05 at 1 40 tawfikpvx web conferencing
TRANSCRIPT
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INTERACTIVEMULTIDISCIPLINARY WEB
CONFERENCING:The Use of the Aperio and
PolyCom PVX SystemsOssama Tawfik, MD, PhD
ProfessorDirector of Anatomic and Surgical Pathology
The University of Kansas Medical CenterPathology Vision Conf, Oct 2008
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OBJECTIVES
1. Why going digital is valuable?2. What is wrong with the current
system?
3. Can we do better? And why do wehave to?
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Why Digital Conferencing?
– Problem...
• Medicine is changing.
• Medical Practice and Teaching is moving away
from the Major Medical Centers into CommunitySettings.
• Medical Centers are redesigning themselves -clinics, surgi-centers, nursing homes anddoctor’s practices.
• Great majority of patient care will be outpatient,located outside the main Campus.
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Why Telepathology?
– Problem...
• The growing physical separation betweenClinician and Pathologist is problematic incommunication...
• Traditional Pathology Reports will havelimitations in communication.
• How will we communicate with our clients
when they are across town, across the state oracross the world?
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Why Telepathology?
– Problem...
• As medicine becomes distributed, it will becomeincumbent upon us as pathologists to find new
ways of communicating for clinical work,research and education.
• The primary mode of communication has alwaysbeen the pathology report.
• We may now have to rethink the way we report...
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• Pathologists, radiologists, and surgeons
• digital slide/radiology conferencing on aweekly basis
• 500 breast needle core biopsies
• ERROR REDUCTION!!!!
• Evaluation of significantabnormalities/discrepancies
• Correlation with treatment plans for each
patient
INTERACTIVE MULTIDISCIPLINARY
CONFERENCE
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Microcalcifications of the breast:
size matters!
A mammographic-histologic correlation studyX Liu, M Inciardi, JP Bradley, F Fan, P Thomas, W Smith, O
Tawfik
Pathologica 2007;99:5-10
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Core Needle Biopsy Protocol
Specimen radiography
Calcification
Absent
Calcification
Present
< 100 um > 100 um
Proceed w Dx
Tissue block
radiography
Radiologically
negative
Radiologically
positive
Malignant DxBenign Dx
Cut deeper in block
Additional
studies are
required!!
Ca Absent Ca Present
Ca SIZE
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Medical Error Statistics
• Colorado and Utah s tudy
– Adverse events (AE) in 2.9% of hospitalizations
– 8.8% of AE’s led to death (about 44Kdeaths/annually
• New York study
– AE’s in 3.7% of hospitalizations – 13.6% of AE’s led to death (98K deaths annually)
• Eigh th leading cause of death in USA
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Dollar Cost of Medical Error
• Between $17 to $29 billion/year
– Half directly attributable to health care costs
– Other half combination of lost productivity, lostincome and disability
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Goals of the IOM report
• Break “cycle of inaction’ concerning patient
safety and medical error
• Enhance knowledge base about medical error• Breakdown legal and cultural barriers which
impede safety improvement
• Shift from blaming individuals for past errors to afocus on preventing future errors by designingsafety into the health care system
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Goals of the IOM Report (cont.)
• Improve knowledge base about medicalerror and safety improvement
• Develop tools to improve safety
• Cause significant monetary investments toachieve these goals
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Institute of Medicine mandate
• Threshold improvement in quality
– 50% reduction in medical error in five years
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“ARE WE LISTENING?”
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“OUR PROBLEM”
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“OUR PROBLEM”
KU Med Ctr is
Located 3 miles
From Cancer
Center
Man power
Time
Resources
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“OUR PROBLEM”
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• Aperio ScanScopeSystem
• PolyCom PVX videoconferencing System
“OUR SOLUTION”
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• Pathologists, radiologists and surgeons
• Develop a web based pre-diagnostic work-up conference in which the pathologyslides and mammograms could beanalyzed together
• Goals:
– To insure adequate sampling
– To reach a proper diagnosis
– To determine the proper surgical/treatment
plans
Aperio/KUMC Pilot Project
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Application Values
Tested Variables Measured
ConfirmationReviews with DigitalConferencing
Quality Concordance between glass
and digital reads Image quality Comfort level with using digital
slides Ease of use with digital slides
Service andEfficiency Pathologist/Radiologist/Surgeon
satisfaction Comparison of actions taken
based on digital consultationsvs. history of actions for thesame type of discrepancy
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Telepathology/Teleradiology
Unit
• Server with high speed internet connection
• Personal computer w web camera
• Digital pathology system (AperioScanScope XT)
• Spectrum Plus™ digital pathology
information management software
• Web conferencing system (PolyCom PVX)
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Values• Pathology side:Remote viewing and conferencing
Simultaneous view of multiple digital slides
Archiving and intelligent retrieval capabilities
• Radiology side:Remote viewing and conferencing
Simultaneous view of multiple digital images
Alive radiologic images w radiologist andpathologist input
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• Pathology/Radiology:
Audio and Video conferencing while reviewingimages
No need to leave office
No phone calls or typing required
Values
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Cases – Pathologic Diagnosis
• Invasive carcinoma (1 case)
• DCIS (1 case)
• Fibroadenoma (2 cases)
• Fibrocystic changes with microcalcifications (12cases)
• Fat necrosis (1 case)
• Fibrosis (3 cases)
• Intraductal papilloma (1 case)
• Sclerosing adenoma (1 case)
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• Microcalcifications (11 cases)
• Abnormal mammogram, mass (6 cases)
• Fibroadenoma (2 cases)• Abnormal ultrasound, mass (2 cases)
• Spiculated mass (1 case)
Cases – Radiologic Diagnosis
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Concordance
No Impact
100%concordance
MinorImpact
MajorImpact
13 6 3
• Excise lesion (1)
• Re-biopsy patient (2)
• Follow upmammograms (2)
• X-ray tissue blocks
(4)
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Teleconferencing Challenges
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Challenges
• It requires some training (learning curve)
• Psychological barrier!!!!
• Limitations in technology (view of smallarea of slide, length of transmission ofimages, internet connections, etc.)
• Image resolution, size of files transmitted
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Benefits of telepathology
(telemedicine) • Better medical service
• More specialized service
• Primary diagnosis for frozen sections• Second opinion and consultations
(dermatopathology, neuropathology,cytopathology, etc.)
• Quality control
B fit f t l th l
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Benefits of telepathology(telemedicine) cont.
• Cost saving/Time saving
• Exchange of ideas
• Improved collaboration with opportunity forresearch
• E-learning, clinicopathological mtg anddiscussion groups
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CONCLUSIONS
• It can be cost effective solution to the
our university problem.
– It negated the need for an on-site
pathologist to staff the biopsy cases – Provided at-your-desk Telepath diagnosis
Digital Pathology Applications
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Digital
photo-graphs
Tele-
pathology
(remotely
controlledscopes)
Time
S c o p e o
f U s a g e
Before digital slides After digital slides
Digital Pathology Applications Adoption will Occur in Niches
Tumor Board,
Proficiency
Testing, CME
Archival
&
Retrieval
Virtual
IHC
Peer Review,QA
Image
Analysis
Manual Read
of DigitalSlide
Remote
viewing
Secondary
Consults
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AcknowledgmentsMarilyn Davis
Dennis FriesenMark Redick
Ryan Spaulding
Dennis SchuckmanSherri Heffner and Aperio Co.
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