Digital Pathology Blog

MEDTING: Medical Exchange Video with teleconsultation for surgical pathology

Very nice video presentation on use of Medting for global collaboration and pathology consultation. Audio adds to the presentation. 

Applied Spectral Imaging (ASI) Launches PathEx Duo: the First Detection System for Double Pathology Staining

Press release brief but ability to seperate multiple stains on same section has major implications for not only looking at tumor morphology but tumor biology as individual cells can be seen with multiple stains at one time. 

Migdal Haemek, Israel, July 07, 2009 -Applied Spectral Imaging (ASI) a leading provider of comprehensive imaging solutions for Pathology and Cytogenetics, announces the release of "PathEx Duo" - the first detection system for pathology doubly stained specimens.

The DUO application provides the pathologist with a full statistical description of the examined tissue with regards to the expression of two antibodies (proteins). DUO classifies each object (e.g., cell) and marks it according to its class association. This system supports the pathologist diagnosis under circumstances where two stains are used to classify the tissue objects into four categories: non-stained, singly stained (of each stain) and doubly stained objects.

DUO displays the resultant statistics for the entire sample, or sub regions thereof. It offers three modes of operations: automatic, semi-automatic and manual.

According to Limor Shiposh, CEO of ASI, "The uniqueness of our new product is that the Pathologists are now able to evaluate objectively slides that are simultaneously doubly stained. This makes the common, cumbersome practice of comparing two different tissue sections, unnecessary and redundant.

We are proud to present this new product to the market and believe that our "PathEx Duo" will provide a faster, more accurate and efficient diagnostic aid for clinicians who make life-saving decisions."

Medting CEO appointed as new HIMSS Board Chair

Medting US CEO, Barry Chaiken, MD, MPH, FHIMSS, assumed the one-year term as chair of the HIMSS board.

“It is a great honor to serve as board chair-especially during this exciting time with healthcare reform and the use of health IT as an enabler as top priorities,” he said. “This is such a key time for our industry and I will work very hard to continue to motivate staff, the board of directors, members and industry professionals to contribute and participate in this transformation.”

Dr. Chaiken has also played a key role in HIMSS’ international efforts, serving as board liaison to HIMSS Europe for the past two years. “Internationally, there are great opportunities for HIMSS and its membership to transcend borders, languages and engender a truly worldwide dialogue,” he said.

Read the complete news here.

Cleveland Clinic launches its own WebMD

Cleveland Clinic last week unveiled Clevelandclinichealth.com, the hospital’s health-and-wellness portal and the latest in a string of online creations in the past year.

More health-care institutions have tried to turn their medical knowledge outward as they witness the success of social media and sites like WedMD. A site like MayoClinic.com is the standard bearer for the concept. And for nearly 15 years Case Western Reserve University, the University of Cincinnati and Ohio State University have developed the health-care question-and-answer site NetWellness.

The Clinic’s site, which redirects readers to a section of ClevelandClinic.org, culls the information from many of its print and other online publications, draws from a video database, includes an alphabetic index of health problems and intersperses personal stories about diseases.

Read the rest at MedCity News.

Aurora Opens Viewer Architecture

Came across this press release on LinkedIn about Aurora Interactive.  Aurora recently also announced they power the new PathXchange and provide a universal viewer for the site.

Aurora Interactive in line with its “Open Architecture” philosophy will supply developers with a SDK and free developer licences for its mScope universal medical image viewing platform.

"Aurora Interactive, the world leader in digital pathology communications, announced today that, in line with its “Open Architecture” philosophy, it will supply developers with a software development kit and free developer licences for its mScope universal medical image viewing platform.

Medicine is increasingly becoming a knowledge and information industry and it makes sense to draw on digital pathology in making this type of transition, to use information technology to improve health care. Aurora has achieved a worldwide leadership position by collaborating on a continuous basis with its healthcare customers and its highest priority is satisfied customers.

“It is a commitment to overall quality that extends to our customers, shareholders, partners, employees and, most importantly, to those patients who depend on us all” declared Mr. Pierre Le Fèvre, President and Chief Executive Officer of Aurora Interactive.

Mr. Le Fèvre further added: “We are committed to better patient outcomes and believe that digital pathology will greatly contribute to these. We want to encourage and facilitate the development of the analytical tools that will improve the diagnostic efficiency and efficacy of today’s pathologists”.

Aurora’s customers receive the kind of quality and service they expect from a leader. Aurora continues to evolve as the needs of its customers change and as new opportunities are created in the market."

 

Aperio Introduces Industry's First Digital IHC Solution With Integrated Image Analysis for Quantification of Breast Cancer

In yet another step towards full adoption of digital pathology in the clinical workspace Aperio recently announced a complete solution for reading and IHC stains with integrated reporting for a wide variety of tissue types and stains.  

Pathologists now can read and report digital slides with added ease of reporting in the same application.  Adoption has been occurring in niches and this is another barrier to entry that has been crossed - the ability to interpret and report in a more functional clinical workflow.  The added advantage of "real-time onsite image analysis" provides another deliverable over "analog pathology".

