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A common phrase is,
Better, faster, cheaper- pick two! You cannot have it all.
To stay ahead of the competition often the belief is you have to be better, faster, and cheaper then everyone else. Unfortunately this is not very realistic, you cannot have it all. Therefore you have to focus your strategy on two of the three.
Better relates to quality. If you understand what digital pathology really is then you know the quality of your histology is essential to create diagnostic quality whole slide images (WSIs). Specimen tracking (ie. barcodes) is also essential and dramatically reduces manual errors, improves patient safety, and enables the WSI’s to be organized and distributed without any manual entry. Digital pathology makes the diagnostic experience better by enabling more tools for the pathologists including:
Digital pathology also enables better tools for marketing your laboratory services, including:
Faster relates to Turn-Around-Time (TAT). Digital pathology creates an environment for fast and efficient communication and improved distribution of cases. Once glass slides are converted to WSIs they can be shared easily via the internet or through a LIS or Pathology PACS system. This can improve TAT for:
Digital pathology will not be cheaper, but it does not have to be more expensive and leveraging competitive advantages will help grow your practice and revenue. Although you cannot have it all, I think you can come close. Stay tuned for my last three tips next week where I will provide insight on how to control and bring value to the cost of digital pathology with Tip 3: Build a Business Case, Tip 4: Discover your ROI, and TIP 5: Make a Sound Business Decision and Follow Through.
A Healthcare Information and Management Systems Society (HIMSS) survey found that iPad deployment in healthcare will reach 70% in 2011. Wow, that’s a huge number! Sounds like a good reason for me to run out and buy one as a tax right off. But is that really practical?
An article in InformationWeek summarized the results of the survey. The text for the article is below:
Results from a survey of nearly 950 Healthcare Information and Management Systems Society (HIMSS) members indicates that iPad deployments are accelerating in large part due to the mobile device’s compelling point-of-care applications and uses.Conducted October 26 during an online webinar cosponsored by HIMSS and BoxTone, a mobile service management (MSM) company, the survey’s results were released earlier this month. Data showed that nearly 70% of the attendees were from hospitals or healthcare organizations with more than 1,500 employees, and 15% of attendees were executive-level staff or physicians. More than 25% of the HIMSS respondents plan to deploy the iPad and other iOS devices immediately and nearly 70% plan to deploy the devices within the next year. One-third of respondents identified point-of-care applications — including lab order visualization and results, clinical decision support, and medical image viewing applications — as top priorities, while 18% identified general administration, including billing, coding, and claims applications, as top priorities. Nearly 75% identified secure configuration and deployment as the number one iPad IT management challenge, and 53% identified mobile application deployment as a key issue. Lynne Dunbrack, analyst with IDC Health Insights, said security will remain a top concern for healthcare CIOs, especially if clinicians bring in their own devices to access the hospital’s healthcare information systems, such as electronic medical records (EMRs) and computerized physician order entry (CPOE) systems. “As more patient information is moved into EMRs and made accessible both inside and outside the organization via a range of devices, including mobile devices and tablets, the risk of a privacy breach rises. Organized deployment and virtualized clients will help to mitigate this concern,” Dunbrack said. Dunbrack also noted that the iPad, which has a sleek design, an intuitive user interface, and a large screen (relative to a smartphone), is becoming increasingly popular among clinicians. As the iPad gains traction among healthcare providers, EMR vendors will develop bidirectional integration between their EMR applications and clinicians’ mobile point-of-care devices such as smartphones and tablets. Vendors are also developing EMR applications specifically for the iPad, Dunbrack observed. One example is St. Louis-based ClearPractice, a company that develops Web-based ambulatory EMR and revenue cycle management applications. ClearPractice recently launched Nimble, a comprehensive EMR application designed and developed specifically for the iPad. Alan Snyder, BoxTone’s CEO, said in a statement that the iPad is redefining how organizations leverage mobile technology in the enterprise and the healthcare community is leading this paradigm shift. “As these devices are used more frequently at the point of care, IT must ensure both data security and privacy, as well as superior remote connectivity,” Snyder said.
Results from a survey of nearly 950 Healthcare Information and Management Systems Society (HIMSS) members indicates that iPad deployments are accelerating in large part due to the mobile device’s compelling point-of-care applications and uses.Conducted October 26 during an online webinar cosponsored by HIMSS and BoxTone, a mobile service management (MSM) company, the survey’s results were released earlier this month.
