The Daily Scan

Bostwick Labs plans IPO

Of interest, CNN reports: Bostwick Labs plans IPO.

"Bostwick focuses on the urologic pathology market segment, including prostate cancer biopsies, and the gynecologic pathology segment, including cervical cancer screenings.

"In its prospectus, Bostwick said its business model was developed by founder and Chief Executive David Bostwick, a former professor of pathology and urology at the Mayo Clinic. The CEO will continue to be the company's controlling shareholder after the IPO.

"Bostwick, which was founded in 1999, has five laboratories in Virginia, Arizona, New York, Florida, and London. The company has more than 750 employees. In 2007, Bostwick analyzed about 291,000 cases, compared with about 159,000 in 2006, an increase of 83 percent.

Seems like one use of the IPO proceeds could be implementation of digital pathology?

EMR Failures and a Recipe for Their Avoidance in the Future

Bruce Friedman discusses EMR Failures and a Recipe for Their Avoidance in the Future.

"Everyone involved in healthcare information technology (HIT) is familiar with the history of frequent failure or inadequate performance of EMRs.

"For me, the answer is the wide adoption by EMR vendors of the federated system architecture whereby the ancillary content experts are allocated "white space" in the EMR to organize and populate with the information generated in their own ancillary departments.

"Drs. Ul Balis and Mark Routbort will lecture on both order entry and results reporting using a federated architecture at the Lab InfoTech Summit on April 11 in Las Vegas.

I wonder if prototyping EMR systems in Second Life might help also?

Electronic Medical Records in a Virtual Hospital

Found on ScienceRoll, a great blog about “Medicine 2.0”: Electronic Medical Records in a Virtual Hospital.

“The Ann Myers Medical Center is a hospital in Second Life, the virtual world where we organize medical exercises and simulations. John Norris is more than interested in medical informatics and the opportunities provided by Second Life in medical education. That’s all you should know before reading the next interview with John Norris about his recent experiments to implement electronic medical records into the virtual hospital.”

I’ve contacted John to see about including digital pathology in his electronic medical records. Now that will be cool. Stay tuned!

Adding Breast Density to Risk Model Improves Cancer Prediction

Medscape: Adding Breast Density to Risk Model Improves Cancer Prediction.

"Adding breast density measures to standard clinical models can improve the prediction of invasive breast cancer, according to a report in the March 4th issue of the Annals of Internal Medicine".

"Most women greatly overestimate their risk of breast cancer -- having a realistic estimate readily available can help place a woman's risk for breast cancer in the context of her risk for other diseases, such as heart disease. The model may also help identify women who would benefit from treatments to prevent breast cancer."

Grand Rounds 4.22: The Future of Medicine

I just discovered ScienceRoll, a great blog run by Bertalan Meskó.  If you're interested in virtual medicine - what he calls Medicine 2.0 - then by all means check it out.  There is some great stuff in there.

Recently he hosted Grand Rounds, a weekly compilation of posts from other medical bloggers.  (Grand Rounds is a moveable feast; each week a different blogger hosts it, and collects contributions from many other bloggers.)  Anyway there is a ton of interesting material in there, some of general interest, and some which bears pretty specifically on digital pathology.

Consider this one: Something we can all agree on - new stem cell source.

And here's one you might find interesting: Ten great web 2.0 tools for diagnostic imaging.

Anyway please check out the Grand Rounds and ScienceRoll.  I'm subscribed now, so I'll share stuff that is especially interesting or relevant here, too.

The Serendipity of New Technology

Yesterday morning I had the privledge of attending a breakfast hosted by Aperio at the USCAP conference in Denver.  Dr. John Spinosa gave a great presentation about using digital pathology to help prepare for tumor boards (John is the new Chief of Staff at Scripps Memorial in La Jolla, CA).  What struck me most in his remarks was that Scripps began the project with a rather straightforward goal - streamline preparation and presentation of pathology information in tumor boards - but once they became familiar with the technology, they found many other serendipitous uses for it.

I think this happen often with new technology; it is developed to solve one problem, but then once adoption starts, hidden applications emerge and the technology is adapted to new problems.  This effect is closely related to the Innovator's Dilemma, wherein new technology developed for one market "attacks from below" into another market.  (These are often called "disruptive technologies".)

Among current new products, I can't help wondering whether the iPhone presages new devices with similar technology that will be used for mobile medical image viewing.  People probably wouldn't buy iPhones specifically for this purpose - at least, not yet - but once you have an iPhone as a phone, or handheld email reader, why not use it to access digital sides too?

the checklist

I've been meaning to post this for a while...  The New Yorker published a great article in their Annals of Medicine called The Checklist, by Atul Gawande.  The article describes how an emergency room physician named Peter Pronovost created simple checklists for routine emergency room procedues, and how use of these checklists has has a dramatic reduction in unforced errors.

"If a new drug were as effective at saving lives as Peter Pronovost’s checklist, there would be a nationwide marketing campaign urging doctors to use it."

It makes me wonder about the value of checklists in Pathology.  Many labs use checklists, either formally or informally, and there are some "standard" checklists in existence, such as the one found in the College of American Pathologists' Breast Cancer Protocol.

Aperio is in the process of running several clinical trials comparing digital pathology to conventional microscopy, for particular diagnosis situations (tissue type, preparation, etc.).  As part of these studies, it is necessary to devise a way of recording a diagnosis, in such a way that it can be objectively compared.  After reading The Checklist, it occured to me that perhaps the very act of recording the diagnois, by means of a checklist, might make the diagnosis itself more consistent and accurate.