Digital Pathology Blog

Mayo en route to virtual patients

   7/9/2008 10:25:02 AM

By Jeff Hansel
Post-Bulletin, Rochester MN 

Mayo Clinic wants people to know that the organization's virtual door -- like a scene from the movie Monsters Inc. -- can be found anyplace in the world.

"We've kicked around the term 'Mayo Clinic anywhere,'" said Jeff Korsmo, Rochester chief administrative officer.

Officials plan to offer new and existing Mayo services in ways that won't require visits to Rochester, helping counter the soaring price of fuel.

Virtual technology eventually will allow Mayo to offer remote products such as advice, information and direct care. The effort could build the clinic's patient numbers in Rochester, even though the goal is to serve patients remotely.

Patient visits have climbed 1.6 percent this year, but they haven't grown as much as expected, Mayo officials said. Missing the expected patient levels is something that happens every two or three years, Korsmo said.

"Being a destination medical center can be challenging in difficult economic times, and the cost of travel can affect people's choices to travel for health care," Chief Executive Officer Glenn Forbes wrote to employees in a June newsletter.

Gasoline has soared to nearly $4 a gallon, doubling in less than four years.

"It obviously increases the cost of anything that relates to fuel. So it has had an impact," Korsmo said. "We will make adjustments in the short term, but we always try to stay focused on the long term -- and this is probably a long-term reality. We don't expect gas prices to plummet."

Plans to remedy the problem remain in their infancy, Korsmo said. But he expects patient numbers to grow remarkably as plans take shape.

Already, regional Mayo Health System doctors use technology to remotely link patients to specialists, Korsmo said, eliminating trips to Rochester. In the future, Mayo will be able to serve new and existing patients virtually.

"In that model, we would actually touch many more people -- many times more people -- than we do today," Korsmo said.

The percentage of patients served who visit the city in person could decrease. But because the overall numbers will be larger, planners expect Mayo's census in Rochester to increase.

Mayo has more than 30,000 employees in Rochester, and many commute to the city from outlying towns. To counter high gas prices for them, Mayo officials will consider options such as hybrid bus service and light rail, Korsmo said.

Medicare Laboratory Competitive Bid Repeal Passed by Senate Yesterday

Yesterday was big news for the lab industry as Senate passed the “The Medicare Improvement for Patients and Providers Act of 2008” (HR 6331).” This bill includes repeal of the Medicare Laboratory Competitive Bidding Demonstration Project. Because the House passed this bill last month, it means the bill now moves to the President for his signature or veto.

Also included in this Medicare funding bill for 2008 are a reversal of the 10.6% cut in Medicare physician reimbursement and an 18-month extension of the “TC Grandfather clause” (which covers independent laboratories located outside a hospital that provide technical component [TC] pathology services furnished to hospital patients). On July 1, 2008, the Medicare physician fee cut of 10.6% took effect. Also on July 1, the Centers for Medicare and Medicaid Services (CMS) implemented “a policy to pay only the hospital for the technical component (TC) of physician pathology services furnished to hospital patients.”

Thus, this Medicare funding bill represents a significant victory for pathologists and the laboratory industry. It is known that the President opposes this Medicare bill, as passed, because it would cut funding for Medicare Advantage insurance plans. However, both the vote in the Senate (69-30 in favor) and the House (355 to 59 in favor) indicates the likelihood that, were the President to veto this bill, there enough votes to probably override that veto.

In the meantime, some attorneys have advice to independent laboratories that provide TC services to Medicare inpatients. They suggest that these labs hold claims originated since July 1, 2008. Once the Medicare funding bill, with the 18-month extension of the TC grandfather clause becomes law, they should be able to submit those claims and be reimbursed.

OLYMPUS TO LAUNCH FASTER DIGITAL CAMERA FOR MICROSCOPES

07/02/2008 23:38:41

TOKYO, Jul 03, 2008 (AsiaPulse via COMTEX News Network) -- Olympus Corp. (TSE:7733) said Wednesday that it will release this coming Monday a new digital camera that connects to microscopes used at medical sites and for inspections at factories.

