further fragment insurance markets, or would the volume of medical tourism expected be too small?

A final category consists of concerns about patients in the destination country. These require both an examination of how medical tourism affects access to health care for patients who live in the destination country and a normative analysis of our obligations to people in those countries. If medical tourism improves access to health care for people in the United States while limiting access in the destination country (a big "if," to be sure), is that a reason to curb the practice? This in turn depends on how we resolve practical questions about how to curb medical tourism and theoretical debates about different conceptions of global justice.

The globalization of health care is an increasing fact of life. Medical tourism is but one piece of that puzzle. Beyond posing ethical and regulatory challenges in its own right, medical tourism offers us a welcome opportunity to reexamine some fixed stars in the constellation of domestic health care regulation.

References

  1. A. Milstein and M. Smith, "America's New Refugees—Seeking Affordable Surgery Offshore," New England Journal of Medicine 355 (2006): 1637.
  2. See D.M. Herrick, "Medical Tourism: Global Competition in Health Care," NCPA Policy Report No. 304, November 2007, at 14, table 1, available at http://www.ncpa.org/pdfs/st304.pdf; The Globalization of Health Care: Can Medical Tourism Reduce Health Care Costs? Hearing before the Special Senate Committee on Aging, 109th Cong. 1, 18 (2006) (statement of Dr. Arnold Milstein), available at http://purl.access.gpo.gov/GPO/LPS78404.
  3. Ibid.; H.B. 2841, 78th Leg. (W. Va. 2007); Tex Ins. Code Ann. sec. 1215.004 (Vernon 2008).
  4. I offer in-depth analysis of patient protection concerns about medical tourism in "Protecting Patients With Passports: Medical Tourism and the Patient-Protective Argument," Iowa Law Review 95 (forthcoming, 2010), draft available at http://ssrn.com/abstract=1523701. Other excellent work in this emerging field includes N. Cortez, "Patients without Borders: The Emerging Global Market for Patients and the Evolution of Modern Health Care,"Indiana Law Journal 83, no. 1 (2008): 71–131; T.R. Maclean, "The Global Market for Health Care: Economics and Regulation," Wisconsin International Law Journal 26, no. 3 (2008): 591–645.
  5. 18 U.S.C. sec. 2423(c), (f).
  6. 42 C.F.R. sec. 482.102(b)(9).
  7. These hypotheticals are loosely based on real world events. See A. Gentleman, "India Nurtures Business of Surrogate Motherhood," New York Times, March 10, 2008; R.R. v. M.H., 689 N.E.2d 790 (Mass. 1998); Culliton v. Beth Israel Deaconess Medical Center, 756 N.E.2d 1133 (Mass. 2001), and Complaint, Abigail Alliance for Better Access to Developmental Drugs v. McClellan, No. 03–1601 (D.D.C. Jul. 28, 2003), and R (Purdy) v. DPP (2009) UKHL 45.
  8. See I.G. Cohen, "Note, The Price of Everything, the Value of Nothing: Reframing the Commodification Debate,"Harvard Law Review 117 (2003): 689–710.

Hamner Institutes for Health Sciences Selects Definiens Software For Liver Toxicology Study

North Carolina-based Hamner Institutes for Health Sciences has selected Definiens image analysis software for comprehensive liver toxicology study

The Hamner Institutes will utilize Definiens TissueStudio and Definiens Developer XD to develop an application that automatically analyzes images of liver tissue slides. The application will identify and quantify apoptotic nuclei in hundreds of whole-slide liver tissue section images, expediting the image analysis process.

Staining liver tissues with terminal transferase and biotin-16-dUTP antibodies (TUNEL Fluorescent Staining), researchers at The Hamner Institutes aim to measure changes in the background rate of apoptosis following chemical treatment.

The goal of the study, which includes 1680 slide sections from 168 animals and is projected to conclude in the spring of 2011, is to better understand whether changes in the background rate of apoptosis contribute to the tumor-promoting effects of the chemicals studied.

According to Definiens, the addition of TissueStudio and Definiens Developer XD provides The Hamner Institutes with the ability to analyze large numbers of histological and cell-based images to study these chemical effects.

Definiens image analysis software provides the flexibility to generate and modify algorithm rule-sets to identify and measure rare occurrences, such as apoptosis in liver tissue sections.

