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I am in the process of accomplishing one of my new years resolutions to become Black Belt certified in Lean Six Sigma. I am two thirds of the way done. I became certified as a Six Sigma Green Belt in April and Lean certified in June; both with a focus in healthcare. I am currently in the process of taking my black belt course and working on a project for certification. These days Lean Six Sigma methods are constantly running through my head and I have applied several methods to my consulting work.
The power of Post-It's and moveable whiteboards!
One of my favorite tools are Post-its and take anywhere, disposable white boards. I use them on-site with clients and I also use them in my office, ALL over my office. So in an ongoing effort to immerse myself more in Lean Six Sigma for the lab I turned to one the leaders of Lean Six Sigma in pathology, Henry Ford Hospital.
Dr. Mark Tuthill, Division Head of Pathology Informatics, was kind enough to give me a tour and WOW was I impressed. Yes.. it was a big WOW! My last blog post was about creating WOWs instead of waiting for them to happen. This is exactly what Henry Ford’s department for Pathology and Laboratory Medicine has done and continues to do, because striving to improve is never complete! You know from the moment you enter the department you have walked into a remarkable place. Placards are prominently displayed with powerful messages including:
Every Life Deserves World-Class Laboratory Service”
Lean Six Sigma is a management philosophy and their department is lead by prominent pathologist Dr. Richard Zarbo, who clearly embraces the power of Lean Six Sigma. The entire department is involved and committed to continuous improvement; a fact that would make their founder, and the father of Lean, Henry Ford proud.
Here are some of my take-aways from my visit.
Gross Room: Process Flow Chart
Defect Tracking
Can you guess their next step for their digital future? Digital Pathology! With the foundation described above, a Lean Six Sigma culture, and a management team with vision I have no doubt that they will be successful. Thank you Henry Ford Hospital for your level of excellence, you truly are a gold standard.
Tis the season for fireworks and a celebration of independence! Fireworks are spectacular and have an amazing WOW (or ooooohhhh aaaaahhhh) factor. Digital pathology use to have a big WOW factor but the industry has lost that over the past couple of years. This has to change! We need to shake things up and create new WOWs! We need to make digital pathology spectacular!
Stop waiting for the ultimate WOW to come from a digital pathology manufacturer. This mindset has to change– it’s time to create your own WOW with digital pathology and become independent of the manufacturers. The technology is very good and it can do what you want it to do today. It just takes work, lots of work to make your digital pathology vision a reality. Work…..ugh, I know. The good things in life are never easy but we need more success stories, more spectacular outcomes with digital pathology! I know we can do it!!
Stressed about the work it will take to make digital pathology spectacular? Need help? Give me a call.
Seven years ago hardly anyone knew what digital pathology (or virtual microscopy) was. I thought we had overcome much of this, yet it turns out we still have a lot of work to do to get the message beyond the pathologists.
Last week I delivered a presentation on digital pathology, sponsored by Nikon Instruments, to an audience of laboratory and diagnostic imaging professionals at the Amerinet (GPO) Member Conference. It was an excellent and eye opening experience (hopefully for my audience too). My presentation began with asking the audience “What is digital pathology?” Some people shock there heads, I had lots of blank stares, and one person who finally said…
You scan a glass slide and share it with others.
I then asked, “how many of you do not know what digital pathology is? Over a dozen people raised their hands. I was not surprised but it highlights the point that we have a lot of educating to do. Not just to educate about digital pathology, but to change perceptions that digital pathology is just a scanned glass slide. Here are some other interesting points I took home from my audience:
We’ve got some work to do! It is time to educated beyond the pathologist and reach our laboratory administrators, histotechs, IT managers, hospital administrators, and physicians who routinely interact with pathologists.
Digital Pathology Consultants introduces a new webinar “The New World of Laboratory Medicine” presented by Richard Friedberg MD, PhD on May 23, 2011 at 3 PM EST / 12 PM PST, supported by our sponsors at www.thedigitalpathologywiki.com.
Description
To thrive in highly competitive markets, clinical laboratories need to look beyond traditional models of service delivery and begin to think outside the box. This may mean integrating with other diagnostic services and delivering different types of results, from laboratory to imaging, to physicians and other clients. This webinar, presented by Richard Friedberg MD, PhD, will explore how lab medicine has changed and is likely to evolve in the coming years and how you can position yourself for the future.
