MedWorm: Pathologists

Cap foundation's futurescape coming up soon

Lab Soft News — Fri, 16 May 2008 12:00:00 +0100

The CAP Foundation launched a conference called Futurescape of Pathology last June (see: CAP Foundation Futurescape Lectures Now Available). It served to fill a critical niche in the world of PLM (pathology and lab medicine) continuing education -- a forward-looking view about how these disciplines will evolve in the future. The various lectures stimulated me to post a number of notes including the following: The Future of Medicine and, Therefore, of Pathology and Lab Medicine. I also posted a critique of the conference written by a pathology resident who attended on the basis of a travel award; see: CAP Futurescape Conference: A Pathology Resident's Perspective. The second conference in this series, entitled Transforming Pathology will be held on June 6-8, 2008, at the Westin O’Hare Hotel near the Chicago ariport. The speaker and topic lineup is once again excellent. The entire program can be viewed here. On-line registration is available. You can also register by fax (847-832-8324) or mail: Futurescape Conference, 325 Waukegan Road, Northfield, IL 60093. The conference is being held over the weekend to accommodate to the schedule of the busy pathologist. It's definitely worth attending. (Source: Lab Soft News)

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Web-based tumor reporting system from university of rochester

Digital Pathology Blog — Fri, 16 May 2008 04:00:00 +0100

I first came across mention of this site at the USCAP meeting this past March. Disclaimer from their site: This tumor reporting system is only intended to be a tool to facilitate the reporting process. The users are expected to use their judgment as to the accuracy and adequacy of information presented here. The owner of this site or its affiliated entities shall not be held liable for any adverse results from use or misuse of the material in this tumor reporting system. (Source: Digital Pathology Blog)

Integration of anatomic and clinical pathology

Lab Soft News — Thu, 15 May 2008 12:00:00 +0100

Although I have posted a number of previous notes about the potential merger of pathology and lab medicine with radiology, I strongly believe that such a change must be preceded by a much tighter integration of clinical pathology (CP) and anatomic pathology (AP). Part of the value of the proposed merger for radiologists will be the ready availability of a total view of disease based on both molecular diagnostics and morphologic observations coming from the pathologists. As I have noted before, one of the key practice models for this future direction for CP and AP will be the practice of hematopathology in which both the morphologic characteristics of malignant cells as well as their biochemical nature are taken into consideration when arriving at a diagnosis (see: Reinventing Pathology: The Hematopathologist as a Model for the Pathologist of the Future). In addition, hematopatholgists frequently participate in the selection of therapy for patients because such choices are frequently based on their diagnoses and thought processes. There is growing evidence that the practice of surgical pathology is now moving closer to clinical pathology. Evidence for this can be found in the lectures of Dr. Jeff Myers. He has emphasized the close collaboration of surgical pathologists with pathology informaticians to increase patient safety (see: Aligning Surgical Pathology & Aligning Surgical Pathology & Informatics to Promote Informatics to Promote Patient Safety). Research in tissue biomarkers will also help to convert surgical pathology to a more quantitative discipline (see: In-Vitro Biomarkers vs. In-Situ Biomarkers; Changing Strategies for Interrogating Tissue Samples: A Systems Pathology Primer). In my past blog notes and in the interest of being all inclusive, I have found myself using the awkward phrase pathology and laboratory medicine to refer to the field. This is truly a mouthful but I can't come up with the better name for the more closely merged CP-AP unit that I am discussing here. Therefore, I have decided to refer to it in the future as PLM. I know that change is merely cosmetic but having a more manageable name will be useful. If and when PLM merges with radiology, this problem will go away. We can then refer to the merged entity as diagnostic medicine. (Source: Lab Soft News)

Service-oriented architecture in healthcare: the end of hierarchy

Lab Soft News — Wed, 14 May 2008 12:00:00 +0100

I have posted previous notes about the federated model in healthcare computing. Drs. Balis and Routbort recently lectured on the relevance of this model, closely linked to service-oriented architecture (SOA), at Lab InfoTech Summit 2008 (see: The Value of a Federated Architecture in Pathology: Test Order Entry;The Value of a Federated Architecture in Pathology: Test Result Reporting). For me, the most appealing aspect of this approach to healthcare computing is that it eliminates hierarchy among systems. Under the federated model in a hospital, each information system becomes a single-source-of-truth (SST). I recently encountered an article in the Financial Times in which an advocate of SOA made some very powerful arguments in favor of this approach (see: What IT means to me: Software will bring about the end of hierarchy). Below is an excerpt from it with boldface emphasis mine:In [the view of Hubertus “Hub” Vandervoort], technological developments march in lock-step with social change. He foresees a world where new data processing methods – essentially service-oriented architecture (SOA) – will force the abandonment of old, hierarchical management practices and the adoption of ways of working based on trust and commitment....SOA has been hailed as the technology that will save the data centre and redeem corporate computing, but the fact is that outside the cognoscenti, it is one of the most obscure of the IT industry’s welter of three-letter abbreviations...[He describes it in the following way:] “The key things are that it is loosely coupled, contract-oriented interfaces. That is what it is from a technology or computer science standpoint. It is sometimes better described through what it enables. It enables, in theory, complete heterogeneity – total isolation of implementation. I don’t have to think at all about what you choose to implement your technology on and if I conform to the standards available in SOA, we should still be able fully to interoperate.....SOA is really the first time we can create true multi-party interactions. Client/server technology, mainframe technology even web technology was essentially point-to-point. The web gave us the ability to connect to millions or zillions of points but only one at a time. SOA enables us to create composite applications that can be built up from the technology provided by 20 parties. From a user experience standpoint, I think I’m dealing with one application but in fact I’m blending in real time the interactions of potentially dozens of third parties.”For me, the federated model/SOA is the only way to go. Hospital CIOs and LIS directors are being buried by the need to create custom HL7 interfaces among often dozens of heterogeneous specialized systems, each of which may be "best of breed" and required by physicians working in their specialty areas. Think instead of the inexpensive and quickly deployed "loosely coupled, contract-oriented interfaces" described above. It would be unlikely that a CIO managing a hospital EMR would be willing or able to refuse to develop an SOA contract with the hospital LIS director at a time when some 70%-80% of hospital diagnoses are based on lab information. Concentrate your thoughts on the desirability of the end of hierarchy in healthcare computing and you will be ahead of the game. (Source: Lab Soft News)

It helping vets get back on feet

Digital Pathology Blog — Wed, 14 May 2008 04:00:00 +0100

from www.eweek.com (Source: Digital Pathology Blog)

Once again mr. histalk clears the air

Lab Soft News — Tue, 13 May 2008 12:00:00 +0100

Mr. HIStalk has responded to my blog note of yesterday (Alphabet Soup and the HIMSS Leadership). I had cited one of his recent notes pertaining to the HIMSS execs and challenged the readers of Lab Soft News to decode the alphabet soup following their names on the HIMSS web site. Here is his comment in its entirety (boldface emphasis mine):I'm sorry to say that I know all of them except two first hand:CAE: Certified Association ExecutiveSPHR: Senior Professional in Human ResourcesCISM: Certified Information Security ManagerFHIMSS: Fellow (HIMSS)CPHIMS: Certified Professional in Healthcare Information and Management SystemsPMP: Project Management ProfessionalMALA - guessing it's either a master's in legal administration or some kind of medical librarianRN-BC - registered nurse board certified (passed an ANCC exam, I think)MPA - master of public administrationIt's the dirty secret of member organizations - making up some credential means you can charge for the test, renewals, and the prep courses, PLUS make it nearly impossible to renew without attending that same organization's conferences or meetings. It carries a mixed incentive: make it easy enough to sell enough of them so that the market recognizes the credential, but just hard enough not to be a complete joke that doesn't even require study or experience.Only two of the alphabet soup components you listed are approved degrees; the rest are private industry certifications. There is at least one for-profit organization selling EHR [electronic health record] certifications (and the related prep materials, training sessions, etc.) without any real oversight except their own. I don't know if it has real-world value, but if somebody thinks employers will like it, they'll pay.For the record, I have no problem with professional organizations providing (selling?) certificates of achievement or mastery of some topic. I just think that the initials representing such certifications don't belong in the same company as formal advanced degrees awarded by accredited colleges and universities and requiring years of study. I really have no knowledge or appreciation of the real-world market value of such certificates, a topic raised by Mr. HIStalk. However, if HIMSS is selling them, then their execs will certainly be buying and using them. In other words, eating their own dogfood. (Source: Lab Soft News)