Data showed that nearly 70% of the attendees were from hospitals or healthcare organizations with more than 1,500 employees, and 15% of attendees were executive-level staff or physicians.
More than 25% of the HIMSS respondents plan to deploy the iPad and other iOS devices immediately and nearly 70% plan to deploy the devices within the next year.
One-third of respondents identified point-of-care applications — including lab order visualization and results, clinical decision support, and medical image viewing applications — as top priorities, while 18% identified general administration, including billing, coding, and claims applications, as top priorities.
Nearly 75% identified secure configuration and deployment as the number one iPad IT management challenge, and 53% identified mobile application deployment as a key issue.
Lynne Dunbrack, analyst with IDC Health Insights, said security will remain a top concern for healthcare CIOs, especially if clinicians bring in their own devices to access the hospital’s healthcare information systems, such as electronic medical records (EMRs) and computerized physician order entry (CPOE) systems.
“As more patient information is moved into EMRs and made accessible both inside and outside the organization via a range of devices, including mobile devices and tablets, the risk of a privacy breach rises. Organized deployment and virtualized clients will help to mitigate this concern,” Dunbrack said.
Dunbrack also noted that the iPad, which has a sleek design, an intuitive user interface, and a large screen (relative to a smartphone), is becoming increasingly popular among clinicians. As the iPad gains traction among healthcare providers, EMR vendors will develop bidirectional integration between their EMR applications and clinicians’ mobile point-of-care devices such as smartphones and tablets.
Vendors are also developing EMR applications specifically for the iPad, Dunbrack observed. One example is St. Louis-based ClearPractice, a company that develops Web-based ambulatory EMR and revenue cycle management applications. ClearPractice recently launched Nimble, a comprehensive EMR application designed and developed specifically for the iPad.
Alan Snyder, BoxTone’s CEO, said in a statement that the iPad is redefining how organizations leverage mobile technology in the enterprise and the healthcare community is leading this paradigm shift.
“As these devices are used more frequently at the point of care, IT must ensure both data security and privacy, as well as superior remote connectivity,” Snyder said.
What I find interesting is that for One-third of respondents their top priorities for use of the iPad were lab order visualization and results, clinical decision support, and medical image viewing applications. All good reasons for physicians and pathologists too. What do you think? Please take the poll below or feel free to leave a comment.
I attended Pathology Visions last week (more on that later…) which is organized by the Digital Pathology Association (DPA). The DPA released on Tuesday two white papers; 1) Interoperability between Anatomic Pathology Laboratory Information Systems (APLIS) and Digital Pathology Systems and 2) Archival and Retrieval in Digital Pathology Systems.
The white papers are good and provide vendor neutral information to help the digital pathology industry and consumers. Here are the abstracts and a few of my favorite points from each:
Archival and Retrieval in Digital Pathology Systems
This white paper frames the issues related to Archival and Retrieval of images and associated data as Anatomic Pathology laboratories adopt a digital imaging workflow in a research or clinical setting. This overview also includes a brief discussion of some of the solutions being developed and offered in digital pathology systems (DPS’s).
DPS’s start with creation of a whole slide image and provide an imaging workflow for pathologists by associating the images with a patient and case and furnishing the tools to review the cases digitally. Whole slide images (WSI) are very large and will drive the need for extensive storage and information life cycle management. Customers seek options for fast access to high quality and highly available data, when they use the DPS in a business critical application. Most importantly, since DPS’s are deployed in regulated environments, data reliability, privacy, and security need to be built into the solution and its management process.
Solutions that are being developed and deployed in digital pathology systems are also presented.
Favorite points:
Interoperability between Anatomic Pathology Laboratory Information Systems and Digital Pathology Systems
This white paper offers an overview of the current state of interoperability between Anatomical Pathology Laboratory Information Systems (APLIS’s) and Digital Pathology Systems (DPS’s). This overview also includes a brief discussion of future work that will impact interoperability.
Both systems rely on data from the other to efficiently deliver full digital imaging functionality to the healthcare provider. Anatomic Pathology (AP) departments and patients will benefit most from imaging workflow when there is a high degree of integration of Digital Pathology information within AP workflow. Implementations of such data sharing already exist via interfaces and standard communication protocols between APLIS’s and DPS’s, and work continues on these interface standards to improve the degree to which these systems can be used together.
The current state of interoperability provides Pathologists with access to images and image analysis data from within the APLIS or the DPS. This information is then available to the Patient Report.
