March 10, 2010
more tweeting!
March 05, 2010
Google Health gains partners
CNet reports Google Health gains partners:
Huh, interesting. With their relationships with Mayo and Cleveland Clinic, Microsoft’s HealthVault looked to have leading momentum in the public EHR space, but I guess we can’t count out Google quite yet.Google is moving forward in the booming health care technology market.
The search giant this week announced several new partnerships designed to expand its free Google Health service.
Google Health is the company's attempt to offer an online medical portal where you can research medical conditions and issues, find doctors and health care professionals, and track down other health-related Web sites. You can also compile and store a health profile by adding test results, names of medications, insurance information, and electronic medical records from your computer or from third-party partners.
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Additionally, Google is teaming up with the University of Pittsburgh Medical Center (UPMC), Citizen Memorial Healthcare (CMH), and Iatric Systems. Patients who use these providers will now be able to link their Google Health accounts to retrieve and organize their medical records.
March 03, 2010
Omnyx Licenses Olympus Digital Pathology Patents
Omnyx Licenses Olympus Digital Pathology Patents:
Olympus America Inc. has signed a nonexclusive worldwide licensing agreement with Omnyx, LLC, a joint venture of GE Healthcare and the University of Pittsburgh Medical Center, allowing Omnyx to access an extensive portfolio of Olympus America patents in the field of virtual microscopy and digital pathology, to help develop solutions in the digital pathology field. The agreement helps clear the path for future imaging and data handling technologies that may one day facilitate 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 involved in the licensing agreement cover software and technology related to creating, storing and delivering virtual microscopy images. Virtual microscope slides enable professionals to review biopsies and other pathology images without handling traditional glass slides, and allow doctors to share high-resolution digital microscope images over the Internet for remote pathology consultation.
Aperio has licensed these patents also, from the portfolio original developed by Bacus Labs, which is now part of Olympus. This seems to foreshadow the increasing importance of intellectual property as the digital pathology market matures.
March 02, 2010
Why understanding medical risk is key to US health reform
The McKinsey Quarterly has posted an interesting analysis: Why understanding medical risk is key to US health reform (PDF).
The fundamental nature of medical risk in the United States has changed over the past 20 to 30 years — shifting away from random, infrequent, and catastrophic events driven by accidents, genetic predisposition, or contagious disease and toward behavior- and lifestyle-induced chronic conditions. Treating them, and the serious medical events they commonly induce, now costs more than treating the more random, catastrophic events that health insurance was originally designed to cover. What’s more, the number of people afflicted by chronic conditions continues to grow at an alarming rate.
As the nature of risk has evolved, neither the funding mechanisms nor the forms of reimbursement for health care have adapted adequately, so the system’s supply and demand sides are both hugely distorted. Consumers are overinsured against some risks and underinsured against others; woefully short of the savings required to pay predictable, controllable expenses; and all too likely to be dealing with doctors who have big incentives to treat individual episodes of care rather than prevent illness and manage chronic conditions effectively.
These are important — yet frequently overlooked — points in the current debate about the future of health care in the United States. With the US government poised to spend billions of dollars to support universal access, reformers must understand this shift in the nature of risk and move to align financing mechanisms and reimbursement with it. Pouring more money into the system without modernizing it will probably worsen the health care challenges facing the country.
March 01, 2010
chalk tip #35: setting image resolution
Greetings all...
Did you know? In ImageScope, it is easy to set image resolution. I'm going to show you *how* easy, and I'll talk a little bit about what image resolution is, too...
First, what *is* image resolution? Every image represents something with little dots called pixels. Image resolution is simply the size which each pixel represents. For example, suppose you had a picture which was 5" x 7" in dimension. Maybe it consists of 1,500 x 2,100 pixels, so that each pixel represents 1/300th of an inch. For this case the resolution of the image is 1/300th of an inch per pixel. (This is sometimes called 300dpi, "dots per inch", and is a typical resolution for photographs.) As another example, consider a digital slide with a sample area of 20mm x15mm, which was scanned with a 20X objective. This would result in an image with 40,000 x 30,000 pixels, where each pixel represents 1/2 micron. The resolution of this image would be .5 mpp (microns per pixel).