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Alphabet soup and the himss leadership

Lab Soft News — Mon, 12 May 2008 12:00:00 +0100

Mr. HIStalk calls our attention to the fact that the HIMSS organization has a CIO:Did I maybe just forget that HIMSS has a CIO? Says it does here.Very interesting. If you link to this list of HIMSS executive contacts, you will also can't help but be impressed by the number of executives attached to the organization (lots of mouths to feed), the creativeness of some of the titles (e.g, Sr. Director, Information Technology; Sr. Director, Business Information Systems; Vice President, Informatics; Vice President, Healthcare Information Systems), but, most of all, the alphabet soup following their names. Here's of list of what you will find:CAE; SPHR; CISM; FHIMSS; CPHIMS; PMP; MALA; RN-BC; MPAWTF? I offer a free subscription to Lab Soft News to anyone who can decode this total list and submit the answer to me. I have a pretty good idea what PMP stands for. I also know that the prefix mal- is derived from the Latin malus meaning bad. (Source: Lab Soft News)

The demand for lab scientists growing

Digital Pathology Blog — Mon, 12 May 2008 04:00:00 +0100

03/10/2008 (Source: Digital Pathology Blog)

Cms launches phr pilot for medicare beneficiaries

Digital Pathology Blog — Mon, 12 May 2008 04:00:00 +0100

By Richard Pizzi, Associate Editor 05/07/08 Healthcare IT News The Centers for Medicare & Medicaid Services this week announced a new pilot project that encourages traditional Medicare beneficiaries to use an online Personal Health Record to track their healthcare services and better communicate with their providers. The CMS pilot - which will take place in South Carolina - gives Medicare beneficiaries the ability to collect and access information about their health or healthcare services, such as medical conditions, hospitalizations, doctor visits and medications. CMS claims that strict privacy and security safeguards will protect all beneficiary data, and affirmed that the PHRs would be under the control of patients. "By using a PHR, patients with the pilot will have easy access to personalized medical information that will enable them to be more involved with their healthcare services," said Kerry Weems, CMS Acting Administrator."The steps we are taking today will help CMS understand how to best educate beneficiaries on the use of a PHR so that we can encourage use of these tools in the future." Medicare beneficiaries participating in the pilot will be given an opportunity to use a PHR populated by their own claims data. Information from hospital and provider medical claims will be automatically entered into the PHR once the individual registers and requests the data. Each beneficiary will control who is able to see the information in the PHR, and can decide whether and with whom the information can be shared. CMS representatives said prescription drug information, even for individuals who participate with a Part D Drug Plan, would not be automatically entered into the PHR, but individuals could choose to enter their own prescription drug and over-the-counter medications into the PHR. The pilot project's PHR also allows individuals to look up information specific to their own personal health status and health conditions. CMS said that the PHR tool provides links to "carefully selected" Web sites with educational material on health topics, which would allow beneficiaries or other authorized users to do research on health issues and better manage their care. The pilot began on April 4, 2008, and is expected to run for 12 months. CMS plans to use information gathered from the pilot to determine future steps with respect to PHRs. The PHR tool selected for the South Carolina pilot is offered by HealthTrio, which currently offers PHRs to patients through employer contracts. The Medicare data will be provided through Palmetto GBA, a Medicare contractor serving the region. Gaithersburg, Md. -based firm QSSI is managing the pilot, which has been termed "MyPHRSC" ("SC" standing for South Carolina. ). The South Carolina PHR pilot follows close on the heels of another initiative launched in June of 2007, where CMS is collaborating with seven health plans to test the use of PHRs for beneficiaries who are enrolled in a Medicare Advantage or Part D Prescription Drug Plan. Currently, Medicare beneficiaries are able to receive some personalized information about their Medicare benefits and services at the MyMedicare. gov page on www.medicare.gov. However, CMS officials say a PHR can provide additional support for people with Medicare, because the technology provides access to a fuller, more comprehensive view of medical history, along with interactive educational resources. Participation in the pilot is voluntary, and interested patients can enroll online at www.MyPHRSC.com and at local events in South Carolina. (Source: Digital Pathology Blog)

Animated dna

pathtalk.org — Sun, 11 May 2008 15:26:52 +0100

This is an incredibly cool animation of the central dogma of molecular biology. It was made by an very talented BAFTA- and Emmy-award winning medical illustrator named Drew Berry at the Walter and Eliza Hall Institute of Medical Research in Melbourne. (Source: pathtalk.org)

Altered cytoplasmic-to-nuclear ratio of survivin is a prognostic indicator in breast cancer

Digital Pathology Blog — Sun, 11 May 2008 04:00:00 +0100

Clinical Cancer Research 14, 2681-2689, May 1, 2008. doi: 10.1158/1078-0432.CCR-07-1760 (Source: Digital Pathology Blog)

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Kodak posts $114m loss

Digital Pathology Blog — Sat, 10 May 2008 04:00:00 +0100

ROCHESTER, N.Y., May 1, 2008 -- Eastman Kodak Co. today reported a first-quarter loss of $114 million, or 40 cents a share, on sales of $2.09 billion. Total sales were up slightly -- one percent -- from the first quarter of 2007, and losses improved from the $175 million, or 61 cents a share, posted one year ago. Kodak said its digital revenue was up 10 percent to $1.36 billion, while its traditional film-based revenues continued to decline, down 13 percent to $724 million, compared to $830 million a year ago. The company has posted profits in four of the last six quarters as it continues to make the transition from film to digital photography (See: Kodak Q4 Profits Rise). "Our first-quarter results are very much in line with our expectations, which included forecasted seasonality, and provide an early indication that Kodak is on a growth track," said Antonio M. Perez, chairman and CEO, Eastman Kodak. "We delivered strong performance across our major digital businesses, reinforcing our confidence in achieving our revenue, earnings and cash goals for the year." The company's gross profit margin decreased from 20.6 percent a year ago to 20.3 percent, primarily due to increases in silver, aluminum and other raw material costs, as well as continued investment in its consumer ink-jet business, Kodak said. Digital cameras and picture frames increased Consumer Digital Imaging Group sales for the quarter by 20 percent, to $554 million, over a year ago, but losses for the segment increased from $75 million in 2007 to $111 million. Kodak said the increased loss was driven by planned investment in the ink-jet business. Sales in the Graphic Communications Group were $812 million, up four percent from a year ago, but the segment posted a loss of $1 million, compared to earnings of $9 million in 2007, primarily because of increased raw material costs and research and development costs for its ink-jet printing business, Kodak said. The company said it expects total revenue for 2008 will be up as much as 2 percent, digital revenues to increase by seven to 10 percent and earnings from continuing operations in the range of $250 million to $275 million. For more information, visit: www.kodak.com (Source: Digital Pathology Blog)