The DP72 attaches to the top of the microscope. It has an effective pixel count of 1.45 megapixels and can capture nine frames of images in a single 3 x 3 image array equivalent to 12.8 megapixels. Image capture time has been shortened to 2.5 seconds from three seconds, making work more efficient.

The new camera also has enhanced color reproduction, enabling the display of colors closer to reality. It is expected to help researchers obtain more accurate information in pathology diagnoses.

The DP72 will have a standard price of 1.61 million yen (US$15,212). Olympus is targeting domestic sales of 1,000 units a year.

Physician 2.0 Award

Medicine 2.0™ is pleased to announce that MDPIXX (dubbed the "YouTube" for physicians) will sponsor a "Physician 2.0 Award" for the best clinical case submitted to the MDPIXX case database.

The award consists of one Apple iPhone for the winner.

The prize will be awarded during the Medicine 2.0 Congress in a public session.

Physicians are eligible for the award. The deadline to submit a medical case to MDPIXX is September 3rd at 12PM (CET Time).

The award will be given to the most valued case, as determined by the MDPIXX user community.

Medicine 2.0™ is an international conference on Web 2.0 applications in health and medicine, organized and co-sponsored by the Journal of Medical Internet Research, the International Medical Informatics Association, the Centre for Global eHealth Innovation, CHIRAD, and a number of other sponsoring organizations.

For further information please see

http://www.medicine20congress.com/awards.php

Issue of "automatic" special stains for GI biopsies

I came across this discussion on a pathologist bulletin board recently.  The original post and responses are from May and I have again scrubbed the names (when used) to protect the innocent. 

What I like about this post is the fact it was started by a pathologist working in a GI POD lab.  This remains a topic of discussion in pathology practice, although their days may be numbered. 

Nevertheless, previous posts on this topic remain one of the most visited pages on this blog and I think this small discussion, largely by pathologists, highlights the issues.  One concern that all of us deal with and we could argue that there is no financial disincentive not to, is the topic of "automatic" special stains in GI biopsies.  Personally, I have not worked anywhere that does this routinely, largely for the reasons below, but realize several labs do, including specialty POD labs, academic and private groups alike.  The other issue of course is the self-referral business and doing more biopsies perhaps than would normally be indicated. 

Questioner:

I'm working in-house for a gastroenterology group as an "independent contractor" pathologist. Before my arrival at the GI office, its pathology operation had been set up by a consultant to maximize income.

I have some ethical and possibly legal/regulatory concerns. First is the matter of whether or not the gastroenterologists might be performing excessive numbers of biopsies, given their financial interest-- but this is something over which I clearly have no control.

Of more direct concern to me is the protocol of default performance of special stains on all gastric and esophageal biopsies. Billing for the special stains is "automatic" from the time of specimen accession. Some of these stains I consider so pointless that I just sign them out as "non-contributory".

Questions for Discussion: 1. Do other GI practices also perform specials routinely, regardless of clinical context or H&E findings? 2. Is the automatic performance of special stains best classified as "standard practice", "outlier", or "egregious"? 3. Is the GI group at risk? If so, what are the specific risks, including their odds and magnitudes? 4. Even though I am neither ordering the special stains nor cashing the checks from the patients or insurers, am I at risk?

Response #1 of 4:

Interesting questions. I can't comment at all on the legal "at risk" issues, but I do know that ordering some stains "up front" on GI biopsies is a pretty common practice in my area of the US. Although I agree that the special stains are often not helpful, it has been advocated by some experts (Montgomery in Biopsy Interpretation of GI Tract Mucosa, for example, recommends upfront ordering of Alcian Blue/PAS for upper GI biopsies although she says it is not essential - see page 1). We don't get these stains upfront at my county hospital, but many of our local private hospital pathologists do, so I don't think you are in the "egregious" category...