For over 10 years, the digital pathology industry has been riddled with vendors speaking their own language or languages (aka file format). Today a major milestone in interoperability was achieved with the final approval of Supplement 145; a DICOM universal format for whole slide images. Although vendors will never give up their native tongue, this new supplement creates a universal language everyone can understand in digital pathology, even those outside of our industry.
WG-26, lead by Bruce Beckwith, MD, has worked hard for several years to create supplement 145. Harry Solomon of GE Healthcare contributed a lot of help over the past year to move this to ballot and beyond. Harry put forward the following comments in an email to WG-26 today:
I’d like to add my thanks to the members of DICOM WG-26 for the significant body of pathology domain knowledge that has been added to the DICOM Standard, both in this new Supplement 145, and in Supplement 122 in 2008. That knowledge is now available to further improve interoperability in a field that was early to health informatics standards with the Systematized Nomenclature of Pathology, now known as the Systematized Nomenclature of Medicine (SNOMED), and is now poised for a significant leap with digital pathology. Here are some statistics on that domain knowledge base: One major new DICOM Information Object Definition (Whole Slide Imaging) with new concepts to manage the huge WSI data set A major revision of a DICOM Information Entity (Specimen) with a rigorous information model 56 new data elements added to the DICOM Standard in 14 new or revised modules 7 new or revised DICOM structured data templates and 18 new defined value sets 80 new coded terminology concepts added to SNOMED, and 36 added to DICOM 40 pages of explanatory information about pathology workflow and imaging
I’d like to add my thanks to the members of DICOM WG-26 for the significant body of pathology domain knowledge that has been added to the DICOM Standard, both in this new Supplement 145, and in Supplement 122 in 2008. That knowledge is now available to further improve interoperability in a field that was early to health informatics standards with the Systematized Nomenclature of Pathology, now known as the Systematized Nomenclature of Medicine (SNOMED), and is now poised for a significant leap with digital pathology.
Here are some statistics on that domain knowledge base:
Overall, this is another major step forward in the clinical use of digital pathology. Thank you to everyone who worked hard to make this a reality! The final document will be available within the next week.
Below is an article I wrote for ADVANCE for Laboratory Professionals, Perspectives In Pathology.
By Amanda Lowe
Digital pathology is often described as the scanning of a glass slide into a whole slide image; yet, it is much more. It is so much more, in fact, that pathologists and laboratory professionals find themselves puzzled with how it will affect their future. As technology progresses, we must start to understand how to put the pieces of it together—from acquisition to integration to data management and interpretation.
Acquisition
Acquisition of a whole slide image from a glass slide is done on a slide scanner, which creates the image necessary for interpretation. Important elements of slide preparation and patient information can make the acquisition process simple or complex.
Slide preparation is a crucial and often overlooked element of digital pathology. Pathologists can handle slide artifacts such as folds and air bubbles under a microscope; slide scanners are not always as forgiving. Also, staining has to be perfected, not only for scanning but for accurate interpretation and use with image analysis software. Poor staining can result in tissue not being scanned, inaccurate image analysis data—and in the worst case—a wrong diagnosis.
Traditionally, when glass slides are prepared, they are manually matched with the patient paperwork (including patient history, requisition and gross review), then delivered to the pathologist. With digital pathology, the process looks different. You now have whole slide images that need to be reconciled to the digital patient paperwork, then delivered to the pathologist. The only way to do this is with a laboratory information system (LIS), electronic medical record (EMR) integration, and bar codes. Bar codes will reduce human error, save time on the constant need for verification and re-checks, and improve quality assurance by tracking all specimens throughout the histology process.
Integration
The LIS and often the EMR need to share information with the digital pathology software to create a pathology picture archiving and communication system (PACS) that consolidates all patient paperwork, gross images and whole slide images for interpretation. This is the most important but also the most difficult piece for labs to handle. The process can be costly and require collaboration of two or more vendors, which can be a frustrating and hard process to manage. However, it can be accomplished with a plan, a budget and someone to manage the project.
Data Management
Many hospitals do not have adequate IT resources or the expertise to handle their already stressed storage demands. Yet these whole slide images have to be stored somewhere. Unfortunately, most IT departments do not understand the fundamentals of digital pathology. Pathology leaders and their lab personnel must improve communication with their IT departments and take an active role in educating IT on the realistic needs of the department now and over the next five years. Hospitals have to prepare for the increase in lab data and pathology images that will soon be their future.
To estimate your whole slide image storage needs, divide the number of surgical slides your lab generates per year by 3,500 to get an estimate of terabytes needed annually; 3,500 is the average number of whole slide images per one terabyte.