The Hamner Institutes plan to conduct a pilot study to statistically detect changes in the background apoptosis rate following chemical treatment and, eventually, measure the change in background rates of apoptosis in a full-time course and dose-response study.

Russell Thomas, senior investigator and director of genomic biology and bioinformatics at The Hamner Institutes, said: “We are using Definiens digital pathology software to measure small changes in the background rate of apoptosis. This capability allows us to assess the effects of chemicals at environmentally-relevant doses. Initial studies demonstrated that Definiens’ software delivers highly accurate and reproducible analysis results.”

Thomas Colarusso, general manager and vice president sales North America for Definiens Life Sciences division, said: “Definiens’ digital pathology software is uniquely suited to the complex challenges of this liver toxicology study. Our context-based image analysis technology will enable The Hamner Institutes to automate, identify and quantify biomarkers quickly and efficiently.”

CBLPath Announces Department of Integrated Diagnostics

Saw this press release yesterday that looks interesting.  Admittedly I do not know much about CBLPath beyond what I saw on their website.  It seems they are a national subspecialty laboratory independent of a clinical facility associated with the laboratory.  While news such as this always seems exciting I often wonder how one gets from diagnosis through integrated diagnostics to personalized treatment at a distance from the bedside.  I am not being critical of the effort but certainly to do so from a free standing laboratory merging data and integrating that information without the convenience of "next door" communications and outcomes analysis seems like a challenge particularly in an effort to reduce redundancy with potential information being obtained from, resulted from and reported to numerous physicians and health care settings.  The flip side is with such models is that local pathologists and physicians may have access to many sources of disparate data that may be able to integrate in the care of an individual patient.

Look forward to seeing where this may go.

RYE BROOK, NY -- 05/17/10 -- CBLPath today announced the creation of its new Department of Integrated Diagnostics under the direction of Madeline Vazquez, M.D., who is based at the company's Manhattan Reading Station in New York City.

This new department provides a convergence of laboratory diagnostics, medical imaging and digital medicine solutions, resulting in improved patient care from diagnosis and prognosis through to treatment.

"By integrating electronic patient information from the laboratory and imaging systems, the process of diagnosis becomes faster and patient care becomes more cost effective, with a reduced possibility of redundant testing," said William W. Curtis, CBLPath Chairman and CEO. "The creation of our Integrated Diagnostics department is just one more way that CBLPath is providing novel solutions to support the convergence in the pathology market."

Chief Medical Officer Carlos D. Urmacher, M.D. concurs that the focus of this new offering is clearly on the patient. "Anatomic pathology is changing and the role of the pathologist is becoming more 'patient-centric,' moving the field beyond proficient diagnostic reporting to advanced integrated reporting," he said.

Although sharing similar aims with CBLPath's existing Histology and Cytology Departments, the Integrated Diagnostics Department will function independently with specific goals, objectives and expectations set forth by Dr. Vazquez in concert with the leadership of the laboratory, the Medical Department and Dr. Urmacher, who tapped Vazquez for her leadership ability and initiative.

"Under the direction of Dr. Vazquez over the past year, CBLPath's small reading station in Manhattan has experienced tremendous growth and exhibits great potential for expansion and achievement," Dr. Urmacher said. "We anticipate that this growth pattern as led by Dr. Vazquez will continue on with our Integrated Diagnostics Department."

Dr. Vazquez is well renowned and respected nationally and internationally for being at the forefront of her field. Prior to joining CBLPath, she was the Chief of Cytopathology at New York Presbyterian Hospital-Weill Cornell. She pursued her specialty training in the Aspiration Biopsy Services of New York University Medical Center and the Karolinska Hospital in Stockholm, Sweden.

In addition to her clinical work, Dr. Vazquez actively participates in a number of professional societies and organizations. She is a Committee Member of the American Society of Clinical Oncology/International Association for the Study of Lung Cancer (ASCO/IASLC) Consensus Conference on Bronchoalveolar Cell Carcinoma, a Member of the Steering Committee of the International Early Lung Cancer Action Program (I-ELCAP), a Contributor to the World Health Organization (WHO) Classification of Tumors, and an ELCAP Cytologist of the International Consensus on Screening for Lung Cancer.

Dr. Vazquez has served as guest lecturer at many national and international conferences and she is the author of numerous peer-reviewed articles, book chapters, and abstracts.