About Richard Friedberg MD, PhD
Chairman, Department of Pathology, Baystate Health, Springfield, MA Medical Director, Baystate Reference Laboratories
Professor and Deputy Chairman Department of Pathology, Tufts University School of Medicine, Boston, MA
In 2007 and again in 2010, Dr. Friedberg was elected to the Board of Governors of the College of American Pathologists, where he also serves on the Council on Accreditation (vice-Chair) and Council of Government & Professional Affairs (Executive Committee), as well as CAP committees such as Strategy Management (Chair) and Finance. Dr. Friedberg holds a BS with Honors from Stanford University, an MD from Duke University, a PhD in coagulation biochemistry from Duke University, and a Master’s (SM) in Health Care Management from Harvard University. He is a Certified Physician Executive (CPE) by the American College of Physician Executives.
To register visit:
https://www1.gotomeeting.com/register/557090784
I grew up with my mom touting the phrase…
If at first you don’t succeed- try, try again.
There are times in all of our lives that we have failed but look failure in the eye and… (say it with me) try again! Failure is very helpful. It gives you insight into what did not work which is just as valuable as figuring out what does. Yet why are so many people scared to fail with digital pathology? Unfortunately people, technology, processes etc are not given the time, opportunity, and money to fail. So the question is… how do we fail safely?
I have not failed. I’ve just found 10,000 ways that won’t work. ~Thomas Edison
Dr. Mark Pool, pathologist and fellow blogger at The Daily Sign Out, had a very nice post about CAP’s Futurescape conference. One of his comments regarding the keynote address said:
The theme of this year’s iteration of Futurescape was innovation. This term has almost become hackneyed but Dr. Jeffrey Myers (DIrector of AP at University of Michigan) provided Saturday’s keynote address. He provided clear, concrete examples of innovation rather than theoretical or poetical definitions. One clear point is that innovation needs its own “space” outside of day-to-day operations to develop, fail, be tested, be refined, etc. before being put into production. Dr. Myers stressed that PDCA is the essential link between innovation and operations/safety/quality. The expectation that innovation will be as “productive” as processes already in operation is not only unrealistic but counter-productive to “innovation.” True innovations probably need to fail a few times before they become successful innovations.
I thought the comments by Dr. Myers were very accurate. It was great to hear him encouraging others to face this fear and fail in a safe environment by creating a dedicated space to work with innovation. But what else can we do to fail safely? Here are a few of my suggestions:
I recently did an audio interview with ADVANCE for Administrators of the Laboratory on adopting digital pathology. My interviewer, Jill Hoffman Managing Editor for ADVANCE, asked me two questions and here is a teaser of my responses:
What are the first steps to take when considering converting to digital pathology? Digital pathology is a complex project. It changes the diagnostic process and interrupts the laboratory workflow. The project of converting to digital pathology must be well thought out and managed carefully. With that in mind, the first and most important step is for a lab to create a plan. The plan must… Hear the rest of my response…
What are the first steps to take when considering converting to digital pathology?
Digital pathology is a complex project. It changes the diagnostic process and interrupts the laboratory workflow. The project of converting to digital pathology must be well thought out and managed carefully. With that in mind, the first and most important step is for a lab to create a plan. The plan must…
Hear the rest of my response…
Once a laboratory has made the decision to adopt digital pathology, do you have any advice for facilities in selecting a vendor and working with that vendor during the transition process? The selection process is not easy. There are over 30 vendors who manufacturer some type of digital pathology solution. This large and evolving market presents a challenge to adopters, especially since adopters want to know they have made the best possible decision for their lab. To make the best decision… Hear the rest of my response…
Once a laboratory has made the decision to adopt digital pathology, do you have any advice for facilities in selecting a vendor and working with that vendor during the transition process?
The selection process is not easy. There are over 30 vendors who manufacturer some type of digital pathology solution. This large and evolving market presents a challenge to adopters, especially since adopters want to know they have made the best possible decision for their lab. To make the best decision…
In post USCAP Part 1: The BIG Players In Digital Pathology I said, “A shift in the mindset of pathologists could be felt throughout the meeting and left the digital pathology industry energized about what 2011 will bring. No more just looking and talking about digital pathology, pathologists were truly starting to plan and think about how to adapt to their digital future.” This is a big step toward the “tipping point” of digital pathology, however, we still have several barriers to work through including cost, regulatory, technical, and psychological.