Abbreviated press release:

Slides to Reports in Less Than 30 Minutes

Aperio Technologies, Inc., (Aperio), a global leader in digital pathology for the healthcare and life sciences industry, is pleased to announce the launch of a digital pathology solution for Immunohistochemistry (IHC) designed specifically for the clinical market. Aperio’s digital IHC solution is the only commercially available FDA-cleared system allowing pathologists to run quantitative IHC image analysis while reading slides on a computer monitor.

A digital IHC system significantly streamlines clinical workflow. By using a single system to read digital IHC slides, perform quantitative image analysis, and create professional reports, pathologists can provide faster turn-around times, more informed decision-making, and accurate and consistent test results.

Eric F. Glassy, MD, medical director at Pathology Inc., stated, "After switching to Aperio's digital IHC solution from a different computer-assisted technology, we immediately experienced improved efficiency. More importantly, the interpretation algorithms offer far more control and accuracy, and the reporting capability is superior. We especially appreciate the ability to link thumb nail images on the PDF file to the actual whole slide images. The power and flexibility are simply remarkable."

The digital IHC system includes FDA-cleared algorithms for HER2, ER and PR stained breast specimens for diagnosing digital slides for clinical use in pathology. In addition, the system comes with a suite of image analysis algorithms that can be tuned for different tissue types (e.g. breast, colon, prostate), stains (e.g. HER2, ER, PR, Ki-67, P53, EGFR), reagents (e.g. Dako, Ventana) or to correlate algorithm results with other test methods (e.g. FISH, CISH).

“An integrated system is key to providing an efficient workflow for pathologists, and a major advantage over add-on image analysis systems,” said Dirk Soenksen, CEO of Aperio. “Pathologists can now use Aperio’s sophisticated cell-based image analysis capabilities with the click of a button while reading a slide.”

Dr. Francis S. Collins tapped to head NIH

The Los Angeles Times (7/9, Maugh) reports that the White House has announced that "Dr. Francis S. Collins, the geneticist who discovered the causes of half a dozen diseases, oversaw the government's efforts to map the human genome and wrote a now-famous book presenting scientific evidence for a belief in God, will be nominated to head the National Institutes of Health." President Obama said in a statement, "My administration is committed to promoting scientific integrity and pioneering scientific research, and I am confident that Dr. Francis Collins will lead the NIH to achieve these goals."

 

Dr. Collins' nomination "had been rumored for weeks," according to the New York Times (7/9, A20, Harris), and "was praised by top scientists and research advocacy organizations for whom the health institute is a crucial patron." The Times calls the NIH "the most important source of research money in the world; over the next 14 months it will dole out about $37 billion in research grants and spend $4 billion on research programs at its Maryland campus."

 

The Washington Post (7/9, Brown) notes that Collins has recently championed "personalized medicine." He "would take over from Raynard Kington, who was named acting director last fall after Elias A. Zerhouni, NIH director during the Bush administration, resigned."

 

The AP (7/9, Neergaard) reports that "Collins has discovered numerous genes important for diseases, including the one that leads to cystic fibrosis. But the true power of genetics, he told" attendees of a medical conference "last month, has yet to be realized as researchers eventually learn enough to provide customized predictions of which diseases really threaten an individual, and personalized care to respond."

 

Bloomberg News (7/9, Chen, Gaouette) reports that Collins formerly headed the NIH's National Human Genome Research Institute. American Heart Association President Clyde Yancy called him "a brilliant researcher able administrator and visionary leader."

 

Dow Jones Newswires (7/9, Favole) adds that, as NIH director, "Collins will have to oversee new rules governing the use of stem cells for research purposes." He "will also have to avoid and deal with conflicts of interest in researchers who receive NIH funding." The Detroit News (7/9, Kozlowski) focuses on Collins' research as a professor at the University of Michigan. The Hill (7/9, Young) and AFP (7/9) also cover the story.

Celestial corpora amylacea

 Several years ago I wrote up a "Nebulous Corpora Amylacea" I came across in a prostate biopsy.

 

Corpora amylacea are simply laminated luminal secretions that are commonly present in prostatic glands and increase in prevalence with advancing age. They are present in 25% of men as early as the third to fifth decades of life and are thought to be related to epithelial cell desquamation and degeneration. 

Shortly after the image appeared in print someone sent along another celestial corpora amylacea with resemblance to the planet Saturn I re-discovered buried in my image files.

Olympus Corporation Introduces The Dotslide 2.1 Virtual Microscopy System

Olympus has introduced its cutting-edge dotSlide 2.1 virtual microscopy system, offering advanced functionality with outstanding image quality. Available in three different models, this flexible and efficient system enables the virtual overview of an entire slide to be displayed in perfect quality on-screen. Furthermore, images are automatically saved in an online database where they are easily accessible for fast and secure remote image access. With excellent throughput for extensive image acquisition and superb documentation of tissue sections and tissue microarrays the dotSlide 2.1 system is ideal for all aspects of pathology and research.

