Digital Pathology Blog

Aurora Firms Up Its Leadership in Digital Pathology

PORTUGAL JOINS OTHER COUNTRIES AND CHOOSES mScope

MONTREAL, June 5, 2009 – Aurora MSC, the world leader in digital pathology communications, announced today the Hospital Espirito Santo of Évora Portugal has chosen to equip the hospital laboratories with mScope digital pathology clinical software. This is part of an ongoing plan to connect multiple pathology laboratories in the Iberian Peninsula, and the European Community in general, for consultation, continuing education and quality control.

The agreement was made possible through funding provided by the European Commission to assist European hospitals in achieving pathology interconnectivity. The objective is to allow access to state-of-the-art technologies to improve patients’ clinical outcome. This is one more step in a series of initiatives to increase the outreach of hospitals in Portugal and Spain.

Dr. Marcial Garcia Rojo of General Hospital of Spain’s Ciudad Real and chair of the European project Euro-Telepath, Anatomic Telepathology Network, commented "this action by Espirito Santo Hospital is one more step in the elaboration of a trans-Iberian network for pathology collaboration".

"We have chosen mScope Clinical suite to create an online diagnostic center of excellence to improve our quality control and diagnostic capabilities" stated Dr. Luis Gonçalves, Director of Anatomic Pathology of the Espirito Santo Hospital. The agreement covers two applications, one is for tumor panels where specialized pathologists from different centers in Portugal and Spain will regularly come together and look at digital slides using mScope. The other application will be for teleconsultation.

Mr. Pierre Le Fèvre, President and Chief Executive Officer of Aurora MSC stated that: "We are extremely happy to add Dr Gonçalves, a leading specialist in Anatomic Pathology who has been recognized by the European Cervical Cancer Association for his work, as a collaborator and user of digital pathology."

Mr. Le Fèvre pointed out that: "increasingly, a larger number of pathology laboratories throughout the world are using digital pathology to communicate faster and more effectively. These initiatives empower Specialists to work better and ultimately positively impact patient care".

About Aurora MSC

Aurora MSC’s mission is to facilitate and contribute to better patient outcomes. Its medical communications software enables physicians and members of the medical community to realize their full potential by eliminating the learning, diagnostic and collaborative restrictions imposed by time and space. The professionals at Aurora MSC develop and commercialize mScope, a universal web viewer and its collaborative tools to view all medical images anytime, anywhere. mScope is aimed at serving the medical practice (doctors and health professionals) and ultimately the patients. Its digital pathology software has three applications, mScope Education, mScope Clinical, and mScope Universal Viewer. A fourth application is currently in the development phase.

Study finds virtual doctors visits satisfactory for both patients and clinicians

Travelers book plane tickets online, bank customers can check their accounts at any computer, and busy families can grocery shop online. Someday, even doctor visits could be among the conveniences offered via the Internet. Researchers considering the feasibility and effectiveness of virtual doctors visits report that patients and physicians found that evaluations done through videoconferencing were similar to face-to-face visits on most measures, according a study published in the May issue of the Journal of Telemedicine and Telecare.

"There is growing evidence that the use of videoconferencing in the medical environment is useful for a variety of acute and chronic issues," says Ronald F. Dixon, MD, an internist at Massachusetts General Hospital and the study's senior author. "Videoconferencing between a provider and patients allows for the evaluation of many issues that may not require an office visit and can be achieved in a shorter time."

The healthcare delivery model in the United States is under scrutiny. Reduced access to providers, rapidly increasing costs and an aging population represent major challenges for the healthcare system. Telemedicine projects, including virtual visits (a patient-physician real-time encounters using videoconferencing technology) are being examined to evaluate their capacity to improve patient access to care and lower healthcare costs.

This study, the largest trial of virtual visits versus face-to-face visits done to date, randomized patients to one of two arms. In the first arm, the patients completed a visit (virtual or face-to-face) with a physician; they then completed a second visit via the other modality with another physician. In the second arm of the study, subjects had both visits face-to-face with two different physicians. All physicians and patients completed evaluation questionnaires after each visit.

