Digital Pathology Blog

Need for Digital Mammography?

These 2 stories appeared in Ireland in early November dealing with quality assurance issues in a hospital's radiology department.  Stories have continued in the local press there about the continuing investigation on the matter.  A link is below for the story that appeared in RTE News on November 6, 2007.  What I find most interesting is request from the radiology department to hospital administrators requesting a digital mammography system to replace aging conventional film technology to provide the highest quality of diagnostic accuracy. 

While PACS systems for radiology are now in the majority of US hospitals, standards and concerns about digital mammography in this country have persisted.  A summary of the issues is available here from the American College of Radiology.  While adoption is taking place for digital mammography it appears to be slower than for other organ systems and studies in radiology, although undoubetedly mammography will follow. 

A New England Journal of Medicine in October 2005, showed no difference between digital and screen-film mammography in detecting breast cancer for the general population of women. However, it did find that digital mammography detected more cancers in women who were 50 or younger, premenopausal and perimenopausal, or had dense breasts.

Apparently the radiologists at this hospital thought enough of the technology to request from their institution forseeing these issues without it.  It begs the questions "Does newer technology, although controversial and perhaps with specific indications and more importantly, contraindications for use potentially allow for replacement of older technology?  Was the motive to obtain new equipment to replace older or enable higher quality diagnostic accuracy?  Would doing so have helped to eliminate the diagnostic errors?" 

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RTÉ News has learned that an eighth case of misdiagnosis has been uncovered at Midland Regional Hospital in Portlaoise, Ireland.

A woman who was told she had no cause for concern after breast cancer tests at the hospital has now been diagnosed with the disease after being re-examined by specialists at St Vincent's Hospital in Dublin. The mother from Co Laois, who wishes to remain anonymous, said she was told by staff at the hospital in Portlaoise in July that her mammogram had indicated she was not suffering from cancer.

But after hearing about the HSE review of the work of a consultant radiologist in Portlaoise last September she sought a new appointment at St Vincent's Hospital. She says she underwent a mammogram and breast ultrasound tests in October in Dublin and has now been told she has breast cancer.

The Minister for Health, Mary Harney, has said the report by the Health Service Executive on the misdiagnosis of cancer patients at the Midlands Regional Hospital will be published when it is completed at the end of the month.  She said it would be meaningless if the report was not published when it is completed at the end of the month.

But she said she wants to take advice in relation to whether, in the wake of what happened at Portaloise, other mammograms should be looked at again.

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The Midland Regional Hospital in Portlaoise was warned ten months ago that problems with mammography equipment meant 'a huge potential for litigation', in relation to delayed or wrong diagnosis of breast cancer.

However, the Health Service Executive has said it is satisfied that equipment in the x-ray department at the hospital operates within the normal quality assurance standards.

In a letter to hospital management, seen by RTÉ News and dated 13 December 2006, the radiology department advised that to deliver the highest standard of patient care it needed an imaging system, which could produce mammograms of the best possible diagnostic quality.

The correspondence expressed concern about the age of the mammography machine and advised that a digital system was needed instead of the film system, which at times was affected by dirt from the darkroom environment.

The letter warned that poor image quality could result in the missed or delayed diagnosis of a tumour, leading to reduced prognosis for a patient, or a false positive test resulting in patients having to undergo unnecessary surgery.

Flaws on the film system meant that patients had to undergo repeat x-rays, increasing the radiation dose and discomfort for them.

'We are also concerned about the huge potential for litigation in relation to delayed or wrong diagnosis of breast cancer associated with using suboptimal imaging equipment', the letter stated.

The HSE said a routine inspection on the machine last May did not include any identifiable faults.

Meanwhile, the HSE has said that six of the remaining 19 patients who were called back for a review of breast screening will require further assessment.

These patients have been contacted and will be seen at St Vincent's University Hospital this week.

To date 3,026 mammograms carried out at the Midland Regional Hospital between November 2003 and August 2007 have been reviewed.

The HSE says that seven patients have so far been found to have symptoms of breast cancer.

There are to be statements in the Dáil on cancer care tomorrow morning, when Mary Harney will address the issue of shortcomings in Portlaoise Hospital.