The Olympus dotSlide 2.1 system is based on the upright BX51 microscope, which ensures an outstanding optical performance. Furthermore, the peltier cooled dotSlide camera ensures high resolutions with fast frame rates and high sensitivity. In combination with a PC-based workstation, slides can be scanned and uploaded with great ease. This easy-to-use system provides superior functionality, usability and performance through the incorporation of an intuitive Scan Wizard, which guides the user step-by-step through the virtual slide acquisition process. As such, the graphical user interface features large, clearly labelled icons so that users at any experience level can produce perfect images every time.

The standard dotSlide 2.1 MD (manual) system is suitable for fluorescent samples and allows slides and any meta-data to be manually loaded. The dotSlide 2.1 SL (slide loader) system is fitted with a slide loader, which holds up to 50 slides and is integrated with a barcode reader for full traceability and hands-off scanning, for the quick and easy archiving of slides. The dotSlide TMA is now a complete system, incorporating a tissue microarray (TMA) module with a new client server database Net Image Server (NIS) SQL. This combination enables the user to acquire small tissue cores as single images, and upload them together with the relevant metadata and TMA slide overview to the NIS SQL database. This allows users to perform effortless analysis of the TMA and meta-data, and select individual cores from the overview TMA slide image for analysis.

Multiple large specimens can be scanned in up to 15 horizontal or Z-planes. With the ability to examine regions of interest in different dimensions, better observations are possible for dependable remote consultation as well as consistent training. The dotSlide autofocus function offers outstanding autofocus capabilities, even with a large Z-distance from the specimen’s focal plane, for example in specimens with a strong topography. Focus points can also be manually set to achieve superior results for difficult samples, improving the reliability of the entire acquisition process. In addition the extended focal imaging feature (EFI) automatically produces extremely sharp and focused images. The NIS SQL provides the dotSlide family with a more flexible and powerful Client Server Database for the secure management of images and data,. Designed to work accross multiple sites, this powerful tool enables the worldwide sharing of images. Additionally, users based at different locations are able to use the secure networking system to combine their results into a single database.

Sensors may be able to differentiate between cancerous and healthy cells

HealthDay (6/26,McKeever) reported, "Researchers at Georgia Institute of Technology and the University of Massachusetts at Amherst say they have developed highly sensitive sensors that pick up subtle differences on the surface of a cell that indicate if it is healthy or cancerous, even whether the cancer is metastatic or not." According to the joint paper published in the Proceedings of the National Academy of Sciences, the "sensors use the polymer PPE, or para-phenyleneethynylene, and three gold nanoparticles that tend to bond with the surface of chemically abnormal cells. When an abnormal cell surface grabs on to the gold nanoparticles, the PPE breaks off and glows," and the resulting "glowing PPE pattern helps scientists identify the cell type, as a cancer cell has slightly different proportions of biomarkers on its surface than a healthy cell." The authors say the next step involves testing "the chemical nose on real animal tissue, as opposed to cultured tissue," and refining "their ability to decipher the information the detection system gives them."

Twitter: What's the use?

I am still getting use to Twitter which I use primarily to send blog postings to as another "feed".  I admit I do not "follow" those I am "following" on a daily basis but check in from time to time. 

This story from amednews.com talks about how a few clinicians use the application. 

 

Illustration by Jashar Awan / jasharawan.com

Early physician adopters say the social media site can help you promote your practice and communicate with colleagues

By Pamela Lewis Dolan, AMNews staff. Posted June 29, 2009.

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As orthopedic surgeon Joel Wallskog, MD, surveyed the operating room at Aurora St. Luke's Medical Center before performing bilateral knee surgery, he spotted one addition to the usual crew: a hospital public relations staffer at a computer, posting Dr. Wallskog's surgical play-by-play live from Milwaukee onto the world of Twitter.

Given how the social media Web site has burst onto the national consciousness over the past few months, you probably know of Twitter but might not know what it's all about.

Twitter is a Web site that also can be accessed on a mobile device. People can create an account to share their thoughts, 140 characters at a time, to other Twitter users who sign up to "follow" that user's "tweets." Registration is free. Twitter accounts start with an "@" sign, and are promoted as "@username."

Physicians are among those jumping onto Twitter. If nothing else they want to see what the hype is about, or what the purpose is of blasting short, random thoughts to whoever opts to listen.

Most users, physicians and otherwise, don't tweet for very long. Data that the Nielsen Co. released in April found only about 40% of users were active a month after creating an account.

Twitter messages, called tweets, are limited to 140 characters.

Doctors who keep tweeting stick around because they find it can be useful. Physicians most often use Twitter as an extension of their Web presence, a patient communication site, a marketing tool or a virtual water cooler with their colleagues. Or, maybe a combination of all four.

"I recognize the power of having a community," said Bryan Vartabedian, MD, (@Doctor_V) pediatric gastroenterologist at Texas Children's Hospital and assistant professor of pediatrics at Baylor College of Medicine. "I didn't realize when I first went on Twitter that there is a lot of strength and a lot of power in having these sorts of connections."