Completing healthcare transactions at the point-of-service

Lab Soft News — Fri, 09 May 2008 11:18:42 +0100

Scott Shreeve in his Crossover Health blog raises the interesting issue of the need to complete healthcare transactions at the point-of-service (see: Millenial Patients: Care Delivery for the Next Generation of Patients). This goes to the question of how to modify healthcare transactions so that they more closely resemble the level of service offered in most other more consumer-oriented businesses. Here's an excerpt from his blog note with boldface emphasis mine: In addition to getting comfortable discussing pricing, providers will need to be able to complete healthcare transactions at the point of service. As more consumers pay a higher percentage of their own healthcare costs (consumer payments are about $50 billion today), healthcare providers will need to adopt new technology and business processes. Failure to do so will result in an ever increasing uncollected payment burden... Part of this transformation includes eligibility verification, real-time co-pay/deductible accumulators, card/reader technology, and financial integration with consumer accounts. In addition, providers will need to become much more transparent with regard to pricing for their services. Retail clinics have led the way in posting cash prices, and physicians will need to learn to not penalize consumers with much higher cash prices. Rather, they’ll need to reward them for the real and tangible savings that cash payments make possible by avoiding the Byzantine insurance payment process. Companies like Recondo, TriHealix, and even practice management companies like athenahealth are leading the way.To put the point bluntly, let's come to expect the same level of service from our healthcare providers that we expect from, say, the local grocery store or retail drug store or health club. For me, such expectations will include the following: (1) we should know the exact cost of medical services when we receive them; (2) we should be able to pay for such services when we order or receive them; (3) we should be rewarded in some way for long-term patronage of a business or provider; (4) we should expect a reasonable response when we judge medical services to be inadequate in some way; and (5) cash sales for services should not be penalized by higher prices and should actually be rewarded. Ironically, direct access lab testing (DAT) is paid for at the time of the test order. The bad news is that these charges are generally not covered by most health insurance plans. The good news is that these DAT charges may sometimes be less than the co-payment amount for lab tests under some health insurance plans. Also, DAT web sites make their price lists readily available and thus make the cost of lab tests more transparent to consumers (see: DAT Makes Cost of Lab Testing More Transparent for Consumers). (Source: Lab Soft News)

Amd telemedicine explores the role of telemedicine during disasters

Digital Pathology Blog — Fri, 09 May 2008 04:00:00 +0100

Noted Emergency Physician Richard Aghababian, MD, Discusses the Benefits of Telemedicine Use at Disaster Scenes. N. Chelmsford, MA (PRWEB) April 23, 2008 -- Executives at AMD Telemedicine, the leader in telemedicine hardware and software solutions with over 5,000 installations in more than 72 countries, today announced that a discussion on the value of telemedicine during a disaster with noted emergency medicine physician, Richard Aghababian, MD, was now available on the AMD web site. Unlike day to day (emergent) operations in which a whole team works together to save one life, in disaster medicine, there can be many more victims than one's immediate resources can handle. So that takes a different mindset. One has to switch from everything for one to best outcomes for the group Dr. Aghababian, a fellow of the American College of Emergency Physicians (FACEP), an Associate Dean for Continuing Medical Education at the University of Massachusetts Medical School (UMMC), past Chairman of the Department of Emergency Medicine at the University of Massachusetts Medical School and past president of the American College of Emergency Physicians (ACEP) explains that telemedicine can play a vital role in the triage process, which is often a critical tool at disaster scenes. "Unlike day to day (emergent) operations in which a whole team works together to save one life, in disaster medicine, there can be many more victims than one's immediate resources can handle. So that takes a different mindset. One has to switch from everything for one to best outcomes for the group," said Dr. Aghababian. "(One has to determine) how to best allocate resources to do the greatest good for the greatest number. (In this process) triage is an important facet -- the ability to determine who, with immediate treatment will live, and who might not, and who can wait for treatment for a while. Telemedicine can be of great help here to identify and understand patterns of injury, as well as to access information and experience on treatment" Noting that preparedness is the key to successful response, Dr. Aghababian also discusses how telemedicine training can be vital prior to a disaster and what that training would entail. "Dr. Aghababian's considered opinion is another vote of support for the value of telemedicine," said Steven Normandin, president of AMD Telemedicine. " A true aid in the triage process, telemedicine can not only provide a critical, visual link between a disaster site and experienced medical personnel at a distant facility, but it can also be a conduit of vital patient data to enable life-saving treatment to begin right in the field." To view Dr. Aghababian's comments on the role of telemedicine in disasters, visit the AMD Telemedicine web site at http://www.amdtelemedicine.com/DrA.html . About AMD TelemedicineAMD Telemedicine is the leading, worldwide supplier of telemedicine equipment and technology devices used in telemedicine with more than 5,000 installed sites in 72 countries. AMD hardware and software products offer clinically acclaimed, cost-effective solutions for the most challenging medical applications. AMD also provides complete technical support in program design, device integration, training, and remedial service to assure a successful program implementation. For more information on AMD Telemedicine, please visit http://www.amdtelemedicine.com/, email us at pr @ amdtelemedicine .com or call 866-511-0923 . (Source: Digital Pathology Blog)

First diagnostic test for alzheimer's and parkinson’s disease available late 2008

Digital Pathology Blog — Fri, 09 May 2008 04:00:00 +0100

First Diagnostic Test for Alzheimer's and Parkinson’s Disease Available Late 2008 (Source: Digital Pathology Blog)

Pathologists’ victory in fair compensation lawsuit to stand

Digital Pathology Blog — Fri, 09 May 2008 04:00:00 +0100

The latest development in a lengthy legal battle concerning fair compensation for physicians is good news for pathologists—and marks another victory for the Litigation Center of the AMA and state medical societies. (Source: Digital Pathology Blog)

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An update on the kaiser healthconnect project

Lab Soft News — Thu, 08 May 2008 12:21:29 +0100

Veteran readers of Lab Soft News may remember a flurry of activity in the November-December, 2006, time period regarding the Kaiser HealthConnect project (see: Kaiser & Epic Respond to Justen Deal's E-Criticism; Is Kaiser Hijacking the Blogosphere?). Much of the controversy related to a young Kaiser employee name Justen Deal who surfaced as an IT whistle-blower and blogged about the total cost of the HealthConnect project, the periodic unplanned and prolonged computer downs, and the rather slow roll-out of the inpatient Epic software to hospitals in the Kaiser chain. Mr. HIStalk provides us with the following update on the HealthConnect project:Kaiser says its HealthConnect outpatient rollout is finished, with all 8.7 million enrollees having access, but inpatient is installed in only 13 of 36 hospitals. They admit to its $4 billion cost, which I believe was angrily denied when that number was first estimated by outsiders. Maintenance is $1 billion (!!). The hospitals and health plan announce a 64% net income drop in Q1 because of investment losses. Still, a $250 million quarterly profit for a "non-profit" in one quarter isn’t too shabby (imagine if they weren’t spending $1 billion on HealthConnect maintenance).Here's some additional information from the article referenced by Mr. HIStalk above on the outpatient rollout:But Kaiser still has a ways to go on the inpatient side. Officials said 13 of its 36 hospitals (34 of them in California) have installed the EHR software, giving 3.2 million enrollees the advantages of an inpatient EHR system. Some 14 hospitals are slated to do so this year, including 13 in the Golden State and one in the Portland, Ore., metropolitan area. The remaining nine hospitals, including one in Hawaii, will follow in 2009 and early 2010, said Kaiser spokeswoman Ravi Poorsina.So Kaiser has thus far spent $4 billion in capital on HealthConnect, is incurring $1 billion yearly in operating expenses, and has deployed the inpatient EMR in only half of its hospitals. I suspect that this project has already set some sort of record for healthcare, or even all large-scale computer projects, perhaps even rivaling the military's periodic and often ill-fated electronic medical record initiatives. (Source: Lab Soft News)

Patients get an instant result

Digital Pathology Blog — Thu, 08 May 2008 04:00:00 +0100

By Emma Wilkinson (Source: Digital Pathology Blog)