Okay, so how is the image resolution for an image known? For many images including most digital slides the resolution is stored somewhere in the image, as an inherent property. For example Aperio ScanScope instruments create SVS (TIFF) files which always contain the resolution. When the resolution is known, it can be used by viewing tools such as ImageScope to display rulers, grids, annotations etc. using the correct dimensions.
Here's an example, a digital slide where the resolution is known:
Note that since the resolution is known, the ruler can be displayed with micron units and the magnification can be displayed as 40X. Selecting Image | Resolution displays the following dialog box:
This shows the current image resolution is .23 microns per pixel, corresponding to an apparent magnification of 40X.
Okay, but what if the resolution is not known? Consider the following JPEG image:
Note that now since the resolution is unknown, the ruler is displayed simply in "pixels" and magnification can only be displayed as a percentage. Selecting Image | Resolution displays the following dialog box:
At this point, if the resolution is known, it can simply be entered! For example if you knew this was a 40X image, you could enter 40 as the apparent magnification, or if you knew the actual resolution in microns per pixel you could enter it. After clicking OK, ImageScope will use the resolution you have specified for rulers, magnification, etc.
It often happens that an image for which the resolution is unknown contains one or more objects of known size. In that case, you can draw a ruler to set the resolution. For example, consider the following gross image:
The resolution of this image is not known, but the image contains an image of a ruler measured in centimeters. We can use that to set the resolution.
First, draw an annotation ruler the length of the known object in the image:
You will note the length of the ruler is given simply in pixels, since the image resolution is not yet known. Now select Image | Resolution to show this dialog box:
Note that "Compute from Currently Selected Annotation Ruler" is selected. Enter the length of the object measured by the ruler, in this case 5cm = 50,000 microns, and then click OK. That's it, the image resolution will be calculated automatically from the known object size! Here's how that image will be displayed now:
Note that the annotation ruler's length is now known to be 50mm.
Please try it yourself, it is easier to use than to explain!
February 25, 2010
February 24, 2010
Bioscience Technology: Digitizing Pathology
Fundamentally digital pathology is the digitization of microscope slides into image files called “digital slides”—the histologic equivalent of computerized x-rays. Yet according to Aperio CEO Dirk Soenksen, digitization is just the beginning. Digital pathology, Soenksen says, “is much more focused on the management of information than on the scanning technology for creating the digital slide.” Computer files can be analyzed, shared, archived, and compared in ways physical slides cannot.
At least 30 commercial systems exist, according to one 2006 study. Available from such firms as Aperio and BioImagene, MetaSystems, and Genetix, most are essentially automated brightfield microscopes in a box, though some, such as 3DHISTECH’s Pannoramic 250 and Genetix’s Ariol, handle fluorescent slides, too.
Whatever the platform, users invariably can view the resulting slides remotely (an application called “telepathology”), typically via a browser-based client often compared to Google Earth (that is, the software sends a low-magnification image that the user can quickly navigate and magnify). As a result, whether they work on a different floor in the same hospital or thousands of miles away, pathologists can make diagnoses and consultations as if in front of a microscope, all without endangering the glass slides themselves.
Readers of this blog are probably familiar with the technology and companies in the digital pathology market already, but this article gives a nice comprehensive overview. It is great to see the market awareness of this technology expanding.
February 22, 2010
The road to positive R&D returns
McKinsey have published an interesting article, the road to positive R&D returns (PDF), which analyzes ways that biopharma companies can increase the efficiencies of their R&D activities.
As productivity in the pharmaceutical industry has fallen, calls for a new paradigm that would radically change pharmaceutical R&D have increased. The trend has been to view diminishing returns as a science problem. But while scientific innovation is certainly part of the solution, management should not overlook other, more familiar ways to create value. Increased attention to costs, speed of development, and decision making could increase the internal rate of return (IRR) of an average small molecule from around 7.5 percent—less than the industry’s cost of capital—to 13 percent.