Aurora Health Care, parent of Aurora St. Luke's Medical Center, is one of a handful of hospital systems that have detailed surgeries on Twitter. It's an inexpensive and easy way to connect with patients, and potential patients, and perhaps get a little media buzz.

Jamey Shiels, social media director for Aurora (@Aurora_Health) who helped organize Dr. Wallskog's twittered surgery in April, said traditional advertising does not result in a two-way conversation. It's more of a push, he said. The hospital saw Twitter as "an opportunity to move to a one-to-many conversation."

The procedure Aurora decided to tweet was not randomly selected. It was a new, less-invasive approach to bilateral knee replacement, using customized tools created from virtual images of the knee. The marketing team thought the novelty factor alone might draw some attention.

It did.

One hospital saw its Twitter following more than double a week after tweeting a surgery.

Aurora reported more than 180 questions and comments in reply to the 250 tweets posted during the surgery. At least 75 of its messages were forwarded, or sent as "retweets," by other Twitter users. This expands the reach to other groups of followers.

The hospital's surgery tweeting was profiled on ABC-TV's "Good Morning America" and got a mention on "The Oprah Winfrey Show." Within a week after the surgery, the number of Twitter users following Aurora grew from 930 to 2,240. By mid-June, that number had passed 3,900.

Within a month of the surgery, Dr. Wallskog saw at least 10 new patients, all potential candidates for the surgery. Dr. Wallskog suspects the seed has been planted, and as the year unfolds, more new patients will come for a consultation as a result of Twitter.

While several hospitals have established a presence for marketing purposes, few physicians are using Twitter for that. At least not yet.

Peter Beck Kim, MD (@doccottle), a family physician in Costa Mesa, Calif., said he started twittering as a way of connecting with other physicians interested in health IT issues. He can see himself eventually using Twitter as another way of interacting with patients, but not enough people are on yet.

"I think there's more out there [on Twitter] than not," Dr. Kim said. "But overall, in terms of my patient base, I wouldn't say it's a tiny minority, but it's a minority."

As the number of users grow there will be a larger pool of local users to connect with, he said.

Extension of a Web presence

Gwenn Schurgin O'Keeffe, MD, (@DrGwenn) a Massachusetts pediatrician who is CEO and editor of the Web site PediatricsNow, already had a pretty devoted Web following. She decided to join Twitter earlier this year as a way of extending her Dr. Gwenn brand.

Dr. O'Keeffe has made contacts through Twitter that have expanded her work as a writer and media source. Now she's weighing the question of how many contacts are too many.

While some Twitter users look for a core group of people who share similar interests, others join with the goal of having as many followers as possible. "It's like a big sales pitch," she said. "You can't filter out the noise from the real conversations."

But, the ability to reach thousands in one place is the real power of Twitter, said Wesley Young, MD (@DrWesYoung), an emergency physician in Honolulu. He's already seeing the benefits of getting your name onto as many platforms as possible, including blogs and Web sites, as well as Twitter.

Part of Dr. Young's practice involves conducting virtual visits through a telemedicine service started by Boston-based American Well and Hawaii Medical Service Assn., a Blue Cross Blue Shield-affiliated plan. One online patient said she chose him from the list of available physicians because she recognized his name from Twitter. "That is a foreshadowing of things to come," Dr. Young said.

Patient communication

Dr. Kim said he sees an increasing number of patients in his practice using smart phones to send text messages and surf the Web. While Twitter use has not yet reached critical mass, he intends to be on the cutting edge and use the site to communicate with patients who are interested in it.

"As an added service, I definitely think it can have an appeal if you are trying to market yourself as a physician saying, 'I will give you Twitter updates on things of interest to you [if] I find a health-related article' or 'I will give you a real-time update if I am running behind,' " Dr. Kim said.

But until local patients reach that critical mass, many physicians are using Twitter to communicate with anyone looking for information.

Dr. Young believes it should be the goal of every physician to educate the masses -- and Twitter is a good tool.

"One method of providing health education is through electronic media, which can multiply, if used properly, a single individual's efforts to promote healthy life choices," he said.

This ability to reach thousands of people with one message also can useful in times of public health scares. The Centers for Disease Control and Prevention and other health organizations have turned to Twitter to help educate people about A(H1N1) flu, spread information and curb misinformation.

Unfortunately, Dr. O'Keeffe said, the Twitter-using public doesn't always differentiate qualified expert advice from unreliable chatter.

Dr. Vartabedian said he saw a number of physicians stepping in during the flu scare to "provide some sound balance to what was really, on Twitter, an amazing amount of hysteria." He sees local physicians, whom the local public knows and trusts, assuming that role more and more in the future.

Virtual water cooler

Physicians tend to gravitate to other physicians in most social networking mediums, and Twitter is no exception. But there are few curbside consults here. Besides the obvious privacy issues related to posting on a very public forum, there's limited dialogue opportunity within the 140-character limit. What you often find is the virtual version of office banter and the occasional sharing of links to useful resources.