Talking up a new role for cell phones in telemedicine

Digital Pathology Blog — Thu, 08 May 2008 04:00:00 +0100

ScienceDaily (May 6, 2008) — After launching a communications revolution, cell phones are talking up a potentially life-saving new role in telemedicine -- the use of telecommunications technology to provide medical diagnosis and patient care when doctors and patients are hundreds or thousands of miles apart. (Source: Digital Pathology Blog)

Big pharma reacts to its drug pipeline problems

Lab Soft News — Wed, 07 May 2008 12:20:36 +0100

I have posted previous notes about the challenges facing Big Pharma in terms of the lack of potential blockbuster drugs in the development pipeline (see: Number of Global Drug Projects by Phase). David Williams has a posted a very interesting note in his Health Business Blog about how the pharmaceutical industry is reacting, or might react, to this problem (see: How big pharma might use manufacturing as a strategic marketing tool). Below is an excerpt from his note with boldface emphasis mine: As pipelines dried up and the generic industry became more sophisticated and aggressive, big pharma adjusted its tactics. In product development it’s turned to in-licensing, creating new formulations (especially extended release products), and combination products. Big pharma has combated generics in the courtroom, introduced “authorized generics” that cut into the profits of the initial generic supplier, and attempted to bundle multiple products into its contracts with payers....It’s unlikely that big pharma will succeed in reviving its pipelines anytime soon, but there are things the industry could try. For example, if branded pharmaceutical companies can demonstrate better clinical results through medication adherence programs, they may be able to make the argument that they are selling a “solution” rather than a product. The suggestion that pharmaceutical companies might launch a medication adherence program as a means to sell a solution rather than a product is very interesting. I know that patient non-compliance with their prescribed drugs is a major, and certainly muiltifactorial, problem. I am sure that some of the underlying reasons include the cost of the medication, avoidance of unpleasant side effects, forgetfulness, mental confusion, and even pure contrariness on the part of patients. I am also sure that inexpensive programs to counter drug non-compliance such as "reminder" web sites would be of little value in counteracting most of these problems. One such site is SmartMinder, a refill reminder program utilizing phone, pager, cell phone, mail, or email notifications. The service is provide by Echo Pharmacies, a small set of independent pharmacies in the Long Island area. I believe that visiting nurse or a pharmacy care program (see: Effect of a Pharmacy Care Program on Medication Adherence and Persistence, Blood Pressure, and Low-Density Lipoprotein Cholesterol) as a means to ameliorate drug non-compliance problems would be more effective than web reminder sites but certainly much more costly. However and given the price of many drugs these days, I suspect that many pharmaceutical companies would gladly eat these costs in order to preserve some portion of their market share in the face of stiff competition from generics. (Source: Lab Soft News)

Using virtual telepathology to train pathology residents

Digital Pathology Blog — Wed, 07 May 2008 04:00:00 +0100

(Source: Digital Pathology Blog)

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Performing procedures can be lucrative for physicians

Lab Soft News — Tue, 06 May 2008 11:19:30 +0100

The Wall Street Journal has just run an excellent piece (see: Medical Specialties Hit by a Growing Pay Gap) about how some highly trained medical specialists like neuro-ophthalmologists end up at the lower end of the pay scale because they don't perform procedures. Here's the "money" quote from the article about why procedures tend to be reimbursed by payors at a high level as compared to, say, physician time and expertise. Blame it on Medicare and the federal government (boldface emphasis mine):But in the early 1990s, Medicare implemented a new system to set standard fees for physicians' services and procedures. The system's aims were to clamp down on prices and, ironically, narrow the disparity between the bread-and-butter office visit and more-expensive specialty procedures. Over time, private insurers have taken their cue from Medicare to set their reimbursements, too. But many health-policy experts argue Medicare's fee-setting mechanisms are making those disparities worse. Its formula still rewards the capital expenses of new technologies, and is slow to reduce those fees as costs depreciate and physicians learn to perform procedures faster. But at the same time, it hasn't significantly increased fees for lengthy and complex patient visits, which are much harder for doctors to make more efficient without harming patient care. The WSJ Health Blog picks up on this pay-gap theme as well as physician reimbursement (see: Doctors Shun Less Lucrative Specialties) and then presents the best graph I have ever seen to illustrate this problem (see left). You just can't argue with these numbers. You are a physician, you perform procedures, and you double your income. Now comes the interesting discussion. What's the most equitable way to compensate physicians? For me, the only reasonable approach would be physician time with the patient plus physician training/expertise, as documented by years of formal training. I would probably factor in some measure of patient satisfaction (hard to do) and outcomes success rate (also hard to do) and perhaps a small kicker for capital investment. Suddenly you have a very complicated compensation program that everyone will immediately start to game and suddenly we will be back in the same mess. (Source: Lab Soft News)

Cost-utility analysis of telemedicine and ophthalmoscopy for retinopathy of prematurity management

Digital Pathology Blog — Tue, 06 May 2008 04:00:00 +0100

Telemedicine articles do not frequently deal with cost-effectiveness; those that do usually show a cost-savings with arguably comparable or better quality. Of course, those that do look at the issue usually do show an advantage over other strategies of care across medical specialties. But who is going to publish a negative study? Here is one from teleophthamology. There are few peer-reviewed publications for this in telepathology. Arch Ophthalmol. 2008;126(4):493-499. Objective To evaluate the cost-effectiveness of telemedicine and standard ophthalmoscopy for retinopathy of prematurity (ROP) management. Author Affiliations: Department of Health Policy and Management, Mailman School of Public Health (Drs Jackson and Graff Zivin), and Division of Neonatology (Drs Scott and Bateman) and Departments of Ophthalmology (Drs Flynn, Keenan, and Chiang) and Biomedical Informatics (Dr Chiang), College of Physicians and Surgeons, Columbia University, New York, New York. Methods Models were developed to represent ROP examination and treatment using telemedicine and standard ophthalmoscopy. Cost-utility analysis was performed using decision analysis, evidence-based outcome data from published literature, and present value modeling. Visual outcome data were converted to patient preference–based time trade-off utility values based on published literature. Costs of disease management were determined based on 2006 Medicare reimbursements. Costs per quality-adjusted life year gained by telemedicine and ophthalmoscopy for ROP management were compared. One-way sensitivity analysis was performed on the following variables: discount rate (0%-7%), incidence of treatment-requiring ROP (1%-20%), sensitivity and specificity of ophthalmoscopic diagnosis (75%-100%), percentage of readable telemedicine images (75%-100%), and sensitivity and specificity of telemedicine diagnosis (75%-100%). Results For infants with birth weight less than 1500 g using a 3% discount rate for costs and outcomes, the costs per quality-adjusted life year gained were $3193 with telemedicine and $5617 with standard ophthalmoscopy. Sensitivity analysis resulted in ranges of costs per quality-adjusted life year from $1235 to $18 898 for telemedicine and from $2171 to $27 215 for ophthalmoscopy. Conclusions Telemedicine is more cost-effective than standard ophthalmoscopy for ROP management. Both strategies are highly cost-effective compared with other health care interventions. (Source: Digital Pathology Blog)

Problems facing pathologists common: national doctors college; problems are also being investigated in newfoundland and labrador, new brunswick

Digital Pathology Blog — Tue, 06 May 2008 04:00:00 +0100

No hospital is immune to the deficiencies that have contributed to problems with medical testing in several provinces that have affected thousands of patients, the Royal College of Physicians and Surgeons of Canada said Thursday. (Source: Digital Pathology Blog)