Earlier in the Dáil, the Taoiseach indicated that misdiagnoses there may not have been due to any system failure.

Mr Ahern was pressed by Labour's Eamon Gilmore on the issue of a consultant at the hospital having been placed on administrative leave, but said he would prefer to leave the facts to the official report which will be published later this month.

Story from RTÉ News:
http://www.rte.ie/news/2007/1106/cancer.html

Digital Infrared Thermal Imaging In Medical Therapy

Digital technology now makes Digital Infrared Thermal Imaging available to all. There now is a completely safe test that can aid in diagnosis, treatment and monitoring with absolutely no risk or radiation exposure.

DITI, or digital infrared thermal imaging, is a noninvasive diagnostic test that allows a health practitioner to see and measure changes in skin surface temperature. An infrared scanning camera translates infrared radiation emitted from the skin surface and records them on a color monitor. This visual image graphically maps the body temperature and is referred to as a thermogram. The spectrum of colors indicates an increase or decrease in the amount of infrared radiation being emitted from the body surface. In healthy people, there is a symmetrical skin pattern which is consistent and reproducible for any individual.

DITI is highly sensitive and can therefore be used clinically to detect disease in the vascular, muscular, neural and skeletal systems. Medical DITI has been used extensively in human medicine in the United States, Europe and Asia for the past 20 years. Until now, bulky equipment has hindered its diagnostic and economic feasibility. Now, PC-based infrared technology designed specifically for clinical application has changed all this.

Clinical uses for DITI include, defining the extent of a lesion of which a diagnosis has previously been made (for example, vascular disease); localizing an abnormal area not previously identified, so further diagnostic tests can be performed (as in Irritable Bowel Syndrome); detecting early lesions before they are clinically evident (as in breast cancer or other breast diseases); and monitoring the healing process before a patient returns to work or training (as in workmans compensation claims).

Medical DITI is filling the gap in clinical diagnosis; X-ray, Computed Tomography, Ultrasound and Magnetic Resonance Imaging (MRI), are tests of anatomy or structure. DITI is unique in its capability to show physiological or functional changes and metabolic processes. It has also proven to be a very useful complementary procedure to other diagnostic procedures.

Unlike most diagnostic modalities DITI is non invasive. It is a very sensitive and reliable means of graphically mapping and displaying skin surface temperature. With DITI you can diagnosis, evaluate, monitor and document a large number of injuries and conditions, including soft tissue injuries and sensory/autonomic nerve fiber dysfunction. Medical DITI can offer considerable financial savings by avoiding the need for more expensive investigation for many patients. Medical DITI can graphically display the biased feeling of pain by accurately displaying the changes in skin surface temperature. Disease states commonly associated with pain include Reflex Sympathetic Dystrophy or RSD, Fibromyalgia and Rheumatoid arthritis.

Medical DITI can show a combined effect of the autonomic nervous system and the vascular system, down to capillary dysfunctions. The effects of these changes reveal an asymmetry in temperature distribution on the surface of the body. DITI is a monitor of thermal abnormalities present in a number of diseases and physical injuries. It is used as an aid for diagnosis and prognosis, as well as therapy follow up and rehabilitation monitoring, within clinical fields that include rheumatology, neurology, physiotherapy, sports medicine, oncology, pediatrics, orthopedics and many others.

Results obtained with medical DITI systems are totally objective and show excellent correlation with other diagnostic tests.

Thermographic screening is not covered by most insurance companies but is surprisingly affordable for most people.

Three-Dimensional Medical Imaging Could Improve Doctors' Ability to Diagnose Fetal Alcohol Syndrome

By Josh Romero Spectrum Online (http://www.spectrum.ieee.org/nov07/5720)

Digital facial models created from three-dimensional scans could give doctors a new diagnostic tool for identifying children with fetal alcohol spectrum disorders, a broad range of effects resulting from alcohol exposure in the womb. Although such children often have symptoms common to other developmental disorders, they require different interventions, and better diagnostics could help more kids get the right treatment.

Unlike other disorders such as Down syndrome, children with fetal alcohol syndrome—the severe form of the disorder that affects two in 1000 children in the United States but more than 20 times that in some other countries—lack genetic or biochemical markers of their condition. Affected children are often hyperactive, learn slowly, and have difficulty with social situations. But none of these symptoms is unique to prenatal alcohol exposure.