Patients found virtual visits similar to face-to-face visits on most measures, including time spent with the physician, ease of interaction and personal aspects of the interaction. Physicians scored virtual visits similar to face-to-face visits on measures including history taking and medication dispensing. Though they were less satisfied on measures of clinical skill and overall satisfaction, those ratings were still in the good to excellent range.

The diagnostic agreement between physicians was 84 percent between face-to-face and virtual visits; it was 80 percent between the two face-to-face visits.

"The tradition of medicine is to lay hands on the patients, which has always been considered paramount to patient care in the minds of physicians," says Dixon. "However, these findings suggest that virtual visits could be a viable option in circumstances where patients need to be monitored routinely for chronic conditions like diabetes, hypertension, obesity or depression, and where self-management strategies are not working. Virtual visits may also be effective for triage of acute, non-urgent issues like back pain or respiratory infections."

Among the benefits of virtual visits are reduce overhead costs for a physicians' practices by reducing the space and resource requirements. For patients, a virtual visit can minimize time taken away from work and transportation costs. The study suggests that both patients and physicians could benefit if virtual visits were used as an alternative method of accessing primary care.

Source: Massachusetts General Hospital (news : web)

 

Recent paper on legal aspects of teleconsultation

One of our recent GI/liver pathology fellows completed a manuscript that addresses the key points of the legal and regulatory environment involving teleconsultation in pathology.  The paper will appear in an upcoming issue of Human Pathology. 

A pdf of the corrected proof can be downloaded here.

Download leungkaplan_humanpathology_medicolegalaspectsoftelepathology.pdf (109.1K)

Summary

A pathologist may practice telepathology in another room from the original slide using the hospital intranet, he/she may practice it if a CD-ROM is reviewed with a “virtual histologic image” or digital slide. As pathology becomes increasingly subspecialized, and pathologists are progressively more engaged in practices situations where they may not be in a centralized laboratory location, use of telepathology technology may be increasingly common. We touch on select medicolegal and reimbursement issues in the practice of telepathology. Primary and secondary legal sources are reviewed, as well as primary medical references. Telepathology is an evolving area of telemedicine. Guidelines for primary opinion telepathology should be driven from best practices in conventional laboratory procedures and can enhance the practice of pathology. However, it should be undertaken with the understanding that the legal and regulatory environment involving such practices is evolving as well.

"Telemedicine" doctor gets 9 months in jail

A few months ago I mentioned a case involving a Colorado physician who prescribed medication over the Internet (see: Telemedicine and the Law) to a patient who later committed suicide.

That physican has now been sentenced to nine months in jail.  The story reports this case is "is one of the first criminal prosecutions of a practitioner of "telemedicine," the furnishing of medical advice by phone or the Internet, for failing to have a license in the patient's state." 

The physician's attorney remarked that "telemedicine is now dead" and goes on to say "no doctor in his or her right mind would now pursue telemedicine unless licensed in all 50 states." 

I couldn't disagree more.  The case seems to stem from the fact that the physician did not have a license in any state to write prescriptions, let alone to someone who clearly needed help and received the prescription after completing a questionnaire alone without an examination or direct contact.  The drugs were "ordered" by the patient through a website who relayed the order through a supplier to the physician convicted in this case. 

As I wrote in my previous note, "While we do not know all the facts of the above case, simply diagnosing and treating, or in our case, diagnosing and affecting potential treatment or management seems a stretch without knowing more than allegedly this physician did before prescribing treatment.  Whichever way this case goes, I presume we are going to see more like it but can help ourselves if we practice telemedicine much like we practice medicine."

I think this case speaks to the need for appropriate regulation, licensure and controls in place to ensure a patient-physician relationship so that practice of telemedicine is analagous to the practice of medicine. 

Recent Twitter "tweets" about Telemedicine

nursebiz: I really need to look into starting up a telemedicine nurse business

2009-03-27 · Reply

 

jmoynihan: I know it's no episode of "24" but for any one interested, here is the link to the Telemedicine webinar I was part of; http://bit.ly/11L53o

2009-03-27 · Reply

 

ICMCCupdate: http://twurl.nl/negvcm The Hawaii Health 2.0 Chapter meeting #health20 #telemedicine #healthcareit 2009-03-27 · Reply

 

mzjones11: @KHASTV Using the typical "telemedicine solution", NE just received funding to connect TWO sites. http://tinyurl.com/cqw97x Long way to go. 2009-03-26 · Reply