Status and challenges of offshore clinical trials

Lab Soft News — Mon, 05 May 2008 12:04:44 +0100

I have posted a number of previous notes about the globalization of clinical trials and the contract research organizations (CROs) that provide lab support for such trials such as Covance and Charles River. Clinical trials are an important market for the clinical lab industry. A recent article about the globalization of clinical trials (see: MIT Study Quantifies Globalization Trends) provides some additional insights into this trend. I provide an excerpt from it below with boldface emphasis mine:Outsourcing of biopharmaceutical clinical trials to China and India is growing at a substantial rate, but in real terms the much-ballyhooed nations are still "very minor players," [according to an MIT professor]. [The U.S.] commands a 48.7 percent share of total trial activity and has eight times the number of trial sites of second-place Germany....India, a growing global hub for trial-related technology, is also well positioned to become a major clinical trials player....Trial density, the proportion of recruiting sites relative to overall population, is greatest in the U.S., Canada, and several Western European countries....But it's becoming substantial in some Eastern European countries such as the Czech Republic, Hungary, and Estonia. Presumably, this makes the region increasingly able to offer a competitive number of sites suitable for global trials....Pooling data from ethnically and culturally diverse populations may become problematic with the march toward personalized medicine and pharmacogenomics...and at some point may even reverse the current globalization trend. Drug-naïve patients on vegetarian diets may also be differentially affected by classes of drugs commonly used in the Western world. Further, the integrity of the informed consent process may be jeopardized in nations where the physician-patient relationship is more "hierarchical."Despite the possible cost advantages of conducting clinical trials offshore in less developed countries, I agree with the general drift of this article that the majority of them will continue to be conducted in the U.S. One reason is the challenge, as noted above, of conducting clinical trials in countries like India where the genetic character of the research subjects may differ from the majority of patients in the U.S. There are other scientific and ethical barriers to overcome with offshore clinical trials as reflected in the following 2004 article (see: Indian Guinea Pigs for Sale: Outsourcing Clinical Trials):"When getting a subject's informed consent, some research is complex and it is difficult to convey the relevant issues," notes US-based bioethicist Ruth Macklin who has participated in the development of various international ethical guidelines for collaborative research in developing countries. Equally worrisome is the fact that "people may not distinguish between treatment and research. There is a false belief that sometimes research may have a direct benefit. Research does not provide individualized medical treatment, titrating doses according to the patient's need, for example."As a former member of a hospital institutional review board (IRB), I found the review of the occasional offshore studies that came to the committee to be very challenging. The motivation of impoverished people to enroll in clinical research studies can be far different than subjects in developed countries like the U.S. (Source: Lab Soft News)

Arizona breastnet completes one year of digital mammography

Digital Pathology Blog — Mon, 05 May 2008 04:00:00 +0100

Arizona Breastnet, a full service breast diagnostic center located in Scottsdale, specializing in breast mammography and breast ultrasound, announces the completion of one full year of providing digital mammograms to their patients in the Valley. (Source: Digital Pathology Blog)

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Missouri bill may prohibit doctors from marking up some anatomical laboratory work

Digital Pathology Blog — Mon, 05 May 2008 04:00:00 +0100

Another state enters anti-markup fray: (Source: Digital Pathology Blog)

Gigapixel image

Digital Pathology Blog — Mon, 05 May 2008 04:00:00 +0100

A Pixel (short for picture element) is a single point in a graphic image. We know about Megapixel as we got digital cameras greater than 10 Megapixel. How about Gigapixel then ? (Source: Digital Pathology Blog)

Hampshire network opts for telepathology solution

Digital Pathology Blog — Sun, 04 May 2008 04:00:00 +0100

Hampshire and Isle of Wight Cancer Network are to install a telepathology solution to improve the care of patients with cancer. (Source: Digital Pathology Blog)

Virtual on-line visits (vovs) support physician/patient interactions

Lab Soft News — Fri, 02 May 2008 11:30:36 +0100

I have published a number of previous notes about the efficiency of physician emails to patients, also referred to as on-line consultations and e-consultations. Here is one example: Doctors Slow to Adopt Email with Patients. Here's another note about the relevance of e-consultations for PCPs: More on Redefining the Role of the PCP. It turns out that a new term is also being used to describe physician interactions with patients: virtual on-line visits (VOVs). A recent article discussed this type of consultation (see: US doctors offer online consultations) and highlighted a web site, RelayHealth, that can be used to enable them. Below is an excerpt from the article with boldface emphasis mine:When Dr Michelle Eads makes a house call, she no longer has to spend time in her car sitting in traffic....[She] checks on several of her patients by logging onto the internet and answering their questions online....Virtual Online Visits (VOVs) are more efficient and convenient since they don't require a telephone call, being placed on hold, missing work, arranging for a sitter, paying for parking....RelayHealth, a website that describes itself as a secure, private way of communicating with a doctor, hopes to overcome those anxieties. Last year, two major US health insurers began aggressively marketing RelayHealth to about 1 million doctors across the US....A study by the New York market research firm...confirms the increase in doctors' use of the internet to serve patients. Thirty-one per cent of family doctors are offering online consultation, up from 19 per cent in 2003....[Dr. Eads] uses the internet frequently for people complaining about upper respiratory infections, sinusitis and chronic disease management, including follow-ups for controlling hypertension and diabetes.'I still see patients every six months if they are well controlled, but the three-month in-between appointments are easily handled in this format,' she said. The cost of a VOV is 25 dollars ...while a traditional visit to a doctor's office costs 65 to 85....Here's some background reading about RelayHealth copied the company's web site:McKesson, the world's largest healthcare services company, has begun the assimilation of Per-Se Technologies,...a leading provider of financial and administrative healthcare solutions for hospitals, physicians and retail pharmacies. McKesson completed the Per-Se acquisition on Jan. 26, 2007....The acquisition [of Per-Se] also gives McKesson the opportunity to combine the connectivity assets from both companies into a new business known as RelayHealth. RelayHealth will expand on McKesson's current physician-patient communications business with a focus on helping to decrease administrative costs and improve care by connecting physicians and other providers, pharmacies, payors, and consumers.So we learn that RelayHealth not only provides a vehicle for physician VOVs but also provides connectivity between physicians and pharmacies/payors. My quick tour of the service on the web site revealed it to be impressive. Of note is the fact that all electronic transactions are stored and retrievable, generating what is referred to as an interactive medical record. Not surprisingly, the drug-prescribing application is particularly well done. (Source: Lab Soft News)

Pathology informatics links at urmc

Digital Pathology Blog — Fri, 02 May 2008 04:00:00 +0100

Pathology Informatics links at URMC website: (Source: Digital Pathology Blog)

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Condom manufacturer promotes safe-sex tour

Lab Soft News — Thu, 01 May 2008 12:00:00 +0100

You can't make this stuff up. The Trojan Company, a major manufacturer of condoms, has gone on the road with a bus tour to promote safe sex (see: Rubber Hits the Road as Trojan Campaigns for Sexual Health in America). The press release announcing the tour makes interesting reading. Below is an excerpt from it with boldface emphasis mine: ...[T]he Trojan Evolve tour will travel across the U.S. raising awareness regarding the poor state of sexual health in America and urging Americans to petition for change. The fact is, this is not a sexually healthy nation, and the Evolve tour is designed to address this head on by inspiring a positive sexual health movement and empowering Americans to change behaviors and opinions about carrying and using condoms. With primetime network television restrictions on condom advertising still in effect, the multi-faceted grassroots effort, which includes a 40-foot long interactive bus and 40-foot wide IMAX-style rollercoaster ride, kicks off its nationwide tour in the hometown of the U.S. Centers for Disease Control and Prevention (CDC)....[The tour] will crisscross America through November 2008 inviting people to evolve, by personally pledging to use a condom every time and advocating for comprehensive sexual education in schools by signing the Trojan Evolve Petition. Along the bus tour route, participants can also encourage friends to continue or change sexual health behaviors by recording video testimonials, which will be posted to the Trojan Evolve Web site....I suspect that this press release was written by some twenty-something copy editor, but I find its upbeat tone mildly irritating. I do have the following comments and questions: Having grown up in a different era, I find myself burdened with a different definition for sexually healthy than the one suggested above. I definitely need to be reeducated. I am confused by the reference in the press release to the need to "evolve" and that the habitual use of condoms is somehow linked to this process. Biological evolution is the process of change over time in the heritable characteristics, or traits, of a population of organisms. When males are born with a condom in-situ, only then can we begin to talk about condoms and evolution in the same breath. I am very much looking forward to seeing some of the Trojan Evolve video testimonials that will be recorded on the bus tour. You can also click on the Trojan-produced video promoting the use of condoms at the company web site to see additional portrayal of the company's evolution theme, but with the young men portrayed as pigs. (Source: Lab Soft News)