Response #2 of 4:

Special stains that are not required (noncontributory), but billed, are fraudulent. If you already see the H. pylori with H&E, why the histochemistry? If you already see the specialized intestinal metaplasia, why the histochemistry? If the special stain is not even appropriate (cluster of squames, ulcer bed, obvious carcinoma...) it is totally inappropriate to bill for it.

The G/I pathology in office ancillary services exception to Stark Medicare exception is already under scrutiny by the OIG (in part due to pod labs and specifically the Uropath lawsuit and because of the obvious financial incentive to biopsy once and bill twice) and likely is a cul-de-sac. I suggest you peruse / subscribe to Endoeconomics http://www.endocenters.com/endoeconomics.html

The spring 2008 issue suggests that this self referral scheme is not going to be around much longer. Your "colleagues" are already "in," so they will ride this scheme (including you) as long as they can. Speak openly and honestly with your G/I client and lay out your concerns. Tell them in writing that you want to be able to cancel the charge for special stains if it was performed, but non-contributory. If they are worthy of your regard as professionals, they will be amenable to addressing your concerns. If they are not, you should distance yourself from these scoundrels and report them to the OIG for Medicare fraud (and collect your whistle-blower reward) with specific examples that you happen to have handy from systematic inappropriate charges to Medicare patients.

Endoscopists are under compensation assault so they are rapacious. Don't compromise yourself to offset their financial woes. Do not be part of what is WRONG with American Medicine.

Response #3 of 4:

[Anonymous], a superb answer. The difference between right and wrong is often very clear indeed and if you want to sleep at night...

Response #4 of 4:

A local GI group has an in-house path lab. The members don't seem sleepy, but are currently doing a prospective study to determine whether or not their biopsy rates have increased since instituting in-house billing. What they'll do if the results show an increase,(I'd bet on it,) will be interesting. One of their members still argues about the necessity of 6-7 minute cecum-rectum times.

FDA approves SPOT-Light test for aggressive breast cancer

The Wall Street Journal (7/9, D3, Chase) reports that on Tuesday, the Food and Drug Administration (FDA)...approved another new test for aggressive breast cancer called the SPOT-Light test." The test is manufactured by Invitrogen Corp. of Carlsbad, Calif., and a company spokeswoman "said [that] the test kits will be sold to hospital laboratories for about $1,400 for a packet of 20 kits."

According to the agency, it "cleared Invitrogen's SPOT-Light test to count copies of the so-called HER2 gene in tumor tissue that regulates the growth of cancer cells," Bloomberg (7/9, Larkin) adds. Some breast cancer patients "have more than the two standard copies, and produce excess HER2 protein, causing cells to grow and divide too quickly." Daniel Schultz, M.D., director of the FDA's Center for Devices and Radiological Health, stated, "When used with other clinical information and laboratory tests, this test can provide healthcare professionals with additional insight on treatment decisions for patients with breast cancer."

HealthDay (7/8, McKeever) noted that the "SPOT-Light test counts HER2 genes through a chemically stained sample of removed tumor observed under a standard microscope." Other tests "required more expensive and complex fluorescent microscopes. The SPOT-Light also allows labs to store the tissue for later reference, a feature not possible with previously available tests."

The FDA's "approval was on the basis of a study using tumor samples from patients with breast cancer in the United States and Finland," MedPage Today (7/8, Peck) explained. Various trials "confirmed that the test was effective in determining how many HER2 genes were in these patients."

WebMD (7/8, Hitti) pointed out that patients with cancer "who overproduce HER2 protein are typically treated with the drug Herceptin, which targets HER2 protein production. This helps to stop the growth of HER2 cancer cells."

YRMC telemedicine: Beam me up, doctor

Yuma Regional Medical Center has been "beaming up" doctors from around the state for the past few years.

For patients who can't afford to visit specialists outside the area, YRMC's partnership with the Arizona Telemedicine Program connects patients to specialists through new technology.

