The Daily Scan

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.

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.

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.

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"...

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.

Kaiser Permanente, VA launch veterans health exchange

HealthImaging reports Kaiser Permanente, VA launch veterans health exchange:

The U.S. Department of Veterans Affairs (VA) and healthcare provider Kaiser Permanente recently launched a pilot medical data exchange program in San Diego enabling clinicians from VA and Kaiser Permanente to obtain views of a patient's health using EHR information through the National Health Information Network.

The pilot program connects Kaiser's HealthConnect and the VA’s EHR system, VistA. In November 2009, VA beneficiaries and Kaiser members in the San Diego area were invited to sign up for the pilot, with the understanding that their information would not be shared without their consent.

Cool.  The number of "public" EHR systems keeps growing; Federal Stimulus money is one reason, of course, but the desire by patients to have control over their medical information so they can take a more active role in directing their own care is another.

FDA Unveils First Phase of Transparency Initiative

The U.S. Food and Drug Administration today unveiled the first phase of its Transparency Initiative which is designed to explain agency operations, how it makes decisions, and the drug approval process.

During an online presentation, the chair of the FDA’s Transparency Task Force, Principal Deputy FDA Commissioner Joshua Sharfstein, described a Web-based curriculum called “FDA Basics,” aimed at helping the public better understand what the agency does. The curriculum is accessible via a link on the FDA Web site.

The curriculum includes:

• Questions and answers about the agency and the products it regulates
• Short videos that explain various agency activities
• Conversations with agency personnel about the work of their office

In addition, senior officials from FDA product centers and offices will answer questions on various topics during future online sessions. Each of these sessions will be announced on the FDA Web site.

In one of her first acts after assuming the office last spring, FDA Commissioner Margaret A. Hamburg, M.D. announced the formation of an internal task force to develop recommendations for enhancing the transparency of the FDA’s operations and decision-making processes.

As more digital pathology applications are targeted at clinical applications, the role of the FDA in regulating the vendors and products in the space becomes ever more important.  This additional transparency is a welcome step, seems like it will benefit everyone.  Ideally the FDA and vendors work together to ensure safe and effective products are brought to market.

What Does it Take to Qualify for the EHR Stimulus Funds?

An interesting hour-long video posted on the Medical Software Advice blog: What Does it Take to Qualify for the EHR Stimulus Funds?

We talk with hundreds of physician practices each month. Their biggest question: “What does the economic stimulus package mean for me?”

Practices understand that up to $45 billion is allocated to provide incentive for physicians to adopt EHRs. However, many questions remain about how and when providers will receive stimulus funds.

We teamed up with Justin Barnes, Chairman of the HIMSS Electronic Health Record Association and Vice President of Greenway Medical Technologies, to help answer these questions. The original presentation was delivered last week, however you can view the entire webinar. In this hour webinar, you’ll learn:

• How the stimulus money will be paid out
• What it takes to qualify for funding
• Which specialties qualify for funding
• How “meaningful use” is defined
• What constitutes a “qualified EHR”

It moves kind of slow, but it is pretty informative, you might want to check it out...

When clinicians lead

Hi everyone, this is Jared Schwartz.  I look forward to sharing my thoughts on The Daily Scan and from hearing yours; please feel free to post comments!

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An article in McKinsey Quarterly titled “When Clinicians Lead” argues there is a critical need for physicians to be actively involved in helping “lead the way” if we are to ever have real health care reform that results in better patient outcome and more efficient use of limited resources.  Having practiced medicine for many years and being actively involved in a variety of management and leadership roles, I can state this will be no easy task.  Leadership is something that can be learned through mentors or just personal drive, personality and education.  The problem is leadership as a core competency for success is not even on the list of topics taught throughout most physicians’ training.  I am not talking about leadership as in CEO, but everyday leadership through example that others will observe.  Treating all with respect, teamwork, more objectivity, mentoring, and demonstrating that you understand how important it is to use resources wisely is everyday leadership.  In my opinion this will have a greater impact on improving both the quality and efficiency of our medical care than all of the congressional committees’ and agencies’ ideas combined.  If medical schools and postgraduate programs do not lead the way in producing physician leaders, we as individuals and professional associations must do it ourselves.

Introducing my blog partner: Dr. Jared Schwartz

Hi all - back in November Aperio proudly announced that Dr. Jared Schwartz would be joining us as our Chief Medical Officer.  And he has indeed done so!  Having such an experienced and well-connected senior pathologist on our team has been amazing.

I have invited Dr. Schwartz to join me in posting to The Daily Scan!  So now in addition to links to things I find interesting, and my ramblings and chalk tips and such, you'll have the benefit of links to things he finds interesting, and his ramblings and such...

Please join me in welcoming Jared to the blogosphere!