To make a diagnosis, experts called dysmorphologists rely on identifying specific facial features, growth deficits, and cognitive difficulties. Just as behavioral indicators are not unique to fetal alcohol syndrome, dysmorphologists can’t use any single feature to reliably assess a child’s face. Instead, they look for a signature combination of features that include small eye openings, a thin upper lip, and a smooth area between the lips and nose that, together, indicate an abnormality.

Unfortunately, this approach doesn’t work for all patients. The severity of the facial indicators varies, depending on both the amount and timing of prenatal alcohol exposure and the patient’s natural susceptibility, which means that less severe cases are difficult to detect. In addition, such facial characteristics of the exposure differ among ethnicities, which means the disorder can be underdiagnosed in some populations.

“There’s really a need to make the diagnosis more objectified,” says Dr. Elizabeth Moore, a research scientist at St. Vincent Hospital in Indianapolis and lead author of the study published in the October issue of Alcoholism: Clinical & Experimental Research. In search of a more universal diagnostic method, a consortium of doctors in the United States, Finland, and South Africa has started using measurements from three-dimensional laser scans.

Moore and her collaborators used a commercial 3-D laser scanner to take six images of each child, two from the front, and two from each side. The scanner captures depth data accurate to less than a millimeter by scanning a low-intensity, “eye safe” laser line over the face while simultaneously capturing a low-resolution color picture. A camera in the scanner measures the time it takes the laser pulses to reflect back from the face. By combining this information with the known distance between the laser source and the camera, the software can calculate the 3-D coordinates for each point on the face and then overlay the color data. Moore and her team stitched three of these 3-D perspectives together to form one complete model. Collecting each image required less than a second, according to Moore, and the device was portable enough to set up in remote locations like a South African church.

Creating digital models provided the researchers with the ability to quantitatively measure and compare more facial features than a dysmorphologist typically looks for, without lengthening the patient’s exam. Moore examined each model and marked the location of 20 facial landmarks, such as the corners of the eyes. Customized software then measured 16 different distances between the various landmarks. In comparing measurements between children diagnosed with fetal alcohol syndrome and those in a control group, Moore and her team found that the best indicators of alcohol exposure varied by ethnicity. For example, while ear length served as a good discriminating characteristic for the South African population, it was not statistically significant for the group of African Americans.

Within each of four different ethnic groups in the 276-patient study, more than three-quarters of the diagnoses based on the digital measurements matched those of Dr. Kenneth Lyons Jones, one of the doctors who first identified fetal alcohol syndrome. According to Moore, the results demonstrate that the technique works for severe cases within different ethnicities. Now that they have proof of concept, she and her consortium hope to expand their studies to more age groups and ethnicities, as well as less severe cases.

Understanding how fetal alcohol syndrome features vary among ethnicities will help identify the disorder in countries where it’s more common and where there’s less access to experts, says Moore. Rates are high in South Africa, for instance, where more than 50 children per 1000 live births are affected.

“One possibility is telemedicine,” says Edward Riley, an expert in treating children with fetal alcohol syndrome at San Diego State University, “where 3-D pictures can be sent to a diagnostic center anywhere in the world.”

Moore’s team looks to use the scanner on infants next, an important step in catching the disorder early. Most children aren’t examined for fetal alcohol syndrome until they exhibit behavioral and developmental problems in school at ages five to seven. “The earlier you can intervene, the less the child falls behind, the better the outcome of the kid,” says Riley.

“This is a technology that has demonstrated some usefulness and shows a lot more potential,” he says.

caBIG Links Newsletter: Issue 5

The September 2007 release of caGrid 1.1, the latest version of the underlying software infrastructure of caBIG™, is a major step towards addressing the cancer research community's needs and promoting interoperable software standards for collaborating institutions.

Issue 5 of caBIG™ Links highlights some of the new features of the latest release of caGrid and includes a feature on Joel Saltz, M.D., Ph.D., whose research team at The Ohio State University Medical Center led the collaborative development of caGrid 1.1. This month's issue features:

• caGrid Release Highlights Usability and Security Functions
• Getting Connected with Dr. Joel Saltz: From Bioinformatics to Medicine and Back

To read this month's edition visit: http://cabig.cancer.gov/media/links/October_07/index.asp .

