Digital Pathology Blog

Do I need blogging insurance?

Westby Fisher, MD is a cardiologist and fellow physician blogger in Evanston, IL who has been blogging since November 2005 at drwes.blogspot.com.  At the time I started this blog we worked at the same hospital and since then I have relied upon his experience from time to time when it comes to blogging among other physician and non-physician bloggers.

His blog is extremely popular and ranks very high among health and medicine blogs by several sites that look at this and several algorithms for doing so.

Awhile ago he shared with me a legal issue that came up because of his blogging activity which he wrote about earlier this month in a post entitled "Bloggers Beware".

You can read the note for yourself but the case stems from a post he wrote and an anonymous  comment on that post. The party who subpoenaed Wes for a discovery deposition claimed he knew who made the anonymous post and insisted he take down the post and comment.  Wes does not know who wrote the comment nor did he take down the post or an image of the post on his blog.

He mentions Karen Seidel of neurodiversity.com and what happened to her. She posted the following comment to Wes's note:

"Your situation doesn't seem a whole lot different from that of a restaurant owner getting hauled into court over graffiti left on the bathroom wall."

I can see exposing yourself in legal issues based on what I  write, but being held accountable for someone else's thoughts, anonymous or not?  The case involving Wes was ultimately dismissed.  I leave comments on this blog open and unedited but this has made me re-think doing so.  It diminishes the full effect of Web 2.0 and others sharing this platform to express their own ideas and opinions.

Kudos to Wes for not removing the post or comment.

General Data's Healthcare Blog

I received a note from Ralph Moher from General Data as did I suspect most registered participants of APIII prior to the meeting that he would be live blogging from APIII.  I have seen this at other meetings (most notably health 2.0 or informatics related meeting) and have been pleasantly surprised at how well this works and the content it offers. 

I think Mr. Moher really hit the nail on the head through his blog on the company website. One major deliverable of live blogging I'm sure is the accuracy and clarity of what is being discussed as oppossed to "back of the napkin" notes and remembrances which I am guilty of. One can literally transcribe speakers' notes into a post and present the information very quickly. 

Here Mr. Moher did something a little different rather than posting notes as the meeting was going on that I think has significantly higher delivery.  He recorded a series of interviews with leaders in the field of pathology infomatics - Bruce Freidman (U of Michigan), Ul Balis (U of Michigan) & Mark Tuthill (Henry Ford Hospital) during the course of the meeting and has posted these videos on the blog.

Here he is able to capture and ask questions of the experts during the course of the week during the meeting and get their ideas to what others are saying and what they are thinking about in "real-time".

The video and audio quality is very good and encourage you to check out the inteviews and hear what the experts said about APIII as it was happening.

Pathology Visions 2008 and Pathology 2.0

Earlier this week I had the good fortune of having the opportunity to speak at Pathology Visions in San Diego.  This annual meeting strives to bring together attendees from around the world to share best practices and learn about exciting innovations in digital pathology. Pathology Visions features thought leaders and early adopters in the digital pathology space as well as stimulating presentations for major topics.

Unfortunately I could not attend the entire meeting but Aperio's chief technology officer provides some commentary on the talks and events of the meeting.

From what I saw and heard aside from the abundant networking opportunities, the cadre of speakers and topics discussed was top-notch in a great venue.

In the wake of APIII, Pathology Visions and some recent comments by Bruce Friedman, I have plenty of thoughts on future notes which I will share in the coming weeks. 

My presentation included some slides on the informatics and digital pathology initiatives we have ongoing at Mayo Clinic as well as my thoughts on "Pathology 2.0".  That is, Medicine 2.0 for Pathology, namely using digital pathology technology in the practice of surgical pathology.  I covered these issues before on the blog and presented these ideas at a Medicine 2.0 conference as part of a medical bloggers panel.  This blog summarizes the presentations from that meeting.

Surprisingly, despite very different meetings and attendees, our work and my ideas on Pathology 2.0 have been well received.  Several have asked for the slides I presented to take back to their own institutions for ideas and collaboration.

So, in the spirit of Web 2.0, here is the talk from Pathology Visions 2008 on clinical applications with digital pathology and Pathology 2.0.

The slides can also be viewed on slideworld.org  which is referenced in the talk as well as several talks on surgical pathology used for teaching I continue to upload to this site.

Kaplan PathologyVisions Oct2008 - Pathology 2.0

View SlideShare presentation or Upload your own. (tags: surgical pathology)

Thoughts on APIII meeting

Last week I was fortunate to have the opportunity to speak at APIII in Pittsburgh with one of my colleagues to speak about our interests and projects at Mayo.  The shared session also included a histotechnologist from Massachusetts General on some of their lean processes at hand.

My colleague, Dr. Schuyler Sanderson presented his extensive experience with passive RFID technology for GI biopsies which was well attended and received.  A lengthy discussion followed showing a lot of interest in this technology from several institutions with the usual point-counterpoint about RFID versus barcoding.

I understand APIII will make the lectures available shortly at their website and would encourage anyone looking at this technology in their organization to check out his presentation.