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Previous industry experience suggests that such goals are attainable: from 1997 to 2001, the return on the portfolio described above would also have been 14 to 15 percent, driven by a higher probability of success and shorter development times. Although the current environment is tougher, managers are not yet fully exploiting the value creation levers described here, and moderate improvements could substantially increase returns. An IRR of 14 to 15 percent on R&D might not sound like a jackpot, but over a large portfolio it would create considerable value.
In the current economic climate biopharma companies have increasingly outsourced R&D; finding ways to make it more efficient internally could reverse that trend.
February 19, 2010
Quintiles rolls out contract pathology service in China
The interestingly-named Outsourcing-pharma.com reports Quintiles rolls out contract pathology service in China.
Quintiles’ new service, which is based at its College of America Pathologist (CAP) accredited central laboratory in Beijing, is intended to support the development of personalized cancer treatments.
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While the global biopharmaceutical industry is expected to grow as a whole in the coming years, Quintiles' investment in China fits with the consensus opinion that the country will emerge as a key market in the near future.
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Working in concert with the CRO’s other laboratories in Scotland and the US, the Beijing lab provides both immunohistochemistry (IHC) and Fluorescence In Situ Hybridization (FISH), as well as a wide range of bespoke biomarker assays.
This project highlights the value of digital pathology for CROs like Quintiles, as it enables them to provide better and faster service to their biopharma customers around the world.
February 18, 2010
Tighter Integration of Nighthawk Reports into Hospital EMRs and RISs
Bruce Friedman posted an interesting analysis on his blog: Tighter Integration of Nighthawk Reports into Hospital EMRs and RISs.
"Nighthawk-type" radiology service firms, launched initially with the avid support of radiologists, have evolved to potentially be their nemesis. Defined succinctly, they provide the diagnostic services of outside radiologists to interpret medical images at times when members of a local hospital radiology group are unavailable. Such services were initially provided off-hours -- hence the name nighthawk. However, "nighthawk" firms have quickly morphed to provide around-the-clock services, putting some radiology groups out of business and causing others to fight back... Although the concept of telemedicine has been in existence for decades, the most commercially viable version of this approach to the practice of medicine today is clearly teleradiology.
Interesting... and yet, Nighthawk companies employ radiologists, so the threat isn't to radiologists per se, it is to radiology groups as formerly configured. Worth keeping in mind because some pathologists fear that the advent of digital pathology will cause a similar change toward outsourcing pathology. My own view is that digital pathology is more likely to cause insourcing, at least from a U.S. perspective, given the relative shortage of pathologists outside the U.S.
The main driver of Nighthawk services in radiology was the need for time-critical interpretations, and the main driver of outsourcing in pathology will likely be sub-specialization, the need for tissue- and disease- specific interpretations.
February 15, 2010
chalk tip #34: useful ImageScope keyboard shortcuts
Greetings all... in today's tip I want to tell you about a few useful ImageScope keyboard shortcuts.
That's it - you're welcome!
Oh, and if you want a complete list of all shortcuts, please see the ImageScope Quick Reference Guide (PDF). It is just eight pages and tells you everything you need to know: opening images, the main window, toolbar icons, and *all* keyboard shortcuts!
February 11, 2010
Trastuzumab Approved for HER2 Gastric Cancer in Europe
MedScape reports Trastuzumab Approved for HER2 Gastric Cancer in Europe:
Trastuzumab (Herceptin, Roche) has been approved for use in the treatment of HER2-positive gastric cancer by the European Commission. This is the first approval in the world for this label extension for trastuzumab, which is already marketed for use in the treatment of HER2-positive breast cancer.
This marketing authorization is effective immediately in all European Union countries, and in Iceland, Liechtenstein, and Norway, according to the manufacturer. Similar approvals for this label extension in other regions of the world are expected to follow soon, says Roche.