Learn more about how caBIG™ tools and infrastructure are being developed to support the development of a cancer researcher network that accelerates discoveries to benefit patients.

Kodak DXS 4000 Imaging Systems

For Digital Specimen Radiography

Carestream Molecular Imaging has introduced a new digital x-ray imaging platform that produces high-resolution radiographs of medical, life science and material science research specimens. The new Kodak DXS 4000 and KODAK DXS 4000 Pro systems will be available in the US in the fourth quarter of 2007, the company said.

Carestream Molecular Imaging group is a division of Carestream Health Inc., which was formed this year when Onex Corp. bought Eastman Kodak's Health Group. The company made the announcement about the DXS (digital x-ray specimen) 4000 systems this week at the Radiological Society of North America's (RSNA) annual meeting in Chicago.

The DXS 4000 and DXS 4000 Pro are shielded, self-contained cabinet x-ray imaging systems that feature a cooled 4-million-pixel CCD camera combined with proprietary phosphor screen technology. With exceptional resolution of up to 25 line pairs per millimeter without geometric magnification, the systems offer the highest resolution available for digital specimen radiography. Kodak DXS systems are ideal for life science and material science applications in areas such as pathology, forensics, agricultural, marine biology and forestry research, Carestream Molecular Imaging said.

"We are introducing our new digital radiography systems at the request of many customers who recognize our world-class expertise in x-ray technology," said Shahram Hejazi, PhD, president of Carestream Molecular Imaging. "Our Kodak DXS systems leverage our proven leadership in digital x-ray imaging and broaden our scope in delivering state-of-the-art molecular imaging solutions to medical, life science and now material science researchers."

Additional features and benefits:

• True 16-bit imaging capabilities produce more than 65,000 levels of grayscale for accurate x-ray density measurement
• 10X optical zoom provides a field of view of up to 20 x 20 cm
• Integrated analysis software enables quantification, annotation and databasing of radiography images to enhance the efficiency of research teams.

The Kodak DXS 4000 Pro system offers all of the superior imaging capabilities of the DXS 4000 with the additional benefit of full automation for greater productivity and efficiency, the company said.

For more information, visit: mi.carestreamhealth.com; e-mail: kmi-orders@carestreamhealth.com

Carestream Health Molecular Imaging
4 Science Park West
New Haven, CT 06511
Phone:(877) 747-4357, Option 1
Fax: (800) 879-4979

VivaScope(R) Confocal Imager May Eliminate Need for Routine Skin Biopsies for Dermatology Patients

Many routine surgical biopsies could become a thing of the past as dermatologists may soon be sharing, reviewing and diagnosing noninvasive digital images of skin cells via the Internet, using Lucid Inc.'s VivaNet(TM) telemedicine server and its VivaScope(R) confocal imagers.

The technology, which relies on using special microscopes to digitally image a patient's skin, may bypass the need to surgically biopsy many patients. "VivaScope imaging sessions require only 5 to 10 minutes of a physician's assistant's time," said Jay Eastman, Ph.D., CEO, Lucid Inc. (http://www.lucid-tech.com).

The cellular resolution images may then be used by physicians to assist in forming a clinical judgment for a variety of skin conditions, including, for example, melanoma, basal cell carcinoma, actinic keratoses, and contact dermatitis.

A typical VivaScope imaging session produces two types of images of the patient's skin: dermatoscopic-quality, full-color macroscopic pictures, and microscopic, cellular resolution images. Like a routine biopsy, the images can then be read by a dermatologist or a pathologist and the diagnosis presented to the patient.

"Just as MRI and CT scans have largely eliminated the need for routine exploratory surgery, in-vivo confocal imaging may one day eliminate the need for routine invasive skin biopsy," Eastman stated.

 

Already, dozens of Lucid's VivaScopes are in regular use throughout the

U.S.

and

Europe

. "Lucid's VivaScope(R) 1500 has the capability of imaging virtually all types of skin cancers, which makes it useful for many everyday procedures in a dermatology practice," stated Dr. Harold Rabinovitz, a

Florida

based dermatologist who specializes in skin cancer. "The VivaScope is an incredible diagnostic tool and now routinely aids me in the clinical evaluation of potential skin cancers."

