Digital Pathology Blog

Best Wishes for a Healthy 2012!

Many thanks to my readers, followers, critics, contributors, commentors and sponsors.  The intent of the blog remains as it did 4 years ago - to educate and inform the pathology and laboratory community on digital pathology, other technology news items and occassional dips into government and regulatory issues for the broader picture of healthcare and pathology's opportunities and weaknesses as we look ahead.  No doubt healthcare reform changes, medicare/medicaid issues, FDA regulation, changes in the practice and business of the practice of pathology and laboratory medicine will affect some change on all of us. And no doubt that social media will affect how that news and commentary is shared and honored to be a part of it in this growing community.  Best wishes for a healthy 2012 and a year of great things to come! Keith

Bags of blood, and not a donor in sight: Lab-grown blood used for the first time

Promising news out of Paris for suitable blood products when inventories remain tight for donor blood. Will see if subsequent use and experimentation can both create viable red cells that can remain in circulation and maintain their oxygen-carrying capacity.

The Chicago Tribune (12/29) reports that according to a study in published in the journal Blood, "red blood cells generated in a lab have been successfully injected into a human volunteer for the first time." French researchers extracted "hematopoetic stem cells from a volunteer's bone marrow" and used various growth factors to induce the cells to differentiate into red blood cells (RBC). "After five days, 94 to 100 percent of the cells remained in circulation, while after 26 days, 41 to 63 percent remained -- a survival rate comparable to normal red blood cells. The cultured blood cells also gave every indication of being safe to use. ... They behaved like normal red blood cells, binding to oxygen and releasing it." While this result is promising, researchers note that "next challenge is to scale up production to a point where the cultured blood cells can be made quickly and cheaply in sufficient quantities for blood transfusions."

Healthcare Reform Said To Be Affecting Millions and Medicaid Cuts

USA Today (12/28, Kennedy) reports that "it can be difficult to dig through the rhetoric to determine just what the 2010 health care law has done," but "proponents and foes say big pieces of the law have been enacted and have already affected millions of people's lives." Don Berwick former administrator of the Centers for Medicare and Medicaid Services, remarked, "It's complicated, but there are very many benefits affecting millions of people. They will not know it's the Affordable Care Act, but it is." The piece highlights "five major changes in health care that occurred in 2011 because of the health care law," including a crackdown on fraud and more benefits for young adults and seniors.

The AP (12/28) reports, "Just as Medicaid prepares for a vast expansion under the federal health care overhaul, the 47-year-old entitlement program for the poor is under increasing pressure as deficit-burdened states chip away at benefits and cut payments to doctors. Nearly every state has proposed or implemented a plan in its current budget to rein in costs, and many are considering additional cuts in the year ahead." The piece notes that for those "who rely on the program...the cuts translate into longer waits for doctors, restrictions on prescription drugs, a halt to vision and dental care, staff cuts at nursing homes and dwindling access to home health care."

Volkswagen turns off Blackberry email after work hours

Smart move by Volkswagen.  Mobile technologies, in my own experience, can disrupt the delicate work-life-family balance.  It is good to be "connected" but checking e-mail as often as you can, likely for many items that can wait until after dinner or the next morning is a trap.  Of course, I suppose one could do this themselves but perhaps the employees felt a sense of having to use this service or perhaps it gave them a sense of belonging to always be "connected" to the office and their colleagues. 

Pathology call aside, when my phone and I get home, it gets plugged in and rarely (OK - seldomly) gets checked before the next morning.  I just get out my laptop and check e-mails...  For the past year on family vacations I do leave my phone and iPad in the room and guess what - do not miss a darn thing that couldn't wait. 

Speaks to digital pathology a bit - while you can review a case from anywhere, anytime which I have mentioned is one of the many value adds for the technology - should you or would you really want to?  In some cases - you are the world's expert in a particular disorder and find yourself skiing in Switzerland when the call comes in.  You may be able to help out someone.  Out of the office at a research meeting and the afternoon is going to be spent on CS protein in the liver, a little outside your sphere of interest while that new client you attracted is now busy with their endoscopes and flooding your colleagues who could use a hand to maintain good service and turn around time?  Sure. Done.  Dedicated consults or make up for shortages or where demand exceeds supply.  Quiet hotel room with high-speed networking. No reason not to. 