Approval for this new indication is based on the results of the international ToGA trial, headed by Eric van Cutsem, MD, PhD, from University Hospital Gasthuisberg in Leuven, Belgium. The results showed that trastuzumab added to chemotherapy significantly prolonged survival — from a median of 11.8 months with chemotherapy alone to a median of 16 months.
When the results from the ToGA trial were first reported at last year's annual meeting of the American Society of Clinical Oncology (ASCO), data were hailed as "practice-changing." ASCO later listed the study as one of the major advances in cancer in 2009.
Wow, this is great, sounds like an important new treatment option for gastric cancer, which is the second most common cause of cancer-related death in the world, and is the fourth most commonly diagnosed cancer with more than 1,000,000 cases diagnosed each year.
February 09, 2010
Apple iPad in Healthcare: Pros and Cons
The ScienceRoll blog considers Apple iPad in healthcare: Pros and Cons. Please click through to read the whole post, but here are the bulleted Pros and Cons:
Possible cons:
- No camera: it means it cannot be used in telemedicine
- No flash: several medical websites use Flash
- No mouse support: it’s not a disadvantage if there won’t be click-heavy applications
- Battery life: It is somewhere around 10 hours which is enough for a doctor working on the hospital but what happens when the iPad gets handed off to the next person? Dying battery can be swapped out for a fresh one in other tablet solutions. Here there won’t be enough time to re-charge iPads.
- It’s too big to fit into a doctor’s pocket.
- iPad is not ruggedized while other healthcare tablets are drop resistant from about a meter.
- No Multi-tasking: it makes it impossible to write a patient report while consulting with a collegue (there are hundreds of examples why multi-tasking is crucial)
- No barcode scanner: it’s used for checking and uploading drugs, among others.
- Such a device should be water-proof and easily disinfected. iPad wasn’t designed for this.
- The iPad has a capacitive touch screen on which gloves won’t work.
Possible pros:
- If there is a company that can get the best out of such a device, that is Apple.
- Probably there will be more and more medical applications designed exclusively for iPad just like there are so many medical apps for iPhone.
- It’s cheaper than other healthcare tablets.
- It was designed to be as user-friendly as possible (a nice advantage of Apple products) so elderly people will also be able to learn to use it easily.
- One scenario might be having an iPad in the hospital as the central database where doctors can upload the information from the iPhones.
Although the screen resolution is modest (1024x768) it does seem like the iPad might be useful for digital pathology. The completely untethered nature of the device is compelling. We'll have to see when they become available, stay tuned!
February 08, 2010
College of American Pathologists unveils patient website MyBiopsy.org
The College of American Pathologists have unveiled a new patient-centric website MyBiopsy.org. From the FAQ:
- What is MyBiopsy.org? MyBiopsy.org is a free resource developed by the College of American Pathologists for people who have been diagnosed with cancer and their loved ones to help them better understand their illness.
- What information can be found on MyBiopsy.org?
Visitors to MyBiopsy.org can find accurate and credible information on more than 40 of the most common cancers and cancer-related conditions, including those affecting the breast, lungs, colon, prostate, and skin.
Each page on www.MyBiopsy.org has been developed by a pathologist, and includes:
- Answers to questions about a specific type of cancer
- A list of available treatment options
- Questions patients should ask their doctors
- A glossary of key terms
- Pictures of normal and diseased tissues and cells
- Who developed the information on MyBiopsy.org? All the patient information sheets developed on MyBiopsy.org were developed by pathologists — the doctors who diagnose cancer and other diseases by examining tissues and cells. If cancer is diagnosed, a pathologist will work collaboratively with a patient’s health care team to assist with treatment plans.
February 05, 2010
KGH Pioneers New Telepathology Technology
From "Stories in the News", from Ketchikan, Alaska: KGH Pioneers New Telepathology Technology:
Imagine looking through a microscope in Bellingham, Washington, and viewing a slide in Ketchikan, Alaska, and you have the idea behind the new telepathology service that now links the two cities. The new service allows surgeons in the operating room at Ketchikan General Hospital real time consultation with pathologists at Northwest Pathology in Bellingham. The pathologist can change focus, illumination, magnification, and field of view at will as he or she uses an online interface to examine a frozen tissue slide prepared in Ketchikan.