The Company is also developing an Internet-based application, the Lucid VivaNet(TM), to enable the transfer of VivaScope digital images between practitioners and pathologists for rapid review of confocal images. The VivaNet technology conforms to DICOM (Digital Imaging and Communications in Medicine), an internationally accepted standard for the secure storage, retrieval and transfer of medical images, and it complies with federal HIPAA requirements for privacy and integrity of medical data.

Ultimately, the VivaNet could make VivaScope images available for review by other dermatologists and pathologists -- anywhere in the world -- in minutes, not days -- thus enabling rapid, real-time professional collaboration. The ultimate goal is that practitioners will rapidly receive a pathologic interpretation of confocal images from a VivaScope session, potentially assisting the practitioner in arriving at a clinical judgment while the patient is still in the doctor's office, Eastman said.

"It's our hope that the VivaScope and VivaNet will improve the quality of life for dermatology patients by eliminating the need for painful, invasive skin biopsies and drastically reducing the time required for diagnosis and treatment," Eastman said.

For information on Lucid's VivaScope or VivaNet technology, contact Lucid by phone at 585-239-9800, by email at info@lucid-tech.com, or on the web at http://www.lucid-tech.com.

Hospitals and Social Media

Posted on www.hospitalimpact.org by Tony Chen on 18 Dec 2007.  Thought it worth re-posting.

Definitely not the phrases you see together very often, right? Maybe it won't be so foreign in a few years.

I've posted in the past on whether hospitals should blog. I've also previously mentioned how pleasantly surprised I was to see a hospital classified ad on facebook. Where exactly are hospitals at when it comes to social media?

Obviously, as a whole, hospitals aren't even close to implementing (or even understanding) these new social media technologies. However, you might be surprised at how savvy some hospitals already are. Here are a few examples:

1. Cleveland Clinic is on Facebook. I think you have to be a facebook user to see these, but you too could join the Cleveland Clinic Lerner College of Medicine Group (currently 84 members) and the Cleveland Clinic Group (55 members). Their group description: This group is for all employees, interns, volunteers, patients, or anyone who is associated with the Cleveland Clinic or the CCF health system. If you look around, there are other hospitals that are also dabbling with various groups. Do a search for other hospitals (try MD Anderson), and you'll find all kinds of different groups and people who are associated as employees/volunteers.

2. Mayo Clinic Health Policy Center is also on Facebook with fans. This is different than a "group." As of just a few months ago, companies and organizations can join facebook, and individuals can declare themselves as "fans." This is a way for people to show their friends what they're excited/passionate about. Viral marketing at its best (and worst).

3. Partners Healthcare is on SecondLife. Check out their website for how they explain SecondLife and why they believe it is important. Some folks may have heard of Second Life as a 3D virtual world for gamers and slackers. Obviously, this isn't the case anymore. Tons has been written about it recently - everything from the pros/cons of job interviews done on second life to why GM created a pretend virtual dealership. CNN even has a blog that solely covers second life developments.

4. Hospital CEO blogs - I think we are all already familiar with these. Just in case you aren't, check out Nick's Blog (CEO of Windber Medical Center in PA) and Paul Levy's blog (CEO of Beth Israel Deaconess Medical Center in Boston)

5. Some hospitals are using internal collaborative tools (like Microsoft's SharePoint) to better facilitate cross-functional collaboration. Once organizations get over the initial hurdle of learning a new system, lots of synergies are to be had - worklists, wikis, lists, and calendars.

There are more, but this is a pretty representative list.

The bottom line is this: While some hospitals are embracing social media, hospitals as a whole won't be getting into social media anytime soon. But, many patients will. And as such, hospitals that take the plunge as early adopters will be well-known as savvy and transparent.

Data indicate 12 million new cancer cases worldwide in 2007, nearly eight million cancer deaths

          The AFP (12/18) reports, "More than 12 million new cancer cases were diagnosed in 2007 and 7.6 million people were killed by the disease," roughly "20,000 [deaths] each day of the year," according to Global Cancer Facts and Figures, a study published by the American Cancer Society (ACS). The study also detailed that only "5.4 million new cases and 2.9 million fatalities occurred in developed nations over the course of the year."