About CBLPath
CBLPath is a national specialty lab offering a full convergence of anatomic, molecular and digital pathology services. The company provides a one-stop solution for comprehensive sub-specialized diagnostics, and timely, accurate, patient-centered disease management guidance. Through its Best Practice™ Partnership Program, CBLPath partners with pathologists to help them grow their practices, while giving them the ability to stay independent and "keep medicine local." The company also provides sub-specialty physicians access to comprehensive, high-quality testing in their local market. Founded in 1988, CBLPath established a reputation for providing timely, highly accurate diagnoses along with extraordinary customer service and a true patient-centered commitment. For more about the company, please visit http://www.CBLPath.com.

“This is what your healthcare is going to look like.”

Last month I was in a post office standing in a particularly long line for that location. The line eventually extended beyond the lobby and outside the doors. The delay seemed to stem from the fact that this was between 12 and 1 PM when there were several customers and only 1 staff member during a busy day and time. The situation was made worse by the fact that the staff person was trying to assist an elderly customer who was asking for an unusual denomination for a particular stamp to go to a particular place somewhere in the world. And she wanted to write a check and appeared to have a terrible tremor which made writing clearly difficult. Plus you have to retrieve and show valid photo ID when presenting the check to the post office.

These things happen. It was going to cost me an extra 10-15 minutes.

An equally elderly customer about 5 people behind me yelled out “This is what your healthcare is going to look like”.

I disagree. We can only hope healthcare reform allows for what I consider a normally efficient service.

For some of the shortcomings of the US mail, with its rigid policies and procedures I can count on 1 finger the number of times an intended delivery or sent item was not received over several decades of using the US mail for pen pals, college applications, med school applications, licensing forms and business transactions. Of course, e-mail and other electronic services have minimized the necessity for traditional “snail mail” services which has affected the bottom line for the quasi-governmental organization. I find the need for delivery confirmation or certified letters to be negligible given the time and accuracy of mail delivery.

Let’s assume some components of the healthcare reform do look governmental or quasi-governmental if you don’t have “private insurance”. Having worked and received care in military, VA and large academic institutions, my experience is that quality overall is the same, the speed (meaning wait time from definitive diagnosis to definitive care/management) varies greatly with access issues and beaurocratic inefficiencies sometimes causing delay between getting seen and getting treated. While commerical hospitals are not immune from their own inefficiencies, generally access is simplified and referrals are timely.

So, while your health and your mail are not the same, if 42 cents buys you 2-3 day delivery at the expense of a few minutes to get it going, perhaps cost can be controlled with quality outcomes with reasonable wait to get the necessary service particularly for those who would not normally be afforded these services or for whom alternatives are not available.

Would it be so bad if healthcare ran like the post office?

Case of the Week 52

The following images were taken from a Giemsa-stained peripheral blood smear. The different stages of the organism shown represent a single species, and each stage is characteristic for this species. The stages are so characteristic, in fact, that each has an ‘unofficial’ name (e.g. nick-name) or description.

Question 1 – What organism (genus and species) is shown?
Question 2 – What is the nick-name of each stage?

Up-to-date News from BioImagene

The folks over at BioImagene sent over a summary of the latest BioImagene news.  Over the past several months they have brought several new products and applications to market.

Had a chance to see try out the slide input device and thought the responsiveness and accuracy was very good.  As I have mentioned before, the mouse is not the best human user interface tool and perhaps this is one more step towards moving digital pathology to "as fast as glass". 

Check out their other products and services below.

Digital pathology (DP) applications are gaining acceptance in the clinical, academic, and research markets, and BioImagene is at the forefront of several innovative technological advances sweeping this industry.

In the past few months, BioImagene has launched a new slide scanner, announced the availability of a new input device to transform the viewing experience of digital pathology images, unveiled a new version of its DP software, and entered into collaborations with several leading pathology vendors and academic medical centers, to further the development of next generation digital pathology solutions.

This email will keep you up-to-date on the latest BioImagene news from the past few months, by summarizing our most recent press releases:

BioImagene launched the iScan Coreo Au Slide Scanner and
Introduced the next generation of Virtuoso Digital Pathology Software
.

This marked a key milestone for the industry as it unequivocally took the speed of scanning and viewing to benchmark levels.

BioImagene’s Virtuoso digital pathology workflow software is now integrated with several market-leading anatomic pathology (AP) laboratory information systems (LIS).