Internet trends presentation

Digital Pathology Blog — Thu, 01 May 2008 04:00:00 +0100

Internet Trends031808meeker (Source: Digital Pathology Blog)

Fantastic 1819 anatomic illustrations by kyoto physician yasukazu minagaki

Lab Soft News — Wed, 30 Apr 2008 11:48:27 +0100

The Tohoku University Library in Japan provides an online display of the painfully-real Kaibo Zonshinzu anatomy scrolls created in 1819 by Kyoto-area physician Yasukazu Minagaki. The style of these medical drawings is markedly different than the more sanitized approach favored in Western countries (see: Kaibo Zonshinzu Anatomy Scrolls Online). More details about the these Japanese anatomic drawings are supplied at the Pink Tentacle (see: Kaibo Zonshinzu anatomy scrolls (1819):Unlike European anatomical drawings of the time, which tended to depict the corpse as a living thing devoid of pain (and often in some sort of Greek pose), these realistic illustrations show blood and other fluids leaking from subjects with ghastly facial expressions. The fact that the bodies used in scientific autopsies in Edo-period Japan generally belonged to heinous criminals executed by decapitation adds to the grisly nature of the illustrations.These works of medicine and art from 1819 are worth a look and somewhat shocking even for physicians who may have been trained using Gray's Anatomy, now available on-line. The online display of the drawings requires you to click the "left arrow" to navigate through the scroll. (Source: Lab Soft News)

India's foray into telemedicine faces difficulties

Digital Pathology Blog — Wed, 30 Apr 2008 04:00:00 +0100

(Source: Digital Pathology Blog)

The musculo-skeletal system as an emerging specialty focus,

Lab Soft News — Tue, 29 Apr 2008 12:19:21 +0100

The New York Times on April 22, 2008, featured a full page advertisement for the Hospital for Special Surgery. The motto for the hospital, as seen in this ad, is "Specialists in Mobility." Also, according to the ad, the Hospital for Special Surgery is a "world leader in musculoskeletal research, linking laboratory science to state of the art clinical procedures." This caught my attention and caused me to think about the topic of specialized hospitals (see: Cardiology Morphs into Cardiovascular Medicine). It's commonplace for various organ systems or patient categories to form the basis of a specialty practice in medicine. Think cardiovascular medicine, gastroenterology, pediatrics, and obstetrics/gynecology. Also increasingly common, as in the case of cardiovascular medicine, has been the development of specialized hospitals that offer both inpatient and outpatient care in that specialty area. These trend has evoked the ire of the execs of general hospitals by siphoning off many of the high-margin cases. I find that the blending of orthopedics and rheumatology in a specialized hospital, as exemplified by HSS, to be interesting and relatively unique. First of all, it cuts across several medical specialty boundaries, including internal medicine, orthopedic surgery, and sports medicine. In this regard, such hospitals are analogous to multidisciplinary cancer centers. The hospital's research program is also cross-disciplinary, focusing on rheumatoid arthritis, autoimmune disease, and the design and testing of joint prostheses. I am wondering whether we will see the development of other specialty hospitals and centers for, say, gastrointestinal or respiratory diseases in addition to the current major current examples of cancer, cardiovascular, children's, and women's hospitals/centers. In the case of the musculoskeletal orientation of HSS, one gets the impression that the orthopedic surgical procedures pay the rent and autoimmune diseases attract affluent donors to support the research programs. Good synergy. (Source: Lab Soft News)

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Doors closed on cancer screenings

Digital Pathology Blog — Tue, 29 Apr 2008 04:00:00 +0100

Uma Bingham/My Word/The Times-Standard (Source: Digital Pathology Blog)

Himss president slams phrs: i wonder why?

Lab Soft News — Mon, 28 Apr 2008 12:07:47 +0100

According to an interview in the WSJ Health Blog, Steve Leiber, the chief executive of HIMSS, is nervous about personal health records (PHRs) (see: How Personal Health Records Could Make Care Less Efficient). Here is an excerpt from the note (boldface emphasis mine):...Steve Leiber — who runs Healthcare Information and Management Systems Society, the trade group for health IT — pointed out a potential downside to the patient-centric records. “Physicians aren’t going to trust it,” he said. That could be trouble if patients opt for the personal records and try (because of privacy concerns, say) to keep their medical information off of a doctor or hospital’s electronic medical record. John of the Chillmark Research blog places this remark from Leiber into the appropriate context and comments on it (see: HIMSS Leader Raises Doubts on PHRs). Below is an excerpt from his comment: ... Leiber should provide full disclosure that HIMSS receives a boat-load of money from the EMR vendors that have a lot to loose should records begin migrating beyond the four walls of a hospital. First, it will force the issue of interoperability, something EMR vendors are loathed to adopt for like any other industry, interoperability gives the buyer choices and easier paths for migrating from one system to another. Also, these vendors are beginning to offer their own tethered-PHR, which is simply a consumer-centric EMR portal to their records. A PHR that resides outside of the EMR limits their market opportunity.Mr. HIStalk joins the fray with the following comment:Steve [Leiber] of HIMSS says doctors won’t trust PHRs. I’ve been saying that all along, but he’s got more vested interest since EMR vendors pay HIMSS while PHR vendors probably won’t. He’s right, though: duplicated tests don’t cost a doctor or patient anything, so why should the doc put themselves at risk by trusting someone else’s information, no matter what the source? I bet they redo a lot of tests even when the paper records are right there in front of them. That’s how defensive medicine works. I have posted a number of previous notes about PHRs, the most recent of which is the following: President of eClinicalWorks Discusses PHRs and Patient Portals. I have the following responses to Leiber's remarks: A physician's trust or distrust for a PHR is largely irrelevant. The PHR is, and will continue to be, a tool adopted by healthcare consumers for their own uses and not those of physicians. Physicians have access to their own office and hospital electronic records. They will always turn to these "sources of truth" although they themselves are not infallible. The major challenge at hand regarding PHRs is not whether patients "keep their medical information off of a doctor or hospital’s electronic medical record" but rather how to replicate physician office and hospital information to the PHRs in order to make them more useful for consumers. Information copied to PHRs from a "source of truth" needs to be made permanent and validated with a digital fingerprint such as a hash value. PDF files also serve the same purpose. John of Chillmark is correct in speculating that EMR vendors are suspicious of system interoperability but I believe they are generally supportive of tethered PHRs. Such products can generate additional revenue without jeopardizing client control. What's really worries Leiber and the EMR vendors, from whom he takes his orders, is the likes of Microsoft's HeathVault and Google Health. Note that the latter company has recently created a partnership with the Cleveland Clinic (see: Google CEO Discusses New Partnership with Cleveland Clinic). What Leiber and the EMR companies fear is that Microsoft and Google will launch a fully-featured EMR/PHR combo that will deliver both value and functionality. Microsoft already has an EMR product in the market (see my previous note: Microsoft Renames and "Integrates" Its Healthcare Software Line). You can browse the home page for Amalga, the Microsoft Hospital Information System. (Source: Lab Soft News)