In the meantime, hold off on e-mails that likely will wait a few more hours to be opened, read, responded to or trashed.  The e-mail will wait for you patiently and not care. 

Looks like this idea of turning off the e-mail server is gaining popularity in Europe. 

The comments are worth a read on this as well.  And I promise not to hound you with late night e-mails.

Volkswagen has agreed to stop its Blackberry servers sending emails to some of its employees when they are off-shift.

The carmaker confirmed it made the move earlier this year following complaints that staff's work and home lives were becoming blurred.

The restriction covers employees in Germany working under trade union negotiated contracts.

Campaigners warned that the move would not be suitable for all companies.

A spokesman for VW said: "We confirm that this agreement between VW and the company's work council exists", but would not comment further.

Under the arrangement servers stop routing emails 30 minutes after the end of employees' shifts, and then start again 30 minutes before they return to work.

The staff can still use their devices to make calls and the rule does not apply to senior management.

"We wanted to take a preventative approach to tackling the issue," said Gunnar Killian, VW's works council spokesman.

"At Volkswagen flexitime is between 0730-1745, with our new arrangement workers can only receive emails between 0700 and 1815."

Spare time

The move follows criticism of internal emails by Thierry Breton, chief executive of the French information technology services giant, Atos. He said workers at his firm were wasting hours of their lives on internal messages both at home and at work. He has taken the more radical step of banning internal email altogether from 2014.

Last month the maker of Persil washing powder, Henkel, also declared an email "amnesty" for its workers between Christmas and New Year saying messages should only be sent out as an emergency measure.

Industry watchers say the moves reflect growing awareness of a problem.

"It's bad for the individual worker's performance being online and available 24-7. You do need downtime, you do need periods in which you can actually reflect on something without needing instantaneously to give a reaction," said Will Hutton, chair of the Big Innovation Centre at The Work Foundation.

"Secondly it has a poor impact on an individual's well-being. I think that one has to patrol quite carefully the borderline between work and non-work.

"So I can see why some firms are taking this action, the problem is that a universal response is impossible... but certainly we should have the capacity to be opted out of it rather than be opted in."

Consultations

Union officials in the UK have also cautioned other firms against repeating Volkswagen's move without consultation.

"The issue of employees using Blackberrys, computers and other devices out of working time is a growing one that needs to be addressed as it can be a source of stress," Trades Union Congress (TUC) secretary general Brendan Barber told the BBC.

"However other organisations will need different solutions and what works in VW may not work elsewhere.

"By working in partnership with their union, Volkswagen's policy will have the support of all their employees. Where employers simply introduce policies on their own, however well-meaning they may be, they are unlikely to be successful."

 

Lab results in: BGH appeal slides over top

Nice story for the holiday season -- Brockville General Hospital in Ontario, Canada recently exceeded their annual fundraising goal and will use the donations to purchase a telepathology system for purposes of secondary consultation.

BGH raises $142,300 for laboratory

They answered the pleas and put patients at ease.

Donations to this year's Brockville and District Hospital Foundation Annual Appeal surpassed the goal of $135,000, coming in with a total of $142,300 as of Thursday.

The result has officials at Brockville General Hospital once again astounded at the generosity of local residents.

"The generosity of the community is always heartening to see," BGH chief executive officer and president Ray Marshall told The Recorder and Times. "There are so many causes out there at this time of year that seem to be doing well, and it's heartwarming and encouraging to see the continued support from the community for the hospital and our equipment needs."

This year's funds will be used to purchase a telepathology system for the hospital. The system uses electronic imaging and information transfer to allow for transmission and sharing of digital images of pathology samples – commonly referred to as "slides."

Marshall said the equipment allows staff to take a slide and digitally transmit the images to garner second opinions.

"It will speed up diagnosis," he said. "It's really focused on those cases where our local pathologist is looking for a second opinion on a particular slide."

He said in many cases it could be used to determine cancer diagnoses, which, by speeding up the process, will lead to the easing of patient anxiety.

"It is focused on being able to provide worried patients quicker response once they biopsy or a sample has been taken," he said.

The annual appeal is a mail-out campaign in which the hospital sends out a request forms to some of its previous donors and other members of the local community.

Each year, the funds raised are used to purchase a key piece or pieces of equipment for the hospital. Marshall said 6,000 letters were sent out to previous donors.