COST
Cost justification is difficult in digital pathology, however, there are several options to help deal with this barrier. At USCAP two companies, MikroScan and Motic, showcased small, affordable, high-quality scanners for only $35,000.
Mikroscan's D2 Desktop Scanner
Mikroscan’s Victor Casas said “we are here to disrupt the workflow” by creating an affordable system that is outside the lab and on the pathologists desk. Mikroscan believes that they do not compete against the high-throughput systems created by other manufacturers, instead their systems are positioned to work with them. Mikroscan wants to focus on intra-operative/frozen section scanning; small, remote labs in rural areas; and the personal scanning needs of pathologists. The D2 scanner’s has a very nice “desktop” look and the paddle (aka slide holder) can load four 1×3 slides, two 2×3 slides, or one 2×3 and two 1×3 slides. Objectives include a 2.5x for the macro scan, 20x, and 40x for high resolution scanning.
Motic’s microscope based system can be configured for 1 or 25 slides, and offers microscope-like flexibility with slide acquisition up to 100x and of the z-axis. Scans average around 4 minutes for a 15 mm2 area (scan time only). Their system supports a server software and viewer, and has the capability for real-time remote telepathlogy of the microscope.
However, if your digital pathology needs include mid or high-throughput scanning the cost barrier will not be overcome simply with low cost equipment. Instead you need a business plan and strategy. My company, Digital Pathology Consultants, helps organizations of all sizes create a business plan that will ”cost justify” digital pathology and set you up for digital success now and in the future. Our 5WH program provides clients with a cost-effective, unbiased business case for digital pathology. The 5WH program is based on a common methodology for information gathering and the goal is simply to answer the who, what, where, when, why and how of digital pathology. Although the methodology is simple, discovering the best answers to these questions is not easy and that is why you need help.
REGULATORY
Some day (hopefully within the next 10 years…) I’ll be able to blog about the FDA’s plan on how to regulate digital pathology manufacturers. Until that day comes pathologists, and their labs, must determine ways to safe guard themselves but still move forward with the use of digital pathology. Remember the FDA regulates what digital pathology manufacturers can claim or say their technology is used for, not what a pathologist or a hospital does with digital pathology. CLIA is who regulates laboratory use of digital pathology. At USCAP, CAP announced that the Pathology and Laboratory Quality Center were developing guidelines for digital pathology titled “CAP Validation Principles for Whole Slide Imaging in Digital Pathology.” The goal of this document is to develop principles to assist pathologists in properly validation WSI digital imaging systems. The draft recommendations will be available for public review in Sring 2011.
TECHNICAL
In post USCAP Part 2: Innovation Trends in Digital Pathology I discussed technology trends and how these are helping to address technical barriers of adoption. However, our biggest initiative must be to educate others in the HIT world and share what we learn, and to not shy away from this very real component of digital pathology. Two white papers were published by the Digital Pathology Association in 2010 and are good examples of what we must do to prepare for the data wave and the level of integration necessary to ensure pathology departments are successful with digital pathology now and in the future.
PSYCHOLOGICAL
Psychological barriers is a “hot topic” for me. I firmly believe this is an area the digital pathology industry must have a plan to address or adoption may never truly succeed. At Digital Pathology Consultants we have developed a coaching program to help departments or individual pathologists overcome the psychological impacts of digital pathology. I also know this is a point of interest for Aperio, and their CMO Jared Schwartz, MD PhD. Dr. Schwartz recently did a webinar on the Psychological Barriers and how Aperio is working to address them.
Overall, USCAP 2011 was an amazing meeting with lots to see and discuss about digital pathology. What do you think- take the poll below:
Digital Pathology is innovation. Digital Pathology make changes to something established (ie. pathology) by introducing new methods, ideas, and products. At USCAP last week there were examples all over the exhibit hall of digital pathology being used with other types of innovation including mobile devices, cloud computing, Software As A Service (SAAS), and methods to improve the pathologists workstation experience.
iPads, iPads, and more iPads!
Nikon Live Remote Viewing
I recently blogged about the iPad trend in healthcare (see post iPad Deployment In Healthcare to Reach 70% In 2011). This trend was reinforced by the number of iPads in use at USCAP. The Information Week article stated that 1/3rd of the 950 respondents listed lab order visualization and results, clinical decision support, and medical image viewing applications as “top priorities” for the use of the iPad in healthcare. All great reasons for digital pathology too!