Ketchikan General Hospital (KGH), in partnership with the PeaceHealth Laboratories and Northwest Pathology, is among the first hospitals in North America to use telepathology in an intraoperative setting. This technology has been used for research, academic instruction and general pathology consultations but KGH is pioneering this use of the technology, which is especially beneficial to smaller, rural critical access hospitals where technical experts may not be readily available.
The use of this technology will improve patient care and reduce travel costs. Here is how it works: a surgeon at KGH submits tissue for pathology review during a procedure. A histotechnologist at the Ketchikan lab will freeze the tissue, prepare the slide and scan it. In Bellingham, one of the pathologists will log into an online site to review the whole slide image and call the surgeon directly in the O.R. to discuss the results.
How cool is that? The technology of digital pathology has such value in remote locations like Ketchikan, to bring the required expertise to each case when needed.
January 29, 2010
Not so fast? Concrete considerations for digital move...
CAP Today has an interesting article about the adoption of digital pathology: Not so fast? Concrete considerations for digital move... from Walter Hendricks, taken from his talk at last fall's APIII Conference.
My goal in this talk is to focus on the operational and workflow aspects that we and our vendor partners need to examine now that we’re starting to use images for clinical purposes. A number of things have to be accounted for in processes and procedures if digital pathology is to become anything close to a scalable workflow.
I’m going to define digital pathology as pathology practice based on digital representations of glass slides, and for this talk it’s mostly through whole-slide imaging. We all know it involves more than just scanning a slide and viewing it on a screen.
There’s a lot of talk about the merging of digital radiology and pathology and the similarities between the two. I appreciate and understand these discussions, but let’s take a small step back. Now and then I have encountered people outside of pathology who have said, ‘Look, it’s an image. You look at it, digitize it. Radiologists have done it. They’re out there making money doing this. Why can’t you?’ Well, guess what? Digital pathology is not digital radiology. And pathology isn’t radiology. Digitization is seamlessly integrated into radiology workflow and actually is the workflow. The images are created digitally, with no additional steps. They’re ready to go; they’re ready for interpretation.
We have that little inconvenience of, oh, by the way, actually having the tissue, having to look at the tissue before we have an image generated. We have to process the tissue, create a glass slide, stain it. All of the routine tissue procurement, gross exam, tissue processing, glass slide creation steps must still occur before digitization.
Therefore, digital pathology is extra work. It requires extra effort and time over and above all the steps that would have to take place anyway. Digital pathology means extra cost. We have to invest in image capture and digitization, transmission, displaying, viewing, and storage. In addition to the capital expense, there are labor and other expenses that come from having to incorporate digital pathology into any type of clinical workflow. These are all investments that have to be justified. The value proposition for digital pathology, then, hinges on benefits that outweigh the costs associated with the incremental work and required investments.
Please read the whole thing, it's a nice balanced overview of the pros and cons of adapting digital pathology into clinical workflow.
January 27, 2010
Where Do We Go from Here in Healthcare Reform?
Bruce Friedman asks, in the wake of Scott Brown being elected and the likely failure of this Congress to pass a healthcare reform bill, Where Do We Go from Here in Healthcare Reform?
There are four bad options facing congress; listed in parentheses are examples of how each option might be executed: (1) Heedless and Arrogant Approach: (ram the current policy through); (2) Weak and Feckless Approach: (try incremental reforms); (3) Dangerous and Demagogic Approach: (stripping the health bills of anything that might be unpopular and passing the rest regardless of the cost); and (4) Incoherent and Internecine Approach: (settling on no coherent policy but just blaming each other for cowardice and stupidity).
It seems that the incremental reforms approach of (2) is the only thing that can work; everything else runs afoul of one special interest group or another which is capable of derailing the the whole thing.