Healthcare providers are required to save medical records for a specified time; for most, this is a minimum of seven years. Security is not optional, and HIPAA mandates backup and disaster recovery plans for patient records, including all medical images. The specialty of pathology will not be an exception to the rule.
Interpretation
One goal of digital pathology is to enhance the sign-out process for pathologists. Pathologists should be able to sit down at a computer monitor to sign out digital cases retrieved from a pathology PACS system. Easy access to archived cases for disease progression or comparison, rapid case sharing and consultations, data mining for decision support and image analysis will all help improve the diagnostic process.
Powered by the rapid and endless growing portfolio of image analysis algorithms, pathology will transition from a qualitative to a quantitative discipline. Digital pathology partnered with image analysis will create the infrastructure necessary so pathologists can confidently determine the severity of a disease and predict responses to a target therapy.
Digital pathology streamlines laboratory workflow, enhances the sign-out process, and can improve diagnostic outcomes and treatment responses for patients while at the same time forge a new foundation for the use of pathology data to drive translational research and higher standards of care.
Walking the floor of ToxExpo this week, I came across a Barco medical display monitor at the SlidePath booth. The monitor was the Coronis Fusion model, a 6 MegaPixel wide-screen diagnostic color display. This monitor has some impressive features including:
Courtesy of www.barco.com
In addition, Barco medical imaging displays come with MediCal QAWeb. A software package that provides surveillance of all the Barco monitors. QA Web can:
It seems logical that diagnostic displays will have a place in digital pathology, however the size, specifications and requirements will likely change. For example, diagnostic displays for mammography must have 510(k) approval and mandate a display standard of at least 5 MegaPixels. Will digital pathology diagnostic displays require FDA approval? The topic of monitors was briefly discussed at the FDA advisory panel meeting in October. Also, the Diagnostic Intelligence and Health Information Technology (DIHIT), a department of CAP STS, issued information last fall on a prototype of a pathology diagnostic workstation, which was supported by many digital pathology solution providers. In addition, many vendors are starting to market and sell similar solutions to the pathology diagnostic workstation, like Bioimagene’s Crescendo which includes a Barco monitor. Aperio and Olympus are compatible with Barco monitors and will be displaying their digital pathology solutions on them at USCAP in a few weeks. Lastly, we can only hope that costs on diagnostics displays will start to decrease. Currently, the 6 MP Coronis Fusion lists for $17,500 USD.
Other companies who manufacturer color diagnostic displays include EIZO/RadiForce and NDS.
Cloud storage, or storage as a service (SAAS), is definitely the new buzz word in the informatics world. New cloud companies are being formed every day trying to capture their piece of blue sky; and similar to real clouds, each one seems to be unique. But could the use of SAAS be an answer to the strain digital pathology puts on IT and their all ready overtaxed resources?
Zetta, a new Cloud company, just released the results of a survey they did on over 400 IT professionals, with healthcare/medical being in the top five of the industries that responded. In the survey, the most often-cited issues with current storage methods included:
As a result, nearly half of the respondents (47%) either already were or are planning to use cloud storage. The applications most often planned for include backup (38%), archive (37%), and primary storage (25%). The expected benefits of cloud storage included:
In a white paper issued by Iron Mountain, titled “Iron Mountain Reduces Medical Storage Costs.” issues that healthcare providers face in today’s data explosion are outlined. The paper states that assuming a provider needs to store approximately 22 TB of medical images over the course of five years, a cloud based solution would produce savings of over 60% compared to an onsite storage alternative. The cost savings jumps to 240% if the provider chooses to replicate the onsite storage solution to a secondary location for disaster recovery purposes as mandated in the HIPAA Security Rule (Contingency Plan Standard- section 164.308, and Device and Media Controls Standard- Section 164.310), which Iron Mountain includes at no additional cost as part of their solution. See Fiqure 1 from the white paper.
In addition, the white paper outlines that customers will save with their cloud solution because:
On a big picture scale, it does not seem that healthcare providers are planning for or considering the impact that digital pathology will have on medical image storage in the near future- much of the talk is still focused on radiology imaging studies. However, current users of digital pathology solutions know what I am talking about as they work to manage all the data that scanners produce.
i-Path Diagnostics offers PathXL™, a novel web-based virtual slide viewing technology and management software for digital pathology with a high performance hosting capacity to provide a cloud-based service to customers. Dr. Peter Hamilton, describes PathXL™ as “…cloud computing for virtual microscopy at its best! PathXL™ offers a unique solution across a range of applications including education, training, competency testing, biomarker research, biobanking, and digital archiving of clinical samples.” Some of iPath’s cloud benefits include:
Overall, I believe that SAAS may be “Cloud 9″ for Digital Pathology. If you have an opinion or question about cloud storage, please feel free to comment, our take the Cloud poll. Feedback is always welcome.