Cancer fears as x-rays increase

Digital Pathology Blog — Mon, 28 Apr 2008 04:00:00 +0100

New Zealand's Medicare is investigating a sharp rise in digital imaging procedures such as X-rays and CT scans amid fears that some tests could be putting patients at risk of cancer. (Source: Digital Pathology Blog)

Recent news from american medical association

Digital Pathology Blog — Sun, 27 Apr 2008 04:00:00 +0100

Specialty hospitals measure rightly removed from farm bill (Source: Digital Pathology Blog)

Group predicts shortage in medical lab technicians

Digital Pathology Blog — Sat, 26 Apr 2008 04:00:00 +0100

Minnesota's NBC affiliate KARE-TV (4/24) reported that on Thursday, "local college and university medical instructors gathered with representatives from the Allina health system to let it be known [that] there is a shortage in lab technicians and it will soon be dire." The conference attendees attributed the impending decline to the fact that "many schools [are] not offering the program due to budget cuts in recent years, and, the decline in overall interest because it's in many ways a hidden field in healthcare." But "[l]ab professionals provide 70 to 80 percent of the objective data that physicians use to diagnose disease and treat their patients," said "St. Paul College instructor Michelle Brinski." Nevertheless, the "announcement of a 3.2 million dollar federal grant to boost the program at local colleges and universities" in Minnesota "was good news." College set to expand medical, clinical laboratory program. The St. Paul Business Journal (4/24) reported that "Saint Paul College will use a $3.2 million federal grant to expand its program for workers in the medical and clinical laboratory fields." Collaborating "with Allina Hospitals & Clinics, other providers and its partners in the Minnesota State Colleges and Universities system," the school aims "to help increase the number of trained clinical lab workers." Throughout the nation, "43 percent of the schools that trained such workers have closed, either due to the expense of the programs or the lack of industry partners willing and able to provide students with the required 720 hours of clinical training." Jane Renken, "manager of Workforce Planning/Sourcing for Allina Hospitals & Clinics," said, "It is truly a workforce crisis." (Source: Digital Pathology Blog)

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Diseases and behavioral targeting: some limits on what the web remembers

Lab Soft News — Fri, 25 Apr 2008 12:11:50 +0100

AOL’s Advertising.com and Google’s Doubleclick are responsible for placing advertising on other companies’ web sites. They, with other similar companies, belong to a trade organization called the Network Advertising Initiative. The group recently published its proposed guidelines to be adhered to by its members when engaging in behavioral targeting. These companies keep track of the behavior of individuals when browsing the web in order to show them ads at some later time for products that they may want or need (see: Ad Industry Bans Targeting People With Cancer; Ads to Widows and Orphans Allowed). These guidelines make interesting reading. Below is an excerpt from the article about them with boldface emphasis mine: If you’ve got AIDS, cancer or erectile dysfunction a group of big advertising networks are going to promise not to remember that you read sites about those topics and remind you...of your condition with ads for related drugs as you surf the net. But if you have Parkinson’s disease, congestive heart failure or warts, the ad companies have decided it may well be acceptable to keep track of your interest in medical subjects and fill your browser with ads for helpful products from pharmaceutical companies....Last year, the Federal Trade Commission proposed its own rules for behavioral targeting. Public comments on those rules are due Friday. The N.A.I. [Network Advertising Initiative] is hoping that its approach to self-regulation will head off stricter government mandates. The essence of the proposal is to identify sensitive subjects that advertising companies should not keep track of. Here is the list: HIV/AIDS status Sexually-related conditions (e.g., sexually transmitted diseases, erectile dysfunction) Psychiatric conditions Cancer status Abortion-related Sexual behavior/orientation/identity (i.e., Lesbian/Gay/Bisexual/Transgender) Criminal victim status (e.g., rape victim status) I must admit that it's mildly shocking to see these guidelines in black-and-white. Obviously and as noted above, the N.A.I. is hoping that self-regulation will avoid even stricter governmental regulation later from the Federal Trade Commission. I had to suppress a laugh when I read the N.A.I.'s own web page labeled: What is the NAI doing to help you protect your privacy? Link to it if you learn more about the organization. The answer to this question is -- not much. I believe that protecting one's privacy on the web is going to get a lot harder as the technology behind behavioral marketing becomes more sophisticated. When you perform a Google search, take a minute to scan the ads that are being presented to you on the "search engine retrieval page." As long as the displayed ad items are closely related to the theme of your current search, you are probably OK. If and when they relate to one of your personal characteristics that you consider a private matter, you may want to curtail your web-surfing activities or try to keep ahead of the game by deploying counter-measures on your PC such as anti-adware/spyware. Additional reading: Just how targeted can that targeted ad be? Ad networks set new guidelines (Source: Lab Soft News)

Ehealth and telemedicine associations of germany, austria and switzerland join forces

Digital Pathology Blog — Fri, 25 Apr 2008 04:00:00 +0100

(Source: Digital Pathology Blog)

Mp3 audio files now available for lab infotech summit 2008

Lab Soft News — Thu, 24 Apr 2008 14:03:39 +0100

If you click here, all of the audio files from Lab InfoTech Summit 2008 by individual lecture will populate the playlist of the MP3 player on your PC or Mac. You can also elect to save this file elsewhere. When you click on any of the lectures by name in your new playlist, it will provide the audio of the lecture in streaming mode. You can also simultaneously launch the relevant Power Point file (see: Lab InfoTech Summit 2008 PowerPoint Lectures) to replicate the live lecture. I will also provide a link beside each of these individual PowerPoint lectures so that the audio file can be saved individually. (Source: Lab Soft News)

Physician reluctance to invest in their office it

Lab Soft News — Thu, 24 Apr 2008 12:08:01 +0100

John of the Chillmark Research blog comments (see: Dis-information Among Those in the Know) on what he believes to be the incorrect perception that physicians are reluctant to invest in IT to support their office practices:[One example of disinformation is the] whining that physicians can not go digital because of costs. As I related in my notes from the first day [of the conference], this should be viewed as an investment in the business. Granted, there will not be an immediate ROI, but it will come in time, that I am sure of and ultimately, it will allow providers to participate in the future as more and more consumers look to engage their providers over the Web and desiring greater access and control over their records. I personally believe that this perception about physicians is correct and that they are reluctant to go digital. John's comment is more about what he thinks should happen than what is actually occurring. I have come to my conclusion not directly but through my discussions with many lab managers responsible for reference lab programs requiring the use of computers in physician's offices. To put the matter very bluntly and at the risk of a gross overstatement, I have been told the following: do not expect physicians in private practice to pay for anything. My personal theory about why this is the case, and an explanation that elicits nods of agreement from my lab colleagues, is that physicians in small private practices do not view themselves as running small businesses. For example, they often tend not to have a formal business plan and do not allocate a portion of their budget to, say, marketing or information technology. They tend to view money spent on office computing as a loss of income rather than a means to increase the efficiency of their practice or to increase patient satisfaction. In other words, they do not view IT as part of the cost of running their business. Returning to John's note above, note his references to investment in the business, ROI, and consumer control over records. I believe that this is a vocabulary that is rather foreign and therefore irrelevant for many physicians. (Source: Lab Soft News)

Cleveland clinic becomes a bedfellow with google to deliver online medical records

