Transcript Document

Extending Your Reach
Pathology in the Age of Digital Imaging
Jared N. Schwartz, MD, PhD FCAP
President, College of American Pathologists
Extending Your Reach
Pathology in the Age of Digital Imaging
• What can we learn from the Internet
development story?
• What is happening in healthcare?
• How will it impact pathology?
• What drives innovation & adoption?
• Threat or opportunity?
The Internet Story
“Victorian Internet”: Telegraph
• Invented in the 1840s.
• Signals sent over wires
established over vast
distances
• Used extensively by the U.S. Government
during the American Civil War, 1861 - 1865
• Morse Code was dots and dashes, or short
signals and long signals
• Electronic signal standard of +/- 15 v. is still
used in network interface cards today
More than 100 years later, the
Internet is born
1968:
DARPA (Defense Advanced Research Projects
Agency) contracts with BBN (Bolt, Beranek &
Newman) to create ARPAnet (packet switching)
1972:
First email sent
1974:
1984:
Transmission Control Protocol (TCP)
specification by Vint Cerf established
Internet with its 1000 hosts converts en masse
to using TCP/IP for its messaging
1989:
Tim Bemers-Lee creates the World Wide Web
2004:
Web reaches 1 billion users
1969: UCLA to Stanford
“Do you see the L?”
“Yes, we see the L,” came
the response.
“We typed the O, and we
asked, “Do you see the O?”
“Yes, we see the O.”
“Then we typed the G, and
the system crashed…”
Dr. Leonard Kleinrock, UCLA
Yet a revolution had begun
The Internet solved several
challenges
• Basically inventing digital
networking as we know it
• Survivability of an infrastructure
to send and receive high-speed
electronic messages
• Reliability of computer
messaging
To get a market of 50 million people
participating…
• Radio took 38 years
• TV took 13 years
• Once it was open to the general
public, the Internet reached the
mark in just 4 years!!!
* Delivered to the President and the U.S. Public on April 15, 1998 by Bill Daley,
Secretary of Commerce and Chairman of the Information Infrastructure Task Force
Internet Usage: June 2008
Asia
15.3%
48.1%
Europe
North America
73.6%
Latin America/Caribbean
World Average
21.9%
24.1%
Africa
5.3%
Middle East
21.3%
59.5%
Oceania/Australia
0
500
1,000
1,500
Population by Region
Source: Internet World Stats: http://www.internetworldstats.com/stats.htm
Estimated Internet users is 1,463,632,361 for Q2 2008
Estimated World Population is 6,676,120,288 for mid-yr 2008
Copy@2008, Miniwatts Marketing Group
2,000
2,500
3,000
Internet Users by Region
3,500
4,000
…and they are mostly
communicating in English
220.0
Rest of Languages
Italian
34.7
Korean
34.8
Portuguese
58.2
Arabic
59.9
German
61.2
68.2
French
94.0
Japanese
124.7
Spanish
276.2
Chinese
430.8
English
0
100
200
300
Millions of Users
400
500
The Internet continues to change
our lives
• New vocabulary and
meanings for existing
words (e.g., viruses and
worms)
–
–
–
–
–
• New ways to think about
data and build information
HTML: Hypertext Markup • New ways to communicate
Language
and break language barriers
URL: Uniform Resource
• New ways to work and work
Locator
locations
Hyperlinks
WWW: World Wide Web • New challenges (e.g.,
security, spam, access)
TCP: Transmission Control
Protocol
– IP: Internet Protocol
Fascinating…
…but what does this have
to do with pathology??
Our landscape is
changing
Technology is an accelerator…
Automation and
robotics
Bioinformatics
Biomarkers
Molecular Targeting
Nanotechnology
Personalized
Medicine
…but technology is
not the only driver
Government regulations are
inhibiting progress
• Applying arcane standards to new
technologies
• Requiring more paperwork not less
• Continuous battles over
government agency oversight
responsibilities (CMS, FDA, and
CDC)
• Inconsistent application of
requirements; different standards
of practice
• New roles for pathologists and
others not recognized
Recent developments in
the world economy will
only worsen the pressure
on health care spending
…and most of the rest of
the developed world is
experiencing a shortage of
pathologists
Newfoundland–May 2008
India–Nov 2007
Australia–Jul 2008
Canada–May 2008
United Kingdom–Jan 2008
China–Mar 2007
Pathology must focus on
expanding value
•
•
•
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Right patient
Right test
Accurate results
Reported on the right
patient
Quality care
requires
quality testing
• Reported to the correct clinician in a
way they can understand and brings
value to the treatment plan
We are clinicians with a direct
impact on patient care
Pathology
…so what’s it going to
take?
It has taken us 500 years to get
to this point!!
Mid-1700s: Cuff-style
microscope; 1st to
provide ease of use
and accurate focusing
mechanisms
1595: 1st
Compound
Microscope
1680s: English
Tripod
Microscope
1899: Ernst Leitz
Compound Binocular
Microscope
1998: State of the art contains
accessories for DIC, fluorescence,
polarized light, phase contrast,
and photomicrography
Pathologists
need a bias for
action
Necessity is the mother of all
innovation…and adoption
•
•
•
Reduce time from biopsy to
diagnosis
Increase productivity
Expand access to expertise
and special stains
Some will always see the glass
as half full
•
•
•
•
•
•
•
•
Slower than current microscopy
Adds a step to the process
Pathologists resist change
Has not been fully vetted in the
literature
Capital investment barrier is high
Operating costs may exceed current
practice
Lack of stands; non-interoperable
solutions
No integration with existing AP
systems
“Construct barriers to progress”
• Look to professional societies to
impose certification standards
• Encourage professional societies to
lobby for restrictive laws
• Rely on hospitals to reinforce
institutional credentialing
requirements
• Rely on insurance companies to
enforce reimbursement only
hospital-credentialed physician
services
• Employ marketing techniques to
raise public awareness of
pathologists’ local contribution to
health care
We’ve considered every potential risk, except
the risk of avoiding all risks.
Imaging
It’s just a matter of time
40-sec
20x scan
20-sec
20x scan
20-second
40x multi-angle
scan
Applications
Multispectral imaging
Rapid
secondary
consultations
Subspecialist
work flow
triage
Computer-aided
detection
Storage
100 Terabytes
Computer-aided
diagnosis
Petabytes 100 Petabytes
Enterprise image management
Pathology PACS
2007
2012
2017
* Source: Sg2 T3 Virtual Slide Imaging
It’s knocking!!!
There has never been
a greater need for
pathology expertise
and resources
Digital Imaging expands our tool
kit and extends our reach
• Broaden practice statewide, regionally,
internationally
• Extend expertise with CAD
• Collaborate with peers; possibly increase
demand for 2nd opinions
• Improve your value as the gatekeeper for
subspecialty expertise and for patient
information, and integration of diagnostic data
from any source
• Better serve patients
It’s time to bust out
…and maximize
use of all tools
available to us
to assume new
and expanded
roles
Our Vision
When it comes to the future,
there are three kinds of people:
those who let it happen, those
who make it happen, and those
who wonder what happened.
~ John M. Richardson, Jr.