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INTERACTIVE MULTIDISCIPLINARY WEB CONFERENCING: The Use of the Aperio and PolyCom PVX Systems

INTERACTIVE MULTIDISCIPLINARY WEB CONFERENCING: The Use of the Aperio and PolyCom PVX Systems. Ossama Tawfik, MD, PhD Professor Director of Anatomic and Surgical Pathology The University of Kansas Medical Center Pathology Vision Conf, Oct 2008. OBJECTIVES.

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INTERACTIVE MULTIDISCIPLINARY WEB CONFERENCING: The Use of the Aperio and PolyCom PVX Systems

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  1. INTERACTIVE MULTIDISCIPLINARY WEB CONFERENCING:The Use of the Aperio and PolyCom PVX Systems Ossama Tawfik, MD, PhD Professor Director of Anatomic and Surgical Pathology The University of Kansas Medical Center Pathology Vision Conf, Oct 2008

  2. OBJECTIVES Why going digital is valuable? What is wrong with the current system? Can we do better? And why do we have to?

  3. Why Digital Conferencing? • Problem... • Medicine is changing. • Medical Practice and Teaching is moving away from the Major Medical Centers into Community Settings. • Medical Centers are redesigning themselves - clinics, surgi-centers, nursing homes and doctor’s practices. • Great majority of patient care will be outpatient, located outside the main Campus.

  4. Why Telepathology? • Problem... • The growing physical separation between Clinician and Pathologist is problematic in communication... • Traditional Pathology Reports will have limitations in communication. • How will we communicate with our clients when they are across town, across the state or across the world?

  5. Why Telepathology? • Problem... • As medicine becomes distributed, it will become incumbent upon us as pathologists to find new ways of communicating for clinical work, research and education. • The primary mode of communication has always been the pathology report. • We may now have to rethink the way we report...

  6. INTERACTIVE MULTIDISCIPLINARY CONFERENCE • Pathologists, radiologists, and surgeons • digital slide/radiology conferencing on a weekly basis • 500 breast needle core biopsies • ERROR REDUCTION!!!! • Evaluation of significant abnormalities/discrepancies • Correlation with treatment plans for each patient

  7. Microcalcifications of the breast: size matters! A mammographic-histologic correlation study X Liu, M Inciardi, JP Bradley, F Fan, P Thomas, W Smith, O Tawfik Pathologica 2007;99:5-10

  8. Core Needle Biopsy Protocol Specimen radiography Calcification Absent Calcification Present < 100 um > 100 um Ca SIZE Tissue block radiography Additional studies are required!! Radiologically negative Radiologically positive Proceed w Dx Benign Dx Malignant Dx Ca Absent Ca Present Cut deeper in block

  9. Medical Error Statistics • Colorado and Utah study • Adverse events (AE) in 2.9% of hospitalizations • 8.8% of AE’s led to death (about 44K deaths/annually • New York study • AE’s in 3.7% of hospitalizations • 13.6% of AE’s led to death (98K deaths annually) • Eighth leading cause of death in USA

  10. Dollar Cost of Medical Error • Between $17 to $29 billion/year • Half directly attributable to health care costs • Other half combination of lost productivity, lost income and disability

  11. 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 a focus on preventing future errors by designing safety into the health care system

  12. Goals of the IOM Report (cont.) • Improve knowledge base about medical error and safety improvement • Develop tools to improve safety • Cause significant monetary investments to achieve these goals

  13. Institute of Medicine mandate • Threshold improvement in quality • 50% reduction in medical error in five years

  14. “ARE WE LISTENING?”

  15. “OUR PROBLEM”

  16. “OUR PROBLEM” KU Med Ctr is Located 3 miles From Cancer Center Man power Time Resources

  17. “OUR PROBLEM”

  18. “OUR SOLUTION” • Aperio ScanScope System • PolyCom PVX video conferencing System

  19. Aperio/KUMC Pilot Project • Pathologists, radiologists and surgeons • Develop a web based pre-diagnostic work-up conference in which the pathology slides and mammograms could be analyzed together • Goals: • To insure adequate sampling • To reach a proper diagnosis • To determine the proper surgical/treatment plans

  20. Telepathology/Teleradiology Unit • Server with high speed internet connection • Personal computer w web camera • Digital pathology system (Aperio ScanScope XT) • Spectrum Plus™ digital pathology information management software • Web conferencing system (PolyCom PVX)

  21. 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 and pathologist input

  22. Values • Pathology/Radiology: • Audio and Video conferencing while reviewing images • No need to leave office • No phone calls or typing required

  23. Cases – Pathologic Diagnosis • Invasive carcinoma (1 case) • DCIS (1 case) • Fibroadenoma (2 cases) • Fibrocystic changes with microcalcifications (12 cases) • Fat necrosis (1 case) • Fibrosis (3 cases) • Intraductal papilloma (1 case) • Sclerosing adenoma (1 case)

  24. Cases – Radiologic Diagnosis • Microcalcifications (11 cases) • Abnormal mammogram, mass (6 cases) • Fibroadenoma (2 cases) • Abnormal ultrasound, mass (2 cases) • Spiculated mass (1 case)

  25. Concordance • Excise lesion (1) • Re-biopsy patient (2) • Follow up mammograms (2) • X-ray tissue blocks (4)

  26. Teleconferencing Challenges

  27. Challenges • It requires some training (learning curve) • Psychological barrier!!!! • Limitations in technology (view of small area of slide, length of transmission of images, internet connections, etc.) • Image resolution, size of files transmitted

  28. 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

  29. Benefits of telepathology (telemedicine) cont. • Cost saving/Time saving • Exchange of ideas • Improved collaboration with opportunity for research • E-learning, clinicopathological mtg and discussion groups

  30. 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

  31. Digital Pathology ApplicationsAdoption will Occur in Niches Manual Read of Digital Slide Archival & Retrieval Peer Review, QA Scope of Usage Secondary Consults Tumor Board, Proficiency Testing, CME Image Analysis Tele- pathology (remotely controlled scopes) Virtual IHC Remote viewing Digital photo-graphs Before digital slides After digital slides Time

  32. Acknowledgments Marilyn Davis Dennis Friesen Mark Redick Ryan Spaulding Dennis Schuckman Sherri Heffner and Aperio Co.

  33. ?

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