 As of Thursday, 641 people had donated to the 2011 campaign.

Funds raised in the 2010 campaign were used to purchase an orthopedic surgical package that included power equipment, positioning devices, a camera and other arthroscopic instrumentation tools.

steve.pettibone@recorder.ca

REFCOR Chooses mScope for National Expert Pathology Panel

Aurora will supply the French Expert Network for the Diagnosis of Rare Otolaryngology (ENT) Cancers (REFCOR) for their medical multi-disciplinary team meetings (MDTMs) and their case reviews by the national pathology expert panel

MONTREAL (CANADA), December 22, 2011 - Aurora Interactive Ltd., the world leader in digital pathology communications, announced today that the company has signed a contract for the supply of its mScope clinical communications platform following a request for proposal from the REFCOR group for the establishment of a national telepathology network to implement: information sharing; case management; and the viewing and analysis of diagnostic pathology images. The system allows for remote diagnostics and collaboration among expert pathologists and clinicians.

"REFCOR’s goal is to improve the management of treatment for patients with rare head and neck cancers including those of the paranasal sinuses, salivary glands, ears and rare cancers of the upper aerodigestive tract. The mScope network will provide us with a communication tool for the submission of cases to the national MDTM or the national pathology expert panel,” said Dr. François Janot of the Gustave Roussy Cancer Institute.

Pierre Le Fevre, President and CEO of Aurora Interactive, said: "We are very proud to have won this contract and to have earned the trust of the REFCOR group's leaders and their partners in this project. We are also very pleased to partner with a project that is at the forefront of the use of digital pathology to advance the science relating to rare head and neck cancers.”

About Aurora Interactive

Aurora Interactive has developed the leading Web-based software platform (mScope) for simplification, productivity and ease of pathology communications.  mScope’s Universal Web Viewer has collaborative tools to view medical slides and images anytime, anywhere, regardless of file format.  The software has four applications to aid digital pathology web based communications needs: mScope Education, mScope Clinical, mScope Research and mScope Universal Viewer. Aurora’s mission is to improve patient outcomes and help members of the medical community achieve their full potential by eliminating the learning, diagnostic and collaborative restrictions imposed by time and space. www.aurorainteractive.com  
 

The French Rare Head and Neck Cancer Expert Network (REFCOR)

Created in 2008 under the patronage of the Société Française ORL (French Society of Otolaryngology), REFCOR’s objective is the improved management of medical treatment for patients with rare head and neck cancers. The first four objectives of REFCOR are: The publication of reference national recommendations on the four main types of rare head and neck cancers; The creation of a national database referencing cases and incorporating epidemiological, clinical and anatomic and cytopathology data; The establishment of reference centres including the ability to coordinate medical multi-disciplinary team meetings to review "rare head and neck cancers" at the regional level while providing an efficient network for national collaboration; and the organizing of tumor banks / serum banks / tissue banks, the standardization of methods for the collection and systematic storage of samples taken from targeted patients. REFCOR currently organizes national MDTMs for the most difficult cases and a system of case review by pathologists specializing in  these cancers.

 

GOP Poised to Postpone Doc Pay Cut

As I mentioned in a recent prior note, the show that never ends - the issue of professional reimbursement from Medicare for physicians has gone through one more year and the result is another short-term patch with no long-term permanent fix, correction, adjustment or controls...

From Medscape Medical News

December 22, 2011 — In what some see as a capitulation in the face of mounting pressure in and outside the party, House Republican leaders reached an agreement this evening that, among other things, would postpone the 27.4% cut in Medicare physician reimbursement schedule to take effect on January 1.

Along with delaying the cut until March 1, the deal, if pushed to a successful full vote of the House, would also extend the payroll tax cut and unemployment benefits for the same period. Each of these provisions is outlined in a Senate bill that House members rejected on Tuesday by a vote of 229 to 193.

In return for their compromise on the Senate bill, House GOP leaders will ask their Senate counterparts to appoint members of a conference committee to work out longer-term solutions for the doctor pay cut, as well as the payroll and unemployment benefits issues.

The American Medical Association (AMA) and other physician groups have made no secret of their impatience for what they call "short-term patches" to the formula for determining physician Medicare compensation.

"Congress had the entire year to repeal the broken physician payment formula and provide stability for the millions of seniors and military families who rely on Medicare and TRICARE but has hailed to act," said AMA President Peter W. Carmel, MD, on Tuesday, the day the House voted down the Senate bill.