        According to the CBC (12/17), "The report identifies major differences in the most common types of cancers between developed and developing nations," with "[t]he three most common cancers in men in developed countries" listed as "prostate, lung and colorectal cancers," compared to the three most common cancers in men living in developing nations, which are listed as "lung, stomach, and liver" cancers. Meanwhile, the three most deadly cancers in women living in developed countries "are breast, colorectal and lung cancer," while women in developing nations face the largest threat from "breast, cervi[cal], and stomach" cancers.

        HealthDay (12/18, Reinberg) quotes Dr. Ahmedin Jemal of the ACS's Cancer Occurrence Office, as saying, "The point of the report is to promote cancer control worldwide, and increase awareness worldwide." Explaining the rising number of cancer cases worldwide, Jemal noted, "There is increasing life expectancy, and cancer occurs more frequently in older age groups." Data in the study also highlighted differences in cancers between developed and developing nations, as "the incidence of infection-related cancers remains three times higher in developing countries compared with developed countries (26 percent vs. eight percent)."

        WebMD (12/18, Hitti) adds that there may be several explanations for differences in cancer rates between developed and developing nations. "Part of that gap is due to infection and lack of access to medical care in the developing world." However, "Lifestyle factors also play a role." Jemal noted that the "cancer burden is also increasing as people in the developing countries adopt western lifestyles such as cigarette smoking, higher consumption of saturated fat and calorie-dense foods, and reduced physical activity." Survival rates are also different between depending on where patients live, as highlighted by data indicating that "roughly 81 percent of U.S. women survive for at least five years after breast cancer diagnosis, compared with about 32 percent of women in sub-Saharan Africa, where early detection and state-of-the-art treatments are" less readily available.

        Access, contact may be main barriers to mammography for the underserved, Mayo Clinic researchers suggest. The UPI (12/18) reports, "The problem with the breast healthcare of underserved women" who have an abnormal finding on mammogram centers on access and contact, according to researchers at the Mayo Clinic's facility in Florida.  Based on the results of a free service run from the clinic for five years, researchers contend that some of the greatest obstacles involved "transportation" and "housing."  The Mayo Clinic's Multidisciplinary Breast Clinic provided free services to 447 women who had initially received an abnormal mammogram result.

        According to the AHN (12/18), "Barriers to coordinating diagnosis and treatment for cancer to underserved women include the fact that many of them don't have a telephone or address."  Additionally, "many uninsured women don't have cars and most of the clinics were not accessible by public transportation."  During the course of the program -- which ultimately detected 38 cancers in 447 patients -- treatment time for the patients lasted from "several months to less than 36 days."

Webmicroscope

I have posted on this previously here.  Having toured the site, the applications and uses are numerous and include pages for atlases, supplements, slide seminars, applications (excellent), services/products in addition to the virtual microscopy network.  I encourage you to check out their cases.  The viewer plug-ins download easily and quickly with quick refresh rates.  See below for more.

Web-based Virtual Microscopy
Virtual microscopy is a method of digitizing microscope specimens, and viewing the produced virtual slides on a computer screen.

WebMicroscope serves as a platform for a wide range of applications and activities, including slide seminars, Quality Assurance projects, interactive educational material, research applications (Tissue Micro Array analysis), publication supplements and clinical services.

WebMicroscope can also be installed locally at campuses, automatically joining the European Virtual Microscopy Network.

The aim of the network is to eliminate regional differences in connection and viewing speed, and to act as a platform for sharing and serving contents to the microscopy community

If virtual slides are served from a single location, it may result in considerable regional differences in viewing speeds. Users from regions near the server will experience very fast virtual microscopy, while users far away may encounter unacceptably slow viewing.

Their solution is to mirror identical copies of important projects on a network of servers around Europe. An intelligent system will guide the user's browser to always load image data from the fastest server.

Visit the ECP 2007 pages to see a live demo of the network.

A virtual microscopy network will have a critical influence on the practical implementation of large scale quality assurance projects, delivery of educational material and arrangement of major congresses and slide seminars.