The Virtuoso - LIS integration enables sharing of data between the two systems in the pathology laboratory, making critical information readily available to pathologists, and increasing pathology efficiency.

BioImagene adds New Companion Algorithms for Colon Cancer in their Virtuoso Digital Pathology Software.

Virtuoso is the only digital pathology software in the industry today to offer users Companion Algorithms to reproducibly quantify immuohistochemical stains used in breast, prostate, and colon cancers.

BioImagene announced the availability of the iSlide input device, an innovative device that allows pathologists to use a microscope-like interface to manipulate digital images of slides.

BioImagene is also the platinum sponsor of PathXchange (Px), a leading social networking tool for the pathology community. Px conducted its first trans-Pacific digital case conference between two leading hospitals in Mumbai, India and the University of Nebraska Medical Center (UNMC).

PathXchange (Px), also announced the launch of Px Athena, an eLearning management system with Web 2.0 capabilities. Px Athena utilizes digital pathology technologies to provide a comprehensive online research and education solution to the academic pathology communities.

BioImagene also recently attended the annual USCAP meeting where we conducted a seminar series on digital pathology, amongst other events. To view a video of our presence at the meeting, click here.
To learn more about our company, please visit http://www.bioimagene.com.

Errata and miscellaneous news

OK.  Lot of e-mails on my previous post about the post office and healthcare.  Apparently readers are unable to comment on the blog.  Since Typepad changed their platform to compose posts this has been a recurring problem. I have always kept comments open and unmoderated.  Will ask Typepad to look into this again.  The good news is there are no spam comments either.

Someone mentioned it costs 44 cents to mail a letter.  Not 42 cents.  Thanks for the correction.

In other news, Walgreens has decided not to sell Pathway Genomics genetics kits since the FDA has intervened.  I was really hoping I could run down to my corner drugstore and pick one of these up.  I think it wise for the FDA to do what they did and for Walgreens to postpone for the time being retailing this product.  There are still too many unanswered questions someone may be left with to have the ability to manage without appropriate reason for screening.

And finally, the US Census Bureau confirms preliminary data that more US residents claim a jail cell rather than a college dormitory room as their residence. Let's hope college students weren't as diligent about returning the forms or were counted elsewhere skewing the data.

“This is what your healthcare is going to look like”

Last month I was in a post office standing in a particularly long line for that location.  The line eventually extended beyond the lobby and outside the doors.  The delay seemed to stem from the fact that this was between 12 and 1 PM when there were several customers and only 1 staff member during a busy day and time.  The situation was made worse by the fact that the staff person was trying to assist an elderly customer who was asking for an unusual denomination for a particular stamp to go to a particular place somewhere in the world.  And she wanted to write a check and appeared to have a terrible tremor which made writing clearly difficult.  Plus you have to retrieve and show valid photo ID when presenting the check to the post office. 

These things happen.  It was going to cost me an extra 10-15 minutes. 

An equally elderly customer about 5 people behind me yelled out "This is what your healthcare is going to look like". 

I disagree.  We can only hope healthcare reform allows for what I consider a normally efficient service.

For some of the shortcomings of the US mail, with its rigid policies and procedures I can count on 1 finger the number of times an intended delivery or sent item was not received over several decades of using the US mail for pen pals, college applications, med school applications, licensing forms and business transactions.  Of course, e-mail and other electronic services have minimized the necessity for traditional "snail mail" services which has affected the bottom line for the quasi-governmental organization. I find the need for delivery confirmation or certified letters to be negligible given the time and accuracy of mail delivery.

Let's assume some components of the healthcare reform do look governmental or quasi-governmental if you don't have "private insurance".  Having worked and received care in military, VA and large academic institutions, my experience is that quality overall is the same, the speed (meaning wait time from definitive diagnosis to definitive care/management) varies greatly with access issues and beaurocratic inefficiencies sometimes causing delay between getting seen and getting treated.  While commerical hospitals are not immune from their own inefficiencies, generally access is simplified and referrals are timely. 

So, while your health and your mail are not the same, if 42 cents buys you 2-3 day delivery at the expense of a few minutes to get it going, perhaps cost can be controlled with quality outcomes with reasonable wait to get the necessary service particularly for those who would not normally be afforded these services or for whom alternatives are not available. 

Would it be so bad if healthcare ran like the post office?