The AMA and other physician groups want the SGR — or sustainable growth rate formula — fixed once and for all in order to avoid the year-end "brinksmanship" that has become a recurring feature of Washington political theater.

In light of this, physician reaction to the latest compromise — which GOP leaders must still sell to many restive House members — is likely to be muted.

Authors and Disclosures

Posted: 12/22/2011

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Medscape Medical News © 2011 WebMD, LLC

Send comments and news tips to news@medscape.net.

 

New eBook on Companion Diagnostics Worth a Look

Many thanks to Digital Pathology Insights for the tip on a book published on "Companion Diagnostics - The Future of Medicine".  Just a brief glance of the book on my Kindle - the book starts with a case study making the case for companion diagnostics and therapeutics and follows with the story of HER2 and Herceptin therapy.  Looks like regulatory issues and other approaches to personalized diagnoses and cure follow in the glance I took.  

The piece from FiercePharma mentions: 

"The balanced perspective offered in this unique work is both daunting and refreshing. Tracy outlines the many problems with these sorts of treatments in today's insurance company-ruled healthcare industry. Reimbursement for experimental drugs, terminology and marketing strategy are among those hurdles facing this burgeoning field. There is light at the end of the tunnel, though, and not just the light provided by the scientists working to break these boundaries: The FDA likes personalized medicine and has encouraged companion diagnostics research.

This book pursues truth and possibility in the promise of increased knowledge. These practices could change the future for all of us."

Courtesy of Digital Pathology Insights:

From the editor: FiercePharma Senior Editor Tracy Staton published an insightful ebook on companion diagnostics last week. It’s suggested reading for anyone interested in the promises of companion diagnostics, the obstacles on the way towards their widespread adoption and suggestions for their most effective development. The FDAs policy and the recent draft guidance on companion diagnostics (also see earlier post) receive particular attention and are very well put into context. It’s no big news that co-development of drugs and companion diagnostics will be required. However, the author’s broad discussion includes valuable thoughts on why the required efforts are challenging and how early partnerships between drugmakers and diagnostics companies can help meeting these challenges. Personalized medicine is still a somewhat distant goal but we’re starting to understand better how to get there. Click here to read the article on Fierce Biotech News or get the ebook.

Read more: Kindle readers: Download our ebook 'Companion Diagnostics: The Future of Medicine' ($4.99) - FierceBiotech http://www.fiercebiotech.com/story/kindle-readers-download-our-ebook-companion-diagnostics-future-medicine-499/2011-12-16?utm_medium=rss&utm_source=rss#ixzz1hHfFe1A8 
Subscribe: http://www.fiercebiotech.com/signup?sourceform=Viral-Tynt-FierceBiotech-FierceBiotech

 

ATA: Telehealth 'birthing networks' could save Medicaid $186M

Via FierceMobileHealthcare by Sara Jackson

No doubt a study such as this could show positive savings for "high-risk" pathology cases.

Medicaid could save $186 million over the next 10 years if it uses telehealth services for high-risk pregnancies, according to a new analysis commissioned by the American Telemedicine Association. And that's a conservative estimate, researchers say. Conducted by Washington, D.C.-based health research company Avalere Health, the new study analyzed Medicaid's costs for pre-term babies, NICU admissions and unplanned physician visits by Medicaid patients. Researchers then applied analytical tools--like those used by the Congressional Budget Office--to create projects that legislators might be more likely to accept, it seems. The proposal doesn't say exactly which telehealth services the ATA recommends, but it does suggest a series of "birthing networks" similar to one in use by the University of Arkansas for Medical Sciences. The 10-year-old program--Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS) network--offers: Weekly telemedicine conferences between a patient's physician/OB and maternal-fetal medicine specialists; Ultrasound reading via at-home fetal monitors; Video-conference training for local technicians on high-risk pregnancy management; 24-hour call center service for physicians to consult maternal-fetal specialists; Call center for women with questions about pregnancy, delivery and post-partum concerns. And it's a hefty program. The network provides upward of 150,000 OB support calls to patients and 2,100-plus telehealth visits per year, university officials say. It also earned the university the ATA's President's Institutional Award for the Advancement of Telemedicine this year. The main goal of the program is to prevent pre-term labor, which ranges from 20 to 45 percent of Medicaid patients, the study reports. Pre-term infants have more costly deliveries, spend more time in the NICU and require more unplanned physician visits than babies that make it to full- or near-full term, researchers explain. Applying telehealth technology like at-home fetal monitoring and telehealth consults to the problem could help lengthen high-risk pregnancies to closer to 32 weeks, when NICU services and intensive physician follow-up are less likely, researchers note. To learn more: - read the ATA/Avalere proposal - check out the ANGELS program at University of Arkansas Medical Sciences - get more detail on UAMS' award from ATA from earlier this year Related Articles: Slim Insitute, West Wireless, Qualcomm on maternal health New mom/baby app born from Imagine Cup Read more about: ATA, maternal-child health, University of Arkansas for Medical Sciences, UAMS back to top