"Most of the physicians I follow are not twittering as doctors, they are twittering as people who are doctors," said Dr. Vartabedian. "They talk about medical things and they link to medical things, but they aren't talking from a position of authority."

Many physicians believe embracing Twitter is just a part of practicing medicine in the 21st century and that, either in its present form or something similar to it, Twitter will be around for a long time to come. Others are not so sure.

"I think the chips are still out," Dr. O'Keeffe said. "It's kind of like an election where we're not going to see the results for a while."

Dr. Wallskog is an undecided voter.

He agreed to the tweeting of one of his surgeries because the idea was "quite unique and novel."

But a few weeks after the surgery, he found he hadn't used his Twitter account much.

"I'd love to say I'm regular twitterer," Dr. Wallskog said. "I am interested in kind of exploring it. It's just I don't have that much time to use that stuff."

The print version of this content appeared in the July 6, 2009 issue of American Medical News.

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ADDITIONAL INFORMATION: 

Twitter 101

Along with the rise of Twitter came the rise of the phrase "microblogging."

As with traditional bloggers, Twitter users can frequently update their accounts with information they want to share with readers, known as "followers." It's micro because users get only 140 characters per post.

To get started, create an account (www.twitter.com). You can use any name, up to 15 letters. This will form the extension for your home page, and will appear with an @ on all your postings, or tweets (as in @amednews or @AmerMedicalAssn).

Now you need to find people to "follow." You can use the search to look for specific names, or check through various Twitter groups to find people with similar interests. When you opt to follow someone, their updates will appear on your home page. You can track who you are following and who is following you.

Other people can opt to follow you and directly receive your updates. People without Twitter accounts also can also read your updates, simply by going to your page (www.twitter.com/amednews).

Depending on your reasons for being on Twitter, your updates could make use of the general question, "What are you doing?" Or, you can use updates to send information, such as links to stories or Web sites.

You can request that your updates be private and available only to a select group that you approve. If you do not do this, remember that everything you say can be read by anyone with an Internet connection.

-- Pamela Lewis Dolan (@Pdolan_amnews)

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Business and pleasure

Howard Luks, MD, says the No. 1 consideration for physicians deciding whether to join Twitter should be the target audience. That's why he runs three separate accounts.

Dr. Luks is an associate professor for orthopedic surgery at New York Medical College in Valhalla, and he has a two-location orthopedic practice. Additionally, he's the medical director of iMedExchange, a social networking site for physicians. His presence on Twitter reflects his multifaceted life.

He maintains one account devoted to the practice of orthopedic medicine (@orthomed). Another is more of a social outlet where he discusses trends in health information technology and health policy (@hjluks). A third account is used to post about topics being discussed on iMedExchange (@imedexchange).

Other physician users keep all their Twitter traffic on one site. They say it can let patients know a little more about your personal side.

But Dr. Luks' rule remains true, no matter how many accounts you have: "In order to be a successful blogger or have a significant following, you have to have a consistent message, and you have to stay the course. If you are all over the place, and your content is not relevant, rational or believable, you are not going to develop a following."

What is your disaster recovery plan?

I was recently asked a question about digital pathology I had never given much thought to.

The question came out of a discussion relating to storage needs for digital pathology, particularly in a full adoption mode for 100% sign-out.  There are matters of capacity, live versus archival, storage time, redundancy, backups, etc...

A colleague of mine recently had his external 1 TB hard drive "crash".  Every powerpoint lecture, reams of research data, manuscripts, personal files & 25,000 mp3 files were thought to be lost.  He neglected to backup any of it obviously.  A commercial service restored the disk with everything but the music files.  We all know this happens routinely.  He did this only recently due to some constraints on enterprise servers and personal storage available on the institutional network and issues with file loss on shared folders with larger capacity.

A clock starts ticking the day you first use such a device that overtime will determine when some mechanical or software function will fail and loss is inevitable, in my opinion.  It has happened to me twice, both after about 3 years of use with varying sized drives and manufacturers.  Both times mirror drives caused no loss of any data.

In pathology we are careful to track what and how much tissue was collected, how may blocks are made, slides from those blocks, stains, recuts, slides sent-out, etc...

As we discuss storage needs and requirements for digital pathology we will have to think about similar issues and disaster recovery plans.

It made me think - what is our disaster recovery plan for stored tissue, wax blocks & glass slides?

I can't recall ever seeing a procedure or policy to address this issue at any institution. 

In case of fire, flood or hurricane what do you do?  What is your lab/institution's policy?

This hospital can trace its roots back to a tornado devastating the town.  The images can always be re-created assuming the real raw data is there to be had.

Hidden Malpractice Dangers in EMRs

Interesting article from Medscape on EMRs and potential malpractice risks. 

I would add that part of "too much information" and overuse of templates may result in a significant information or necessary information not part of a template or buried within it may get overlooked.  With the use of electronic audit trails you can determine from where and when you signed onto the EMR (as well as other applications of course) and it may be determined that while you "reviewed" the appropriate note for a specific encounter the information was not "seen" or easily extracted that may have a clinical impact. 