 

tttsRN: Sucessful telemedicine link to AR ..my TTTS mom can stay till next week 2009-03-26 · Reply

 

jmoynihan: Just added myself to the http://wefollow.com twitter directory under: #healthcare #telemedicine #technology 2009-03-26 · Reply

 

luisluque: probably in may to the 1st telemedicine workshop in the Arctic Glaciar Ocean. Snow mobile with a rifle, just in case polar bears r hungry 2009-03-26 · Reply

 

maikolo: Jay Sanders - "father" of telemedicine - cell phones will be the most important tool in telemedicine 2009-03-26 · Reply

 

occamnetworks: Vela - Potential benefits are life changing..healthcare reform, telemedicine #OccamWebinar 2009-03-26 · Reply

 

InterCall: Telemedicine helps parents who struggle to balance work and family life. http://www.conferencingnews.com/news/24034 2009-03-26 · Reply

 

Pudliszek: med@t el interesting health 2.0 event in Luxemburg (THE INTERNATIONAL eHEALTH,TELEMEDICINE AND HEALTH ICT FORUM) http://tinyurl.com/cjv9fw 2009-03-25 · Reply

 

HumTechNet: Newness: Answering the Call for HELP ? An Interview with Telemedicine Expert and Humanitarian Randy Roberson (http://humanitariantechnet ... 2009-03-25 · Reply

 

repyke: Telemedicine Consultation and Monitoring for Pediatric Liver Transplant http://tinyurl.com/da32ag 2009-03-25 · Reply

 

biodunolusesi: Just received invitation to a high level Telemedicine get-together, billed for early April. 2009-03-25 · Reply

 

teladoc_pat: @mzjones11 www.teladoc.com has been doing telemedicine for 5 years. I'm a developer here, any questions? 2009-03-25 · Reply

Save the Date for ATA

Telemedicine is one of the most exciting developments in healthcare and is an integral part of healthcare reform. The telemedicine and telehealth field are truly booming. From emergency rooms to physician’s offices, from the home to schools, and in the workplace, telemedicine is extending the reach of healthcare services, improving care, and reducing costs throughout the world.

Now is the time to make plans to go the American Telemedicine Association (ATA) premiere forum to be held for the healthcare industry on April 26-28, 2009 in Las Vegas at the Rio All-Suites and Casino. Vital discussions will center on clinical and business issues related to telemedicine plus there will be hundreds of presentations, posters, and workshops.

More than 2400 attendees from all over the world will gather at the Conference to hear James Henry “Red” Duke, M.D. a trauma surgeon from the University of Texas Medical School give the Plenary Presentation. He will give his expert thoughts and opinions on trauma care, stress management, and how to deliver healthcare in remote and underdeveloped areas.

Dr. Duke has served as Special Assistant to the President of UT Health Science Center and holds a distinguished professorship at the UT Medical School as the John B. Holmes Professor of Clinical Sciences. He established Houston’s Hermann Hospital Life Flight operations and remains the medical director of the trauma and emergency services.

Dr. Duke is the former host of the nationally syndicated “Texas Health Reports” and hosted the former PBS series, “Bodywatch”. He has been featured on PM Magazine, NBC Nightly News, Today Show, and the Buck James television series.

Some of the 2009 hot topics include discussions on new the administration, home telehealth, remote monitoring, telepsychiatry, next generation communications, future innovations in telehealth technologies, legal and regulatory issues, workforce issues, telerehabilitation, remote imaging, and managing chronic care effectively.

The ATA 2009 Exhibit showcase is a one-stop shop for telemedicine products and services. This year, the exhibit hall will feature over 160 exhibitors and 100,000 square feet of exhibit space. Vendors covering the telemedicine spectrum, the corporate world, academic medical centers, government organizations, and non–profit services will be on hand to demonstrate the latest telemedicine technologies and telemedicine solutions.

Be sure to take advantage of pre-meeting course and symposiums. Telemedicine 101 is scheduled for April 25th Telemedicine 201 has been added to the educational lineup on April 26th along with several Partner Meetings and a full day International Symposium.

Go to www.americantelemed.org/i4a/pages/index.cfm?pageID=3486 for more information or to register.