Overall, the meeting, true to form allowed a lot of us the opportunity to catch up with colleagues who we may not have crossed paths with in person since last years' APIII.  I think I have attended this meeting nearly every year since 1998 and the collective content, information and progress being made in pathology informatics showcased at this meeting continues to mature and propogate.

The CAP Today Focus session included a talk by Dr. Laposata which highlighted some thoughts from a lecture he heard about a year ago discussing a business model to outsource pathology to India.  He made the argument that you can get the same quality of care for 40% less from US-born and trained pathologists and presents a threat to pathology.  I encourage you to check out this talk as well.

Certainly the case can be made for this but most of us discussing this question the capacity of what can actually be done.  Nonetheless, the real threat of course is in clinical pathology TC outsourcing as opposed to anatomic pathology TC and PC.  Again, I have argued that the expertise and capacity exists in the US and models for insourcing from developing and third world countries provided their are adequate billpayers provide more opportunities for insourcing pathology services more so than the threat of outsourcing from the US.

Be sure to check out the talks from Breakout session D1 presented by investigators from Bern Switzerland and AFIP on virtopsy and virtual autopsy, respectively.  The presentation from Drs. Bollinger and Ross was particularly interesting which covered the virtopsy project at their institution and drilled down into discussion about how one might set up this type of technology.

I doubt most surgical pathologists would miss performing autopsies if this does become mainstream.

Lastly, congratulations to our resident, Dr. Jared Orrock on his e-poster award discussing the use of hyperspectral imaging and digital staining instrumentation that we have been investigating.

More discussion on the proceedings from this meeting to follow in the coming weeks.

Seven Cytotechnology Education Programs “at Risk”

Seven of the 39 accredited cytotechnology education programs in the U.S. have been identified as “at risk” for closure, representing a significant public health threat and underscoring the need for additional program funding in the wake of budgetary cutbacks.

The at-risk programs, identified in collaboration with the American Society of Cytopathology and state associations across the country, points to a trend that could dramatically impact millions of Americans’ access to affordable, quality healthcare.

Issues raised by this trend include:

• Concern over the sustainability of an adequate cytotechnologist workforce
• The fact that for every two new clinical laboratory scientists that enter the field, there are seven preparing to retire
• Assumptions that cervical cytology screening is coming to an end due to the introduction of the human papilloma virus vaccine and the HPV DNA test, despite women’s continued need for current cytology services
• Budget constraints faced by administrators looking to contain costs who may target cytology programs without taking into account impact on women’s health

For example, in Virginia a $2.5 billion deficit along with a law requiring a balanced budget has caused many local services, including state-funded schools, to brace for significant cuts—this pattern is found in states throughout the country.

In light of these findings, the College of American Pathologists and ASC will continue to advocate with state associations for legislative action to stabilize cytotechnology training funding and assure patient access to critical women’s health services.

BJC Study Identifies New Approach to Treating Cancer

This is exciting news - finding the cells that matter... Look for more to come on this!

Last week Ikonisys announced positive results from a clinical study conducted by the Weatherall Institute of Molecular Medicine at Oxford University, validating the company’s CellOptics® platform and proprietary digital microscope, the Ikoniscope®, as a viable method for quickly and easily detecting and detailing circulating tumor cells (CTC) in the blood.

The study identifies a completely new approach for detecting circulating tumor cells (CTCs) in the blood. Published in the British Journal of Cancer, the study proves how important the detection of these cells is for providing a new and effective approach to the overall management of cancer. The study’s findings represent a significant milestone for screening, early detection of recurrence and evaluation of treatment response for a variety of cancers, including prostate, colorectal and ovarian.

With the recent widespread news surrounding prostate screenings and the shortcomings of the current PSA test, the study results are especially exciting, as they suggest this method may be an effective way to reduce the number of false positives for malignancy based on elevated PSA levels.

Fewer colonoscopies and biopsies to come...

There are a number of clinical investigators exploring the use of non-invasive or minimally invasive technologies to scree for colon cancer that I have posted about in the past.  Another study has been published from here looking at DNA in stool samples recently presented at a large national meeting and published in the medical literature.  A summary is below. 

Other investigators have reported success with light scattering techniques in the colon using nothing more invasive than an endoscopy device analagous to a rectal thermometer.  These investigators have reported being able to detect "field effect"  of pre-malignant areas of the colon based on the spectral patterns they have observed in conjunction with traditional colonoscopy. 

While widespread clinical utility may be years off for pathologists in nearly all practice settings, these types of specimens represent a high volume of routine surgical pathology practice.  I wonder what impact some of these technologies will have on biopsy volume down the road. 

As with any test, there will be imperfect sensitivity and specificity with false positives and false negatives necessitating other testing.  We are seeing this as well with companies and laboratories offering genetic testing as a screening tool.  There is tremendous interest in earlier detection of common cancers where stage (extent of disease at time of diagnosis) dictates treatment and prognosis I wonder if some of these screening tests may actually result in more procedures negating their effectiveness. 