Within our EMR, I find the shortest notes that are entirely free text often offer the most helpful information when reviewing a surgical specimen or biopsy.

An estimated 85,000 medical lawsuits are filed annually, which include those against hospitals and individual physicians. One of the highly-touted benefits of electronic medical records (EMRs) is the potential to help prevent malpractice incidents and medical errors. By providing better documentation, automatically checking for medication errors and drug interactions, providing failsafe systems to track test results and follow-up with patients, EMRs can dramatically reduce the risk of malpractice.

While the benefits of EMRs are far greater than the cons, no road is without stumbling blocks. A physician who is not careful when using the EMR could increase his malpractice liability.

Some of the possible malpractice risks are shown below.

Too Much Information

Because EMRs allow physicians to document easily, paragraphs of information can be generated with a few keystrokes or even a checkmark. Doctors can describe a comprehensive examination in great detail using predesigned templates. Lists of negative findings can appear, neatly printed, with the push of a button.

This bevy of information may help the physician breeze through an insurance audit; however, all of this information can also create pitfalls.

Pages of repetitive documentation can be more time-consuming to review than brief, handwritten notes. When important information is embedded in paragraphs of boilerplate, it can easily be overlooked. The chance of missing critical data increases.

Overlooking important information is, of course, a significant cause of malpractice. A positive finding embedded in a string of negative findings can easily be missed. To avoid skipping over important information, positive findings must be documented in a way to enable the reader to find them quickly -- either by highlighting them or placing them in a separate section of the record.

Wrong Template Can Bollix Up the Chart

EMRs contain different templates for various types of specialists and types of visits. Templates are helpful for documenting repetitive acts. However, inadvertently using the wrong template can cause potential malpractice problems.

For example, when a neurologist reviewed his records of a neurologic examination of a 1-year-old boy, the neurologist, who had just converted to a new EMR system, recorded, among other findings, that the baby boy was oriented as to time, place, and person. Such a test cannot apply to small children. Needless to say, the neurologist used his template for a normal neurologic examination, without considering that some of the language wasn't suitable for a year-old child.

Fortunately the case did not evolve into a malpractice suit. Imagine the difficulty the neurologist would have had trying to defend himself from charges of documenting findings that were not medically possible to ascertain.

Changing the Standard of Care

Offices that don't adopt technology integrating clinical practice, documentation, and billing procedures may face malpractice exposure. Insurers, including Medicare, continue to ramp up their auditing activities. When a doctor's medical record documentation doesn't match CPT codes, demands for huge repayment follow.

Failure to incorporate EMR into a practice may, in the not-too-distant future, be considered a deviation from recognized standards. When an EMR could, arguably, have avoided an adverse result, trial lawyers will be arguing that physicians were obligated to use this new technology. Because EMR systems can catch medication errors and adverse drug interactions, track test results and patient follow-up, and make it far easier for a physician to access and review medical history, failure to embrace it could be problematic.

As the EMR technology becomes pervasive, failure to use it to avoid medical errors may also lead to malpractice claims. It will not be too long before EMR becomes the "standard of care."

Attention to the Patient

Some physicians who do not yet use an EMR have expressed concern that working with an EMR could divert their attention from patient signs and symptoms. They worry that this could potentially lead to a greater malpractice risk. Proper training and ease of use are essential elements of any successful EMR system. Doctors must be sure to have sufficient training and experience using the EMR before widespread implementation. During the initial implementation period, physicians should schedule additional time during office hours to address their use of the EMR, so that inattention and missed symptoms do not occur.

Conclusion

No doctor can ignore the growing pressures to start using an EMR. With the Obama administration avidly promoting healthcare information technology, and tens of thousands of dollars at stake in incentives and future penalties for doctors, more physicians will be implementing EMRs in the coming years. Under the recently passed American Recovery and Reinvestment Act, physicians who demonstrate meaningful use of EMR by 2011 will be eligible for full federal subsidies of up to $44,000. Failure to implement EMR by 2014 may also result in increased malpractice premiums and increased exposure to malpractice claims, as well as a reduction in Medicare reimbursement, beginning in 2015.

As with all other aspects of their practice, doctors need to be careful and vigilant when using an EMR. Although it's inviting to let templates do much of the heavy lifting, physicians need to be cognizant of the information contained within them, and to not blindly follow templates.

Research Institute Speeds Cancer Research with High-Performance Computing System

From Microsoft:

"Using Windows HPC Server 2008 for research enhances cancer detection and optimizes the pathology review process. We can now tackle research areas that we’ve never dreamed of tackling before.” - Dave Billiter, Director, Research Informatics Core Nationwide Children's Hospital

Watch a video.

BioImagene Develops Companion Algorithms (TM) to Further Enable Personalized Medicine

This morning BioImagene annouced the use of companion algorithms.  What I think we are seeing in digital pathology is less talk and interest in hardware and more interest with software whether it be image analysis, algorithms for detection/diagnosis or software to help meet the demands of personalized medicine. 