New Olympus VS800 viewer on an iPad
At USCAP Nikon demonstrated live image sharing (aka telepathology) on an iPad with their digital site camera system, Aperio was showing the mobile site of the Juan Rosai Collection on one, Aurora’s mScope really was “anytime, anywhere” on an iPad, and Olympus was demonstrating the new VS800 software on an iPad too!
WSI’s & more in the Cloud
Aurora's mScope
Software (and/or Storage) As A Service (SAAS) are catching on to help overcome the IT barriers of digital pathology. I blogged on the storage element of this over a year ago (see post SAAS- Cloud 9 For Digital Pathology?) and firmly believe that SAAS has it’s place in healthcare and for digital pathology. At USCAP, several digital pathology providers were showing examples of SAAS with support for cloud based storage and secure web-enabled software solutions to ease the strain on IT. Aurora is “building communication networks” and overcoming IT barriers through their SAAS model; Aperio’s SecondSlide & Ventana’sPathXchange are cloud based; Apollo launched a collaboration with Hitachi to offer their Enterprise Patient Media Manager in the cloud, and Mikroscan offers a cloud based solution through a collaboration with Simagis. Why is this becoming more popular? SAAS solutions are accessible from anywhere with an internet connection, do not require installation on a local server or client, can be up and running quickly, and can be rapidly scaled as needed. Another example of SAAS is as an adjunct to a client-based solution. Omnyx developed a web-enabled version of their pathology workstation viewer to work with their client based Pathology workstation software. This will give the pathologist access to cases remotely (home, vacation, etc) and allow for safe, secure sharing of slides outside the hospital network for consultations.
The Pathologist Workstation
The Pathologists workstation experience has become a hot spot of innovation. Barco (see post Diagnostic Color Displays for Digital Pathology) was beta testing software that could improve the “viewing experience” and provide the speed, image quality, and intuitive interaction needed to diagnosis off of a WSI. It was amazing, and they were only using simple input devices bought at Best Buy. The Diagnostic Intelligence and Health Information Technology (DIHIT), a department of CAP STS, were again advocating for and demonstrating their prototype of a pathology diagnostic workstation. Also a few digital pathology manufacturers, like Aperio and 3DHistech, were showing new and/or compatible input devices.
A beta tester at Barco trying out the speed and ease of viewing
Aperio's Innovation Station w/Compatible Input Devices
3DHistech "Microscope like" Input Device
Digital pathology continues to be at the forefront of innovation. It was wonderful to see so many digital pathology solutions leveraging other key innovations!
Look for my final post on Monday, USCAP Part 3: Breaking Down The Barriers Of Digital Pathology.
You literally walked right into the world of digital pathology, sandwiched between Aperio and Ventana, when you entered the exhibit hall at USCAP 2011 in San Antonio last week. A shift in the mindset of pathologists could be felt throughout the meeting and left the digital pathology industry energized about what 2011 will bring. No more just looking and talking about digital pathology, pathologists were truly starting to plan and think about how to adapt to their digital future.
The amount of information I gained last week, specifically about digital pathology (and LEAN too), still has my head spinning. If you missed the meeting or did not get as much time as you would have liked in the exhibit hall, then read on and follow my three part series on digital pathology at USCAP 2011.
Part 1: The BIG Players in Digital Pathology
When I say BIG- literally, I mean BIG! To qualify as a BIG player in digital pathology you must have BIG (and very deep) wallets, BIG exhibit booths, BIG scanners, and BIG plans for the future of digital pathology! The BIG players are (in no particular order):
Aperio
You could not miss Aperio, or their giant projector ball! They were one of the first booths you saw when you entered the exhibit hall. Their two big initiatives were the NEW ScanScope AT and Spectrum Healthcare. The ScanScope AT is similar to the XT, but with a 400 slide carousel and a new flat loading method that “pushes and pulls” the glass slide on to the stage. Aperio says the AT has a 25% improvement in scan time with a throughput of 30 slides an hour at 20x.
In addition to the AT, Aperio was showing a sneak preview of their new workflow solution Spectrum Healthcare to a select few. These demonstrations were to gain feedback and impressions of this new product (not yet released). I was fortunate to be one of the select few (Thanks Ole!) to see it. Spectrum Healthcare has a nice clean look, and is designed to provide an intuitive user experience based on the workflow of key clinical applications.