Perhaps then patients will go for virtual colonoscopy, then traditional colonscopy and biopsy....

HealthDay (10/8, Mozes) reported that researchers at the Mayo Clinic in Rochester have developed SDT-2, a "new and improved DNA stool sample test, to screen for colon cancer," and it "is twice as effective at catching cancer and serious precancerous polyps than either current blood stool sample tests or an older version of DNA testing." Lead investigator David A. Ahlquist, M.D., explained that using "blood as a marker for colon cancer has limitations," because the majority of "polyps basically don't bleed." All precancerous polyps, however, "shed cells that contain abnormal DNA," meaning that "a stool-based DNA test is a strategically more rational approach." According to the paper appearing in the Oct. 7 issue of the Annals of Internal Medicine, "3,800 healthy adults" were subjected to testing. Samples collected by the participants were analyzed using "three different screening methods." The "best blood testing was able to detect 21 percent of actual cancer cases," while the "older SDT-1 DNA test" detected "20 percent of cancer cases." But the "newer SDT-2 DNA test was found to be much more effective -- detecting 40 percent of cancer cases and serious polyp growth."

State Department forms telemedicine public-private partnership to improve Pakistan healthcare

The US State Department has formed a telemedicine public-private partnership in Pakistan, demonstrating the transformative power of high speed connectivity in improving social services in remote areas. 

Telemedicine enables healthcare providers to deliver high quality medical services for patients in remote locations - services that would otherwise be lacking or absent.  The public-private partnership is using telemedicine to help broaden and strengthen technical capabilities supporting the “hub,” Holy Family Hospital in Rawalpindi, with the “spoke” in District Attock. 

According to a news release, other partners include IBM, Wateen Telecom, Motorola, Medweb, USAID, the US Department of Defence Telemedicine and Advanced Technology Center, Holy Family Hospital in Rawalpindi, District Headquarters Hospital in Attock, and the Government of Pakistan.  In addition, the engagement of US Embassy in Pakistan and Pakistan Embassy in USA, particularly its Economic Section, has been critical to the project’s success.

"The goal of this project is to highlight technology’s ability to overcome a significant healthcare imbalance more than 60 percent of the population lives in rural areas but only 22 percent of the doctors work there,” says internationally recognized telemedicine expert and surgeon, Dr. Asif Zafar.

In addition to assembling this public-private partnership, the US Government contributed $220,000 to purchase state-of-the-art telemedicine equipment and services to operate the project.  The equipment combines an Internet-access portal including interactive collaboration tools such as secure email, voice and video conferencing on a secure telemedicine network with advanced medical peripheral devices such as portable ultrasound, digital cameras, stethoscope and X-Ray machines.

The Pakistan telemedicine project has already provided expanded medical care to hundreds of patients; pre-operative planning and follow-up; cardiac assessment; opthamology, dermatology, radiology, infectious disease, and peri-natal evaluations; and medical triage for traumas and acute illness.

The Pakistan Telemedicine Project extends the United States-Pakistan Strategic Partnership, which was formed in 2006.  The broad, long-term partnership of the US and Pakistani Governments reinforces the possibility of collaborative projects like this one, which has had the opportunity to transform and improve the lives of many Pakistanis.

Israel's ASI gives pathologists a vital second opinion

Check out this interesting story out of Israel using spectral imaging for improved diagnostics:

"You won't find many professionals in the field admitting it, but the awful truth is that pathology is not an exact science, and mistakes are made - too many mistakes, according to Limor Shiposh, CEO of Migdal Ha'emek's Applied Spectral Imaging (ASI).

That's why pathologists need a "second opinion," and ASI wants to help them, with a groundbreaking product that applies the techniques of advanced genetic study to the examination of cells for cancer or other diseases.

ASI, a privately held company founded in 1993, has been in the medical imaging business for over 12 years, pioneering the area of advanced imaging in cytogenetic research, the science of chromosomes and cell division.

ASI's highly acclaimed innovation in this area, SpectraCube, is a light-related spectral imaging platform technology used in a variety of the company's products. It allows researchers to distinguish between different materials on a chromosome by highlighting its features with unique colors, instead of the black dye that had been used previously."

Why A Mining Company Sends Its Workers to Fancy, Far-Flung Hospitals

The WSJ Health Blog has an interesting post about companies sending their employees to referral centers, regardless of cost but weighing benefits of rankings and quality of care.  As the story describes, there are a growing number of references that allow patients and insurers alike greater transparency about expected costs of stays and procedures and outcome data. 

The story is also on Bloomberg News.

This appears to be a new model for companies, insurers and patients and seems favorable to Centers of Excellence and large well-known referral centers, even if travel is involved to get the necessary care.

It is interesting that while weighing cost versus quality and deliverables, some are considering quality over cost at the expense of local hospital and health care providers.  Apparently if the local providers cannot provide the quality desired, insurance plans may be willing to pay a higher price. 

Clearly everyone is going to have to try to meet and maintain the highest standards of quality care if this becomes a widespread model or risk losing referrals.