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I recently participated in an audio conference, provided by The Dark Report titled “New Opportunities for Your Lab’s LIS-EMR Interface: How to Profit From the Big Wave About to Hit Healthcare.” The “Big Wave” is simply, the massive increase of physicians who will adopt a certified EMR system within the next 5 years. In 2009, approximately 25,000 practices adopted an EMR, bringing the total physician adoption to approximately 30% nationwide. If the stimulus plan reaches it’s goal of 90% adoption by 2015, then adoption is going to more than double, with around 60,000 practices adopting per year starting this year. But what does this mean for laboratories?
For a physician to get up to $44,000 in reimbursement dollars, available through Medicare, they must prove “meaningful use”. There are three items on the “meaningful use” checklist that pertain to laboratories for phase 1, and they are:
Basically lab orders have to be loaded up, set up in that EMR and adopted by the practice and its employees; lab results have to be deployed, and the lab reports will have to be shared with a public health agency. It’s the first step in this process though that is going to have the largest impact on laboratories as their customers, physician practices, are going to be demanding integration. Thus, laboratories can either hope that their LIS will integrate with the physicians new EMR easily (but is IT integration ever easy?), or they can proactively use this opportunity to grow business and strengthen relationships with their practices. Given that there are currently 11 certified EMR companies and an additional 30 pending certification, it is likely that your LIS will not support them all. You must become proactive! So what do you do to manage the “Big Wave” about to hit laboratories?
Overall, be an informed leader in the process and don’t just wait for the “Big Wave” to hit you.
This information was presented by Pat Wolfram, Vice President of Marketing & Customer Services at Ignis Systems Corporation and Ruth Johanson, Information Technology Program Director at Providence Health & Services. If you are interested in hearing this audio conference you can purchase a CD at The Dark Report, click here to learn more.
An interesting article, HIT to Become a $60 B Market by 2013 on DOTmed.com caught my eye this morning. The article states, “…that the American government is feeding $20 billion into HIT, driven largely by the HITECH provision in the American Recovery and Reinvestment Act signed by President Obama earlier this year. Under HITECH rules, Medicare will start offering payment incentives for hospitals and “eligible professionals” who set up HIT systems probably by some time in 2011.” Pathologists it is time to become friends with your Healthcare Information Technology (HIT) department.
Whole slide imaging systems, pathology PACS systems, LIS/LIMS systems, barcoding technology, image analysis software, new computers, servers, network upgrades, etc. cost a lot of money. But the digital pathology future will make the workflow of pathology more efficient, reduce turn-around-time (TAT), and put more resources in front of the pathologists. With greater efficiency comes cost savings, better TAT improves patient care, and armed with more resources pathologists can make more meaningful diagnoses, collaborate better with clinicians, and issue reports that are more informative to everyone, including the patient. But can implementation of digital pathology fall under the guidelines of some of that HIT funding, with Medicare’s broad statement of HIT being tied to a “meaningful use”? Given all the meaningful uses I just listed above, I believe that it could and should be an area that HIT funds are used for.
The article also talks about Clinical Decision Support Systems (CDSS) as part of personalized medicine, and that CDSS will likely play a large role in the growth of HIT. CDSS are interactive computer programs designed to aid physicians and other health professionals with decision making, including diagnosis. A lot of companies who offer CDSS or DDSS (Diagnostic Decision Support Systems) cater to internists; however a CDSS for pathology could be a very useful. CDSS software appears to partner observations with knowledge to aid in a quicker, more meaningful diagnosis. Pathologists do this every day, all day. However a lot of the knowledge is kept up in their head or in a picture saved on an external hard drive attached to their computer. But with the implementation of digital pathology, the whole slide image and the knowledge that goes along with that slide can be cataloged, referenced and then the data analyzed, creating another type of Clinical Decision Support System, which could become a powerful resource for pathologists and their predecessors. With daily workloads increasing and the number of pathologists decreasing tools like digital pathology and CDSS will be part of our healthcare future.
Wikipedia has a great description and background information on CDSS & DDSS. Click here to learn more.
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