Ventana
“Ventana Digital Pathology Powered by Bioimagene” is the new tag line for the duo. Although the well known Bioimagene brand was not present in the Ventana booth, their iScan Coreo Au scanner, Virtuoso data management software, and whole slide images were. A great example of integration of the two brands were large touch screen displays throughout the booth that showcased whole slide images of new antibodys, like ERG for prostate. It is clear that Ventana has a plan and strategy for digital pathology, and is working hard to fully integrate the Bioimagene team and products into their portfolio.
Omnyx
There were lots of familiar and new faces in the Omnyx booth! Omnyx has been hiring (and is still hiring) a lot of people to support the launch of their digital pathology solutions, currently for research use only. Omnyx showcased new technology with their VL120 scanner and a new web-enabled viewer for mobile devices (think iPad and laptops) for remote access to their pathologist workstation solution. The VL120 has the same components as the VL4 but with a flat-bed load and scan system. There are six stackable trays that each hold 20 slides and can be placed in the VL120. The VL120 will not be available until Q4 2011.
Olympus
Olympus had an very impressive booth fully equipped with a surgical suite, new microscopes, consumer cameras, and their full digital pathology product line. The goal was to make pathologists aware that they are more than a microscope provider, they are a healthcare company. I imagine it worked! You couldn’t help but be curious about the surgical suite and the large array of products on display. Their DP product line included the VS110 with fluor and 100 slide autoloader; The NanoZoomer RS 2.0 with new fluorescence components, a Visiopharm image analysis workstation featuring HER2-Connect, and their new VS800 scanner. The VS800 was impossible to miss with it’s large footprint and blue panel. It has capacity for 300 slides, a custom designed objective, simultaneous parallel slide loading and unloading, real-time auto focus which eliminates the need to create a focal map, and brand new software to run the scanner and manage the data.
Leica Microsystems
Leica’s new tagline is “Total Digital Pathology” designed to create a similar message to their “Total Histology” solutions. Although Leica was not showcasing any new digital pathology technology, they were demonstrating their total solution with the SCN400, Ariol for clinical breast panel analysis, and SlidePath software to support the data management of either the SCN400 or Ariol scanned slides. Both Genetix (acquired by Danaher in March 2010) and SlidePath (acquired by Genetix in May 2009) are now represented as an integrated part of Leica Microsystems, and their “Total Digital Pathology” solutions.
Philips
Philips demonstrated their high throughput (300 slides) scanner, Pathology PACS workflow software, and a new integrated DAKO HER2 algorithm. Their system is designed for the “bench” with a simple, intuitive touch screen, large bright lights indicating the scanning process (to be monitored from across the lab), and the batch can be interrupted to pull out finished slides and to load new ones. Within the PACS software is the Dako algorithm for the Herceptest (HER2). This was one of my favorite features at Philips. Based on the slide barcode the software knows what the stain is and “automatically” applies the algorithm to the slide and generates the score. The user (aka pathologist) only has to delineate an area of interest(s). The algorithm is calibrated to the stain and is very, very easy to use! Further image analysis initiatives by Philips include integration with Definiens for specific algorithms; however, Philips will have an open architecture for image analysis. The entire Philips solution is available today but for research use only. Clinical trials are set to begin at three customer sites in Q2.
Special thanks to Ole at Aperio and his blog for a few of my pictures, and stay tuned for tomorrow’s post- USCAP Part 2: Innovation Trends in Digital Pathology.
The United States & Canadian Association of Pathology (USCAP) annual meeting, the first big pathology meeting of the year, is set to kick off in San Antonio TX and celebrate its’ 100th year this weekend. The topic of the meeting is “Education & Innovation For The Next 100 Years” and will feature lots of information on digital pathology.
Over the past three years USCAP has really become a hot spot for digital pathology companies to make a statement; the exhibit booths just get bigger and bigger! In my summary of USCAP last year I blogged about how there were sixteen companies who represented digital pathology products (see post: All Aboard! The Digital Pathology Bandwagon); this year will be even more impressive- just wait and see!
USCAP ’11 Digital Pathology Highlights
I will of course be there and welcome the opportunity to meet and greet with any of my blog readers or anyone interested in learning more about Digital Pathology Consultants. Send me an email if you would like to set up a time to meet and/or follow me on twitter during the meeting at DPConsultant and look for tweets with #USCAP11.
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