Does telemedicine work? Is this telemedicine?

'GMA' Tries Out Three Web Sites to See How They Would Advise Patients

Came across a story on ABC News looking at use of web-based physician consulting services by providing a list of symptoms to three sites and their responses.  As you might predict, based on the premise of the story, none of the 3 sampled did particularly well helping the "patient".

The reality of this experiment I think amounts to nothing more than calling a physician whom you have never met, equally important, has not met you and providing some symptoms for immediate diagnosis, treatment and follow up plan based on some symptoms at that particular time.  The fact that the encounter is web-based does not eliminate the need for a relationship to be established with appropriate medical history, problem list to date and taking the symptoms into account in terms of generating a differential diagnosis to lead to the appropriate diagnostic evaluation, additional tests as needed and/or follow-up in terms of office visit, referral or as needed. 

I think the story does cover the instances where a patient-physician relationship is established and the practicality of using technology as granular as e-mail (perhaps in place of telephone) for dealing with sub-acute problems that can be addressed when e-mail can be read and responded to appropriately. 

I would consider this "telemedicine" or "telehealth", that is the practice of medicine at a distance and applicable to certain problems in the appropriate context of patient and health care provider. 

Try calling a few physicians at random with some symptoms; I guarantee none will speak to you if you are not an "established patient" and perhaps the same limits should be used for these web-based consultations. 

"Of course, the sites themselves claim no responsibility for their physicians' practices and services and I presume the physicians themselves are somewhat protected in the absence of a "patient-physician" relationship which these sites clearly do not offer.  This will be tested as I have mentioned previously (See: Telemedicine and the Law). 

"With the days of routine doctors' house calls long gone, many patients have turned to telemedicine to get quick, convenient diagnoses.

While 30 million American said they have consulted their doctor via e-mail and another 70 million said they wish they could, only a third of doctors actually offer e-mail or telephone appointments, according to Manhattan Research, a market research and advisory firm for pharmaceutical and health care companies.

So many patients have turned to online resources to help pinpoint their problems.

Several online sites offer symptom checkers and access to medical experts — allowing patients to ask doctors for advice without ever meeting them face to face. But some critics question just how reliable such resources can be."

 

Digital pathology to benefit from Middle East oncology clinics

UPMC and its partnership with Omnyx recently announced the formation of 25 oncology clinics over the next 10 years in the start of a global healthcare business they may expand elsewhere.

Part of this initiative includes Omnyx as part of the project.  Oncology care has at its center, pathology and this use of digital pathology will help further validate the technology, field and use.

This venture offers proven premium clinical services with UPMC, GE Healthcare's experience in global healthcare and IT support, combining key elements essential in the successful implementation and use of digital pathology.  

In doing so, UPMC and its partners will be able to provide "subspecialty care as far forward as possible," and help to elevate the standard of care for the affected patients.

Full story below.   

Oncology specialists take care of in-patient and specialised treatment at the hubs, while outpatient care is offered at more than 30 satellite centres.

UPMC has awarded $300 million contract to Alcatel-Lucent for the development of an IP network project to provide improved communication. It has set up a start-up with GE Healthcare with an investment of $40m for developing and marketing digital pathology systems.

Other major projects include a $367m project for developing IT infrastructure.

Twenty-five oncology clinics will be opened over a 10-year period in the Middle East and Europe by the University of Pittsburgh Medical Centre (UPMC), a global healthcare business.

And UPMC is considering establishing centres in other countries as it seeks to tackle cancer and raise the global standard of healthcare.

"We are in the process of identifying the countries in Europe and the Middle East where we will set up 25 oncology centres," Simona Abbro, UPMC's International Marketing Director, told Emirates Business.

"We see a greater need for treatment facilities for the increasing number of cancer patients in the region. We estimate that one out of three people gets cancer in Europe against the ratio of one in 20 that was seen 20 years ago." The centres will offer advanced diagnosis and radiotherapy treatment in patients' homes.

"We find that most cancer patients wait for months to get advanced treatment," added Abbro.

"To address this problem we are setting up oncology centres with a focus on developed and developing nations. Countries such as Germany, Turkey, Greece, South Korea and Qatar are under consideration.

