Extending Your ReachPathology in the Age of Digital ImagingExtending Your ReachPathology in the Age of Digital Imaging
Jared N. Schwartz, MD, PhD FCAPPresident, College of American Pathologists
Extending Your ReachPathology 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 StoryThe Internet Story
“Victorian Internet”: Telegraph
• 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
• Invented in the 1840s.• Signals sent over wires
established over vast distances
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: Transmission Control Protocol (TCP) specification by Vint Cerf established
1984: 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…”
Yet a revolution had begun
Dr. Leonard Kleinrock, UCLA
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
0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000
Oceania/Australia
Middle East
Africa
Latin America/Caribbean
North America
Europe
Asia
Population by Region Internet Users by Region
Internet Usage: June 2008
15.3%15.3%
21.3%21.3%
5.3%5.3%
24.1%24.1%
73.6%73.6%
48.1%48.1%
59.5%59.5%
World Average21.9%
Source: Internet World Stats: http://www.internetworldstats.com/stats.htmEstimated Internet users is 1,463,632,361 for Q2 2008Estimated World Population is 6,676,120,288 for mid-yr 2008Copy@2008, Miniwatts Marketing Group
…and they are mostly communicating in English
The Internet continues to change our lives
The Internet continues to change our lives
• New vocabulary and meanings for existing words (e.g., viruses and worms)– HTML: Hypertext Markup
Language– URL: Uniform Resource
Locator– Hyperlinks– WWW: World Wide Web– TCP: Transmission Control
Protocol– IP: Internet Protocol
• New ways to think about data and build information
• New ways to communicate and break language barriers
• New ways to work and work locations
• New challenges (e.g., security, spam, access)
Fascinating…
…but what does this have to do with pathology??
Our landscape is changingOur landscape is changing
Automation and roboticsAutomation and robotics Molecular TargetingMolecular Targeting
NanotechnologyNanotechnology
Personalized MedicinePersonalized Medicine
Technology is an accelerator…
BiomarkersBiomarkers
BioinformaticsBioinformatics
…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
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
• 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?
…so what’s it going to take?
1680s: English Tripod Microscope
1595: 1st Compound Microscope
Mid-1700s: Cuff-style microscope; 1st to provide ease of use and accurate focusing mechanisms
It has taken us 500 years to get to this point!!
1998: State of the art contains accessories for DIC, fluorescence, polarized light, phase contrast, and photomicrography
1899: Ernst Leitz Compound Binocular Microscope
Pathologists need a bias for
action
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.
We’ve considered every potential risk, except the risk of avoiding all risks.
It’s just a matter of time40-sec
20x scan20-second
40x multi-angle scan
20-sec20x scan
Multispectral imaging
Ima
gin
g
Pathology PACS
Enterprise image management
100 PetabytesPetabytes100 Terabytes
Sto
rag
e
Subspecialistwork flow
triage
Rapidsecondary
consultations
Computer-aided detection
Computer-aided diagnosis
Ap
pli
ca
tio
ns
2007 2012 2017
* Source: Sg2 T3 Virtual Slide Imaging
There has never been a greater need for
pathology expertise and resources
It’s knocking!!!
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.