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Different Christmas, Same Story

Around this time of year wonder if my work will be reimbursed at 30% of what it was the year before or not.  Historically, not.  Actually small raises.  Now tangled up with an oil pipeline...Predict a cut on order of less than 10% if any...

December 20, 2011 — Medscape — The House today voted to reject a Senate bill postponing a 27.4% cut in Medicare reimbursement to physicians from January 1 to March 1, and to try to meld conflicting legislation through a House–Senate conference committee.

The tortured Congressional proceedings increase the odds that the cut will take effect New Year's Day.

The fight is not over physician compensation, but larger issues that have taken it hostage. The drama dates back to last Tuesday, when the Republican-controlled House voted 234 to 193 to approve a 2-year "doc fix" to the Medicare reimbursement crisis that would have given physicians a 1% raise in 2012 and 2013. This provision was a sideshow in a larger bill that would extend a temporary reduction in the Social Security payroll tax for 1 year, continue unemployment benefits for the long-term jobless, and force President Barack Obama to make a decision within 60 days on a permit for the controversial Keystone XL oil pipeline, which the GOP views as a giant jobs creator. The Obama administration had delayed the decision until 2013 to give it more time to study environmental concerns.

The Democrat-controlled Senate answered the House on Saturday by approving a 2-month extension of the payroll tax cut and unemployment benefits, along with a 2-month doc fix. The bill also includes a hurry-up timetable for the pipeline. In contrast to its counterpart in the House, the Senate measure passed with overwhelmingly bipartisan colors in an 89 to 10 vote.

CMS to Suspend Claims Processing in Early January

In tonight's vote, House Republicans followed the lead of House Speaker John Boehner (R-OH), who said earlier today that the Senate's short-term payroll tax cut extension "causes uncertainty for job creators." Tax policy conducted "2 months at a time" is the kind of Congressional decision-making, he added, that "has put our economy off its tracks." Just 2 days before, Boehner had called the Senate bill a "good deal." Democrats attribute his reversal to Tea Party pressure.

The differences over the legislation go beyond the timeframe. Senate Democrats would like to pay for a 1-year payroll tax cut extension and other provisions in part by raising taxes for millionaires. House Republicans prefer offsets such as freezing the pay of federal workers, raising Medicare premiums for high-income beneficiaries, and defunding portions of healthcare reform.

For the time being, Democrats and Republicans are in a holiday season stand-off. Just because the House Republicans voted today to take their payroll tax dispute to a bicameral conference committee does not oblige Senate Democrats to sit down at the table with them. Senate Majority Leader Harry Reid (D-NV) said yesterday that he will not reopen negotiations about a long-term version of the payroll tax cut extension until the House passes the Senate's 2-month deal, forged with Senate Republican leadership at Boehner's request, Reid noted.

This impasse leaves physicians with the prospect of members of Congress going home for the holidays without averting the 27.4% reduction in Medicare reimbursement set for January 1. Congress could postpone it retroactively when it goes back to work on January 17. Anticipating such an outcome, the Centers for Medicare and Medicaid Services (CMS) announced today that it would instruct its claims processing contractors to hold physician claims for the first 10 business days of January, or through January 17.

By putting claims in suspended animation, CMS can avoid paying them at the drastically reduced rate and wait for a more benign rate to kick in. CMS predicts that the interruption will have "minimal impact" on physician cash flow because a correct electronic claim cannot be paid until 14 calendar days after receipt anyway. Organized medicine counters that the CMS hold on claims processing still creates a financial hardship for practices that have payrolls to meet.