While the actual scanning is not trivial and much effort has been put in to this to provide adequate solutions for clinical use, the value of the whole slide rests not only with being able to view this locally or remotely but use the digital data set to enhance what may not be possible or feasible with the "raw" glass alone.  I gather we will see more applications like this in the near future. 

Full press release below.

SUNNYVALE, Calif.--June 29, 2009  -- (BUSINESS WIRE)--BioImagene, the leading provider of innovative digital pathology solutions, announced today that the company is advancing its goal of bridging personalized medicine and the clinical practice of pathology by providing Companion Algorithms (TM). These specialized algorithms, which BioImagene develops for use with its Virtuoso (TM) suite of web-based software, aid pathologists in the quantitative assessment of specialized diagnostic tests used to determine patient suitability for specific cancer therapies. As pharmaceutical companies work to develop companion diagnostics to individualize therapy for cancer patients, Companion Algorithms further enable pathologists to correctly identify and accurately measure specific biomarkers used to determine appropriate treatment options for patients.

“Companion diagnostics will play an increasing role in cancer care as physicians strive to provide the therapies that are most likely to be advantageous to individual patients,” said Keith J. Kaplan, M.D., Mayo Clinic. “Companion Algorithms bring personalized medicine one step closer to reality and can help the pathologist provide the most actionable information to the oncologist.”

Ajit Singh, Ph.D., chief executive officer of BioImagene, commented: “The Human Genome Project opened the doors to research in the field of biomarkers and cancer diagnostics; however, challenges still exist in using biomarkers to identify subpopulations of patients that are likely to respond favorably to targeted treatments. Providing pathologists with Companion Algorithms will ultimately move our industry closer to the goal of personalized medicine.”

BioImagene’s Companion Algorithms can be used by pathologists to aid in the interpretation of digitized images of cancer diagnostic tests including immunohistochemistry (IHC) and fluorescent in situ hybridization (FISH). Digitized images can be generated by one of BioImagene’s iScan slide scanning systems, such as Coreo, Concerto, or Solo. In February 2009, BioImagene received clearance from the U.S. Food and Drug Administration (FDA) for use of one of its Companion Algorithms in the company’s PATHIAM™ IVD Imaging Software for HER2/neuimmunohistochemistry tests. The iScan Coreo and associated software are used to detect and provide a quantitative measurement of HER2/neu, a protein measured in breast cancer patients to determine their candidacy for treatment with the Genentech drug Herceptin (TM).

“The Herceptest, the first FDA-approved companion diagnostic, is used to identify the subset of breast cancer patients who over-express the HER2/neu protein and will therefore have a high probability of responding to Herceptin,” said Robert Monroe, M.D., Ph.D., chief medical officer of BioImagene. “BioImagene’s FDA-cleared HER2/neu Companion Algorithm improves the accuracy and reproducibility of Herceptest interpretation. BioImagene offers additional Companion Algorithms for breast cancer and is committed to developing new Companion Algorithms for other companion diagnostic tests used in prostate, colon, lung and other cancers.”

 

July 9-10 GTCBio Rediscovering Biomarkers, San Diego

Courtesy of Definiens:
Definiens Cordially Invites You to:
GTCBio's Third Annual Rediscovering Biomarkers
July 9-10, San Diego
Definiens will be demonstrating the Definiens XD image analysis platform for image analysis of cells, tissues, and non-invasive images.
Additionally, Peter Duncan, Director of Marketing and Business Development, Definiens, will be presenting:
Standardizing Image Analysis of Biomarkers Across the Biomedical Continuum
The talk will highlight a “game changing” image analysis software platform, Definiens XD. Definiens XD facilitates image analysis of complex images, from any source, in any dimension; allowing for the first time, a standardized platform for image analysis of biomarkers across the biomedical continuum.
Topics covered include:
• Image analysis of cell-based assays • Image analysis of biomarkers in heterogeneous tumor tissue • Image analysis in non-invasive imaging
If you are interested in attending, please contact us and we will provide a $500 voucher towards the conference registration.
See you at the conference!

Mayo model praised, but can it last?

By Jeff Kiger Post-Bulletin, Rochester MN 

Recent weeks have cemented the Mayo Clinic's reputation as a health care superstar but raised the ominous question of how long that can continue under the present U.S. health care system.

	Time Magazine excerpt: "The Mayo clinic attracts Kings and Presidents, injured athletes and ailing billionaires. ... But Rochester's costs are well below the national average because Mayo also provides tremendous value for ordinary care ..."

With the health reform debate heating up, Mayo Clinic has been praised on the national stage as a model for offering quality health care at a low price. Those patting Mayo on the back include President Obama, Time magazine and The New Yorker magazine.

But the question has been raised: Can even Mayo continue to use the Mayo model?

Dr. Atul Gawande's article in The New Yorker magazine June 1 showed that Mayo's per-person Medicare costs in Rochester were low even though it provided a high level of care. He contrasted that with McAllen, Texas, which has some of the high costs but poor quality.