"We have entered into an agreement with GE Healthcare, which would as a strategic supplier provide medical equipment for our global initiative. We are also actively forging long-term partnerships with global majors from the technology and healthcare sectors."

Full story: UPMC to set up 25 oncology clinics

 

Telestroke and Telepathology

Came across a recent article on stroke telemedicine, or "telestroke".

Stroke telemedicine is a lifesaving practice that deserves further advancement, Mayo researchers write in the January 2009 issue of Mayo Clinic Proceedings. Since its inception, stroke telemedicine has developed nationally and internationally as a reliable means of aiding patients. Yet certain key systematic components need to be developed more fully while specific unsettled issues must be resolved.

In nearly every subspecialty's "tele-" equivalent there always seem to be the same barriers to entry and suggestions made to improve the technology for practical clinical use.

In the article the investigators make several claims -- in every instance if you subsitute "telepathology" for "telestroke" and refer to pathology (histopathology) rather than stroke specifically, the claims and problems are the same for the same reasons and will likely so remain that way for sometime.

Perhaps with the new administration's goals for healthcar, healthcare IT and digitizing of medical care, some of these issues will no longer be obstacles for widespread adoption given the data to date.

"The implementation of telemedicine for stroke is a vital piece to the puzzle of creating universal access to emergency care for all patients with stroke, regardless of geographic location or hospital resources."

“Well-designed studies have shown that this consultative modality is valid, accurate and reliable.  Numerous telestroke networks exist worldwide, and most of these networks have published their implementation experiences and early outcome results.”

“Successfully delivered promises of telestroke include remote instant expert stroke diagnoses, delivery of short-term therapies, and secondary prevention advice.”

“Promises of telestroke applications that have been slower to materialize include widespread national and international telestroke networks that offer standardized evidence-based care, telestroke research networks for testing new stroke therapies, standardized measurements of telestroke quality of care, and acceptable guidelines for telestroke practice. “The long-term sustainability and growth of telestroke practice remains threatened by unresolved legal, economic and market factors.”

These factors include medical liability regulation and state licensing, substantial capital investment requirements and profit or self-sustaining plans relating to private and insurance payers.

“Telestroke practitioners and investigators should focus attention on analyzing and solving the business issues of the practice to allow further advances in the telestroke field and longevity of telestroke practice.”

telepathologylicense.com

Need a license to practice telepathology?  Could be, particularly outside your healthcare organization and/or state.  This is a complicated area that varies from state to state. 

I recently came across a company that offers its services called telepathologylicense.com to handle the application process as well as local credentialing and insurance needs. 

Their website claims:

"Since 2004 our concentration has been the licensing of Pathologist in the practice of Telepathology. Physicians licensing with multiple State Medical Boards at once present more complex needs which must be addressed. TelepathologyLicense.com was founded to address those needs. It is not uncommon for an established Pathologist to have over 40 verifications per application which have to be completed by the 3rd parties and forwarded to the various Medical Boards. Multiple this by the number of State Medical Board which the Pathologist is applying to and you only compound the problem. TelepathologyLicense.com has instituted the most efficient process in the industry. Our typical licensing times run between 45 days to 4 months depending on the State Medical Board and Pathologist. We are able to experience these times due to our knowledge of the process and the systematic follow-up which is assigned to each Pathologist's file.

In 2006 we saw the issuance of over 1600 Medical and Telemedicine/Telepathology licenses to our clients. We believe this is unparalleled in the industry. Our company believes in providing a higher level of service to our clients. This philosophy is demonstrated through our business plan. Due to the volume which each Pathologist provides due to Multi-State Licensing (Telepathology) we actually service a lower number of Physicians when compared to other medical licensure companies. This enables us to provide a higher level of service. We service fewer physicians with more volume. We are able to give each Physician more attention. We know our Pathologist and their needs. Because of our concentration in licensing Pathologist, we are able to concentrate on the needs of our client. We provide custom solutions to our clients. In some cases we provide on-site sign up of Pathologist who are being added to a group. A trained staff member of TelepathologyLicense.com will travel to your business center to enroll any group of Pathologists or new Pathologist as long as the number of State Medical Applications is 40 or more. Updates are given on a weekly basis . TelepathologyLicense.com provides premium licensure services which are unparalleled in the industry."