The Arizona Telemedicine Program at YRMC got a positive review last month from Dr. Ronald Weinstein, director of the program at the University of Arizona Health Sciences Center.

"Telemedicine is the practice of medicine at a distance using video imaging and telecommunications technologies," wrote Weinstein in an e-mail. "The Arizona Telemedicine Program is a large statewide program. It provides the telecommunications infrastructure for telemedicine, telemedicine training and many telemedicine services over its network."

The telemedicine program came to YRMC as part of the Arizona Department of Health Services Children's Rehabilitation Services program. YRMC's "Neonatal Intensive Care Unit... is linked to the University Medical Center in Tucson, for emergency consultations on infants with serious, often life-threatening conditions." It also provides services for disabled children in the Yuma area.

Weinstein came to visit YRMC last month to get an update on current telemedicine activities at YRMC and to assess the utilization of its services.

"Babies' lives have been saved in the YRMC Neonatal Intensive Care Unit. Dozens of children with severe disabilities are being seen by a pediatric orthopedic surgeon in Phoenix over the network," wrote Weinstein.

Mike Sisson, applications administrator at YRMC, works with telemedicine for children's health services. The equipment he works with is a "Tandberg Edge 95 MXP PrecisionHD (camera) that is connected to a 50-inch Plasma Panasonic flat screen television," he wrote in an e-mail.

Sisson said that he works mostly with children who are in wheelchairs and whose families cannot afford to drive outside of Yuma to see a doctor.

Sisson helps the doctors in Phoenix or Tucson to see how a child moves and looks through the plasma screen. There is also therapists in the room with Sisson, who become the doctors' hands by bending, moving and feeling a child's extremities.

Sisson said that the patients love this new program. "Sometimes it is the only way (for them) to see the doctor."

Gregory Warda specializes in neonatology and works in the intensive care unit with newborn babies at YRMC. "This is a great solution," he said. Through the screens "we can see doctors and nurses ... It's just like they were right here ... and I can ask the doctor questions instead of writing a letter."

Dr. Weinstein said that he would like to see YRMC be an example to other hospitals who would like to implement the program.   "This program is fabulous," said Weinstein. "The people of Yuma are extremely fortunate to have this here."

Robot imager evaluates tiny tissue slices

German scientists say a new high-tech imaging center can reproduce and evaluate high resolution images of cells and tissue only micromillimeters thick. The Hamamatsu Tissue Imaging and Analysis Center, or TIGA, at the University of Heidelberg is a cooperative effort between the university and the Japanese company Hamamatsu Photonics.

At TIGA's core is an imaging robot called "NanoZoomer" that makes it possible for the first time to automatically reproduce and evaluate tissue slices in ultra high resolution and in various planes, the researchers said, noting the achievement is an important aid for scientists in understanding cancer or in following in detail the effect of treatment on cells and tissue. "Technically, this has brought the fully automatic evaluation of tissue changes and approaches for new therapy within our grasp," said Professor Peter Schirmacher, director of the Institute for Pathology at Heidelberg University Hospital. "This would represent a new milestone in pathology."

In the future, the robot is expected to be able to determine changes in cells and tissue fully automatically. "The NanoZoomer represents a quantum leap in tissue research," said Niels Grabe of the Institute for Medical Biometry and Informatics and research director at the TIGA Center.

Author's Sought for Chapters in The Handbook on Knowledge Management in Telemedicine