How to join the network

The WebMicroscope Server Solution is a complete software package for virtual microscopy. When users install the server software, they are automatically also connected to the virtual microscopy network.

The technical requirements on a virtual slide server are low. No HTML editing is needed. There are no limits on the number of virtual slides that can be hosted by an institutional slide server, only the amount of storage space must be sufficient for the own needs.

The WebMicroscope administration platform includes complete options to add virtual slides and their related information into applications such as slide seminars, atlases, quizes, exams, consultations etc. However, it is also possible to only use the viewing interface, and keep all other content on an own existing web server, see for example: Embedded & stand alone viewing window.

Mayo joins movement to provide quick health care in retail setting

From the Post-Bulletin comes this story about retail medicine from Mayo Clinic.  Readers of labsoftnews.com are familiar with postings about retail medicine outlets.  The numbers in bold below seem staggering.  I suppose it allows medicine to be "as far forward as possible".  Actually, my recollection of our "primary care provider" is actually a retail ER shop next to a video store in a strip mall by our house.  It was always open, staffed with competent caring physicians with minimal waiting, on-site radiology and laboratory and instant access to transfer if needed nearby.  That physician saw us through broken bones, infections, drug reactions and ultimately well-health visits for routine screening tests.  That business no longer exists and that physician was not considered "mainstream" but evidently people think there is something to this model.  Where does it leave the laboratory community?  While AP will likely not be affected at all, CP could actually benefit from increased points of access to care and increased testing (whether indicated or not).  Primary care physicians in traditional practices may stand to lose the most.

ALBERT LEA -- Not too far from its world-renowned Rochester medical center, Mayo Clinic is testing a new way to deliver health care -- in a shopping mall next to a nail salon.

If plans go well, more "minute clinics" could pop up in other communities within the Mayo Health System, of which Austin Medical Center is part.

For now, Mayo's first effort is in Albert Lea, where a lone nurse practitioner staffs the Albert Lea Medical Center Express Care clinic, treating simple ailments from a 262-square-foot kiosk. It amounts to a surprise turnaround in the medical establishment's response to the proliferation of MinuteClinics and similar ventures.

Mayo is hoping that the year-old Albert Lea clinic can be a prototype for similar clinics across Mayo Health System in southern Minnesota, western Wisconsin and northern Iowa. Mayo officials recently announced plans to open a Mayo Express Care clinic early next year in a Rochester strip mall.

Doctors have previously criticized retail clinics for providing disjointed and possibly unsafe care, but now medical centers are responding to the phenomenon with their own retail clinics as a way to keep existing patients and reach new ones.

"A couple of years ago, medical centers thought if they ignored (the trend), it would go away," said Tricia Dahl, associate clinic administrator at the Albert Lea Medical Center. "But patients tell us this is what they want."

Other large health care providers are getting into the act. Minneapolis-based Fairview Health Services has opened Fairview Express Care clinics in Coborn's Superstores in Albertville and Elk River and plans two more in Princeton and Hastings. In Rochester, Olmsted Medical Center opened OMC FastCare at a ShopKo last summer and plans another late this year.

Tom Holets, president of Allina Medical Clinic, owner of 45 primary care clinics in the Twin Cities area, said retail clinics are "clearly not a flash-in-the-pan event." Allina isn't in the business yet but recently finished a three-year study that concluded "we must be in this marketplace," he said.

Five years after the first MinuteClinic opened in the Twin Cities, 362 outlets have opened in 24 states with a goal of 400 by the end of the year. The no-frills clinics offer a limited menu of services, low prices and walk-in access.

MinuteClinic is now owned by CVS Caremark Corp., the country's biggest provider of prescription drugs. Target and a host of other chains followed suit.

The clinics have "skimmed off simple health conditions that are reimbursed well (and) left primary care clinics with their noses barely above water," said Dr. Loie Lenarz, chief clinical officer at Fairview.

Traditional medical institutions are hoping to bring their own assets to the retail clinic business. At Mayo Express Care, for instance, a nurse practitioner will have access to patient medical records already stored at Mayo.

That could help address one concern about retail clinics among the medical establishment, that they result in fragmented care.

"We're looking at this as part of a system of care," said Dr. David Herman, who leads the primary care effort at Mayo.