January 25, 2010
Clinical Laboratories in Ireland Will Soon Undergo Nationwide Restructuring
From the Dark Daily: Clinical Laboratories in Ireland Will Soon Undergo Nationwide Restructuring:
Pathology testing and clinical laboratories in Ireland will soon be involved in a major project to overhaul the entire system of laboratory medicine in this country of 4.5 million people. Today, your Dark Daily editor wraps up a week-long visit to medical laboratories in Dublin and the pending reorganization of clinical laboratories is a major topic among pathologists and clinical laboratory scientists.
Last year, Ireland’s Health Service Executive (HSE) issued a press release announcing the program to modernize the nation’s clinical laboratory service. The plan specifies that some pathology laboratories will be downsized or closed as regional laboratory testing networks are developed. Another major element in the plan is the creation of two or three “cold” laboratories—what North American laboratory professionals would recognize as a stand-alone clinical laboratory facility providing routine testing to general practice clinics—to serve this segment of the Irish healthcare system.
Huh, interesting... it is possible to make global changes more easily in a smaller country with a single-payer system like Ireland than it is in the U.S., but the same sorts of changes are envisioned in some of President Obama's Health Care Bill provisions. We'll be watching this with great interest.
January 22, 2010
Extraordinary Measures
TheScientist has posted a review of Extraodinary Measures, an interesting new movie about a rare disease and the process of drug discovery:
Rare diseases and drug discovery don't usually make for Hollywood blockbusters. But today (January 22) a film about a genetic affliction that strikes fewer than 10,000 people worldwide hits movie screens, and it has some serious star power behind it. Harrison Ford and Brendan Fraser head up the cast of Extraordinary Measures, a new movie that may lift Pompe disease from the shadows of obscurity into the spotlight, as the focal point of an inspirational story of paternal love and scientific innovation.
Extraordinary Measures tells the tale of businessman John Crowley (played by Fraser) who makes it his mission to promote the development of an enzyme therapy to treat his two youngest children, who are sick with Pompe. Teaming up with University of Nebraska researcher Robert Stonehill (Ford), Crowley starts a small biotech company called Priozyme dedicated to his purpose. (In reality, the researcher who helped Crowley was William Canfield of the University of the Oklahoma Health Sciences Center, and the company Crowley launched was called Novazyme.)
Wow, how interesting, as a Harrison Ford fan as well as someone interested in digital pathology, this seems like a must see. And fortunately it seems that the movie mostly "gets it right"...
January 19, 2010
Do or Die: Clinical Laboratories Must Invest to Build Up LIS-EMR Interfaces with Physicians’ Offices
From the DarkDaily: Do or Die: Clinical Laboratories Must Invest to Build Up LIS-EMR Interfaces with Physicians’ Offices:
By dangling as much as $20 billion in front of physicians to encourage their adoption of electronic medical record (EMR) systems during the next few years, Congress has created a new and expensive challenge for the nation’s clinical laboratories. That challenge is the need for every pathology laboratory to establish a high-function interface from its LIS to the office-based physician’s EMR.
According to one expert, the government’s “carrot and stick” strategy to reward doctors financially for adopting EMR’s, will soon force independent medical laboratories and hospital laboratory outreach programs to play catch up with LIS-EMR interfaces to maintain access to physician referrals and the revenue that accompanies these laboratory test specimens.
It seems to me that the obstacle will be all the physician office systems, not the clinical labs' LIS. Even if they have the capability - and it will take some time before they do - many physicians are not running the latest versions of their vendor's software, and configuration of an EMR will be time-consuming and costly for them, even if there is government assistance on offer. Still, eventually it will happen, and the benefits for patients and physicians will be significant.
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- more tweeting!
- Google Health gains partners
- Omnyx Licenses Olympus Digital Pathology Patents
- Why understanding medical risk is key to US health reform
- chalk tip #35: setting image resolution
- Aperio Webinar: Research and Clinical Applications of AQUA® Technology
- Bioscience Technology: Digitizing Pathology
- The road to positive R&D returns
- Quintiles rolls out contract pathology service in China
- Tighter Integration of Nighthawk Reports into Hospital EMRs and RISs