Download this press release as an Adobe PDF document. The Handbook covers a wide range of topics from early adopters of Telemedicine to the latest innovation and futuristic tele-robotic technologies including the Internet, Web and Data mining. Researchers and practitioners are invited to submit chapters by 5 August and reviewed. Book scheduled to be published by IGI Global, www.igi-pub.com. Washington, DC and India (PRWEB) July 5, 2008 -- Author's working in telemedicine and knowledge management as researchers and practitioners are invited to submit book chapters to be published by IGI Global, www.igi-pub.com. Telemedicine lies far beyond Internet itself and suffers from lack of global technology standards and profuse applications, which would make it a household name like Google or Yahoo!. Herein lies the significance of the Semantic Web. A technology interface or enabler that can rapidly develop simple and efficient applications for telemedicine is urgently required. This is the area from which new innovations are likely to emerge within the next 2-3 years. The Handbook of Research on Knowledge Management in Telemedicine: Advanced Ethics, Policy and Regulatory Applications covers a wide range of topics from early adopters of Telemedicine to the latest innovation and futuristic tele-robotic technologies. The Overall Objective of the Book: In the fields of Knowledge Management in Telemedicine and associated fields of Datamining and Biomedical Ontology, there exists a need for an edited collection of articles in this area. The book aims to provide relevant theoretical frameworks and latest empirical research findings in the area. It is written for professionals who want to improve their understanding of the global significance of Telemedicine and apply it in their profession. Since Telemedicine is expected to provide a strategic thrust at different levels of the global information and knowledge society and bridge the knowledge gaps in developing nations, the book addresses the all important ethics, policy and regulatory applications in a detailed and comprehensive fashion. The Target Audience is professionals and researchers working in the field of information and knowledge management in various disciplines, e.g. library, information and communication sciences, administrative sciences and management, education, adult education, sociology, computer science, information technology. Moreover, the book will provide insights and support decision-makers at local, regional, national and international levels to implement Telemedicine initiatives in their country to advance quality of healthcare, medical education and research and elevate the overall health and well-being of society and communities. Recommended topics include, but are not limited to, the following: History And Evolution Of Telemedicine Internet, Semantic Web And Telemedicine Telecommunications And Telemedicine Information Technology And Telemedicine Devices, Equipments, Instruments And Accessories And Telemedicine Medical Applications of Telemedicine: Global Ethics And Telemedicine Local, National And International Policies In Telemedicine Total Quality Management In Telemedicine University- Industry Alliance In Telemedicine Tele-Robotics- Theory And Applications Biomedical Ontology: Theory And Applications Data mining Applications For Telemedicine Decision Support Systems For Telemedicine Submission Procedure: Researchers and practitioners are invited to submit chapters by August 5, 2008 and will be reviewed on a double-blind review basis. The book is scheduled to be published by IGI Global, www.igi-pub.com, publisher of the IGI Publishing (formerly Idea Group Publishing), Information Science Publishing, IRM Press, CyberTech Publishing and Information Science Reference (formerly Idea Group Reference) imprints. Inquiries and submissions can be forwarded electronically (Word document) or by mail to: Dr. Jayanth G Paraki Telemedicine Research Laboratory, India jparaki @ gmail.com Or Dr. Lawrence Wasserman USA Health Knowledge Management Consultant Fortech1 @ usa.net

Telemedicine Equipment Installed at Guam Memorial Hospital

Telemedicine Equipment Installed at Guam Memorial Hospital       

A complete telemedicine system, courtesy a donation from Dr. Nathaniel Berg and the Guam Healthcare and Hospital Development Foundation, including a video link, LCD television, web camera and a Dell computer was installed in the Guam Memorial Hospital (GMH) boardroom this weekend. 

According to Foundation Chairman, Peter Sgro, the hospital chose the first floor conference room where the board meetings are held to also become the telemedicine consulting room for physicians and for communicating with licensed physicians on the U.S. mainland.  The foundation's goal is to support the development of a private hospital on Guam, but also help improve the quality of healthcare at GMH and other medical facilities on Guam.

The second telemedicine station will be in the hospital's education room which will be used for nursing and physician education. All together the donation cost the Foundation and Berg's office approximately $60,000.  GTA Teleguam will donate high speed internet for a year that will be used for the video link.

Dr. Berg told the Pacific News Center that if used effectively, telemedicine can significantly improve patient's lives.  The key now is to train and inform the medical community on Guam on how to most effectively use telemedicine to improve the quality of care they provide to patients on Guam.