The system of paying for medicine doesn't reward Mayo's quality, and instead drives up costs by encouraging doctors to order pricey scans and surgeries, as they do in McAllen, Gawande concluded,

In his article, "The Cost Conundrum," Gawande wrote, "In the war over the culture of medicine the war over whether our country's anchor model will be Mayo or McAllen the Mayo model is losing."

That was echoed in a June 29 Time magazine article on the Mayo model, which details Mayo's "institutional obsession with evidence-based medicine" it keeps track of what works and does it. Also, Mayo pays doctors fixed salaries so they don't make more if they do more to patients and they don't make less if they take more time to talk to them, the article said.

Mayo Dr. Dawn Milliner was quoted as saying, "We've been able to buffer our staff from the harsh realities of the system, so they can concentrate on patient needs, But it's not clear how long we can keep doing that."

Gawande explained his conclusion this week.

"Their (Mayo's) practice model is closer to the quality and cost we want, though we have a financing system that doesn't make it sustainable," wrote Gawande in an e-mail. "My conclusion is that it's the financing system that has to change, not the medical system."

Mayo Clinic, which lost $840 million on $1.7 billion in Medicare treatment last year, agrees.

"That's the underlying reason we are involved in health care reform," says Josh Derr of the Mayo Clinic Health Policy Center. "The Medicare system is a fee for care system. We want to that shifted to value."

Derr says the short-term fix would factor value into Medicare reimbursement. The longterm fix tosses out the pay-per-service plan, to be replaced with something like a bundled care method. That means a heart attack would be covered with one fee for all related treatment and that encourages a hospital "to do things right the first time," he said.

Of course, change may take a long time, even if Obama admires Mayo's methods.

"Mayo will still find way to stick with its model of care going forward," Derr says. "We'll just have to find different ways to do that."

Dr. In S. Pole Rescue Loses Cancer Battle

Dr. Jerri Nielsen FitzGerald was the center of a dramatic 1999 rescue.

(CBS/AP)  Dr. Jerri Nielsen FitzGerald, whose struggle against breast cancer during a winter at the South Pole captivated the world, has died. She was 57.

Her husband, Thomas FitzGerald, says she died Tuesday at their home in Southwick, Mass. The cause was cancer.

Nielsen was the only doctor at the Amundsen-Scott South Pole Station when she found a lump in her breast in June 1999, raising fears of cancer. Weather conditions didn't permit a rescue, so she performed a biopsy on herself with the help of staff.

She began treating herself using drugs dropped by parachute in the dark polar winter in July, in a mission documented by CBS News.

Despite her illness Nielsen kept busy with her duties up until she left the South Pole, her sister-in-law, Diana Cahill, told CBS News in 1999.

"She didn't have time to focus on her condition at all. She's a very giving person," Cahill said.

Following the dramatic airlift, she told The Vindictor newspaper she wanted to return to the Antarctic.

"It was such a wonderful place. I still love it. I would do it again. Even knowing what happened to me, it was the best year of my life," Nielsen told the newspaper.

Her cancer went into remission until 2005.

Mayo Clinic going to Mall of America

My institution recently announced that it plans an outpost amid the roller coasters, restaurants and retailers as the Mall of America expands into a second phase.  At first glance I thought this would be a "retail clinic" within the large shopping center outside of Minneapolis but organizers have some different ideas that may be more beneficial overall to patients and providers.

I recently had an experience at a retail clinic I will write about in the future but think the exposure is positive for the clinic as another entry point for care that may could provide cost-effective health care, counseling, education or accomodate necessary referrals. 

Come to Minnesota for tax-free clothes and stay for your health care needs.  Will see what this will look likes as plans solidify and how health care providers closer to Minneapolis will respond.

Mayo officials said they haven't decided what services the site will offer, but said they could include diagnostic screenings, wellness counseling and other services that might direct patients to the home campus in Rochester.

"The Mall of America provides a tremendous opportunity to provide a gateway to services we provide and a platform for innovation," said Dr. Glenn Forbes, CEO of Mayo Clinic Rochester, adding: "It's not our intention to replicate what we're doing in Rochester."

The new facility might, for example, offer telemedicine consultations and organize logistics for international patients. But it will not offer routine primary care such as treating sore throats and broken bones.

At a news conference last Wednesday attended by Mall officials and Gov. Tim Pawlenty, Mayo executives said they plan to spend the next 12 months deciding the nature of the facility and the size of their investment. There is no opening date as yet.

Twin Cities hospital and clinic chains such as Allina, Fairview and Park Nicollet compete vigorously for patients in specialty care. Should they be worried?

"I would say a little bit," said Allan Baumgarten, an independent Twin Cities health care analyst. "Although most people have longstanding relationships with their doctors, we are going into a time when people are paying more and more out of their own pocket either because they have lost coverage or have high deductibles.

"This gives someone with a brand name like Mayo an opportunity to say 'Don't think of Mayo being 90 miles away. Think of Mayo as being at the Mall of America.' There's a portal there that could lead to the renowned Mayo Clinic."

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