Digital Pathology Blog — Thu, 24 Apr 2008 04:00:00 +0100

Reposted from Dark Daily. Follow up on previous post here. Because healthcare is about to embark on a major digitization of paper records, lots of new corporate players are positioning themselves to profit from this activity. The latest surprise pairing is Cleveland Clinic and Internet giant Google . Both organizations jointly announced a new collaboration involving online health records that patients can maintain. Dark Daily previously reported that several online health record services, such as Microsoft Health Vault and Steve Case’s Revolution Health, have popped up with Web-based solutions that give patients more control over their own medical history. Now, Google is making its first entrance into the online health record space.Google is partnering with nonprofit academic medical center Cleveland Clinic in a pilot program aimed at giving patients control over their online medical records. The company reportedly has “big ambitions” in health care, according to Google’s company blog. Google wants to try and boost its large user base by becoming a destination for health-related information and services. The program developed by Cleveland Clinic and Google will be opened to 10,000 of Cleveland Clinic’s patients by invitation only. Patients who already use Cleveland Clinic’s personal health record system can securely share medical information—such as prescriptions, conditions, and allergies—between the Cleveland Clinic system and an online health profile offered by Google. Users can access their Google health profile from any computer connected to the Internet. Patients have full control over any information that goes into their profile. This Cleveland Clinic/Google pilot program is intended to free medical data from electronic medical records (EMRs), thus allowing patients to take their data wherever they go and share it with doctors and pharmacies as they see fit. Online health records stored at Google may help lower health care costs if access to more health information, courtesy of Google, helps consumers make better choices about their healthcare. The takeaway point here is that unlikely partnerships are forming specifically to give patients a way to manage their health records outside of the traditional healthcare provider environment. Lab directors and pathologists recognize that these patient-directed online health records will need to incorporate laboratory test data if they are to have maximum value to patients and their care team. That’s one reason why Quest Diagnostics (NYSE:DGX) announced last February that it was working with Google’s online health record service. In many respects, we may be witnessing a digital gold rush, as a host of companies stake their claims to a place in the digital patient health record marketplace.Related Articles:Google, Cleveland Clinic team up on medical data Quest Diagnostics to Collaborate with Google on New Health Offering (Source: Digital Pathology Blog)

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Some additional thougts about the evolution of lab networks

Lab Soft News — Wed, 23 Apr 2008 11:18:23 +0100

In a recent note (see: New Healthcare Delivery Models & Technologies That Will Affect the Clinical Labs), I raised the possibility of the evolution of lab networks in connection with my prediction that IT will become an increasing important competitive factor for national reference labs and hospital lab outreach programs. I want to provide some additional information here about what I mean by the term lab network. There is a long history of reference labs and lab outreach programs providing basic connectivity to their client hospital labs. Such connectivity frequently consists of test ordering from the hospital lab and test reporting back to it. I envision much tighter LIS integration between these types of organizations in the future, forming lab networks. Here are four examples of specimen allocation and reporting scenarios that could become commonplace in the future: For a test performed only in the reference lab, a patient specimen would be labeled and bar-coded only once at the collection point and then automatically and quickly routed to the reference lab for testing. Some genomic and proteomic specimens will undergo initial processing in the hospital laboratory and will then be routed to the reference lab for final processing and final report generation. Some patient specimens will be aliquotted in the hospital lab with some of the aliquots retained in the local lab for testing and others transported to the reference lab. Draft reports of genomic and proteomic tests will be generated in the reference lab and then completed in the hospital lab after review of a patient's clinical record. A major barrier to the development of such lab networks has been the fact that the reference labs and clients hospital labs are frequently supported by different and thus incompatible LISs. Although it has been technically possible to develop interfaces between such systems, the cost of such projects is often so large as to be deemed impractical. Also lurking in the background has been the specter that the contract between the reference and hospital lab could be canceled abruptly, making any substantial IT investment risky. I have published a number of previous notes about the federated architecture with which heterogeneous LISs could communicate without a large investment in complex and expensive HL7 interfaces. The federated architecture is closely related to a service-oriented architecture (SOA), which is defined in the Wikipedia in the following way (boldface emphasis mine):Service Oriented Architecture (SOA) is a computer systems architectural style for creating and using business processes, packaged as services, throughout their lifecycle. SOA also defines and provisions the IT infrastructure to allow different applications to exchange data and participate in business processes. These functions are loosely coupled with the operating systems and programming languages underlying the applications. SOA separates functions into distinct units (services), which can be distributed over a network and can be combined and reused to create business applications.Interestingly enough, Intel has just announced an SOA initiative for healthcare (see: Intel Announced Intel SOA Expressway for Healthcare). Here is an excerpt from the announcement:The product will allow healthcare providers to connect with one another so that each can provide better care while benefiting from reduced integration costs. Until now, the sharing of patient information among healthcare network participants has been hindered by the steep costs and complexities of proprietary data and integration services. Based on Service Oriented Architecture (SOA), Intel SOA Expressway for Healthcare offers a solution to this problem by providing a way to translate, process and connect any data format across a healthcare network. Given the clout of the Intel marketing juggernaut, I believe that the federated/SOA computer model will greater gain credibility in the healthcare market and provide impetus for novel inter-laboratory IT relationships such as the lab network described above. (Source: Lab Soft News)

Learning and telemedicine in rural communities

Digital Pathology Blog — Wed, 23 Apr 2008 04:00:00 +0100

Good news for rural communities - the United States Department of Agriculture has just announced that $128 million dollars will be available to improve medical care and education (Source: Digital Pathology Blog)

The critical pairing of pet/ct and a radiopharmacy network

Lab Soft News — Tue, 22 Apr 2008 11:32:22 +0100

A recent article about the opening of PETNET's first molecular imaging biomarker production facility in Chennai, India, caught my attention for a couple of reasons (see: Siemens to launch PETNET services in India). Below is an excerpt from the article with boldface emphasis mine:Siemens...announced the launch of its project to set up [PETNET's] first molecular imaging biomarker production facility in Chennai. The new facility will enable the healthcare providers in and around Chennai to access the PET.CT technology for diagnosis of patients with life-threatening diseases ...PETNET Solutions, a fully owned subsidiary of Siemens Medical solutions, operates the largest PET radiopharmacy network [comprised of] over 44 radiopharmacies and distribution centers at multiple locations that produce and distribute PET radiopharmaceuticals to hospitals, clinics, and research facility for PET imaging....The new facility will house the Siemens Eclipse HP cyclotron which will be deployed to manufacture FDG (fluorodeoxyglucose), the imaging biomarker used in PET.CT facilities to assist with the diagnosis and staging of disease processes and to monitor cellular response to treatments such as chemotherapy and radiotherapy. Currently, there is no PET.CT in Tamilnadu because of non availability the vital imaging biomarker FDG, which is essential to do the imaging in PET.CT. FDG has a half-life of only 110 minutes (losing half of its activity every 110 minutes) and hence needs to be produced locally. The first point of interest for me in this article relates to the term imaging biomarker. In a previous note (see: Use of Term Biomarker vs. Analyte), I used the following definition of biomarker: any molecular species found to provide correlation to a particular phenotype or perturbation of a biological system. I must confess to my preconceived notion that a biomarker was a substance that was quantified in serum or tissue. The use of the term to apply to an imaging radiopharmaceutical caught me by surprise. Nevertheless, its use in this way is certainly within the scope of the definition that I cited, particularly when modified by the term imaging. The second point of interest relates to Siemens' status as a major manufacturer of PET/CT imaging systems. For the use of this medical imaging technology to flourish, the company needs to ensure a ready supply of FDG to its customers, the most important radioisotope used in for PET imaging. As noted above, the substance has a half-life of only 110 minutes and thus needs to be produced in close proximity to the imaging device itself. I can't articulate the PETNET business model more clearly than the company's itself on its web site:PETNET Solutions has carefully planned and successfully built the SafetyNet, a unique program by which your delivery of PET tracers is guaranteed on time through our national network of cyclotron-based radiopharmacies.On time and reliable delivery of high quality PET biomarkers is essential for the successful operation of a PET practice. An interesting analogy can be drawn between the IVD companies that manufacture both the analyzers and the "juice" (i.e., reagents) that are required for the analyzers to work and PET/CT. In this latter case, Siemens produces both the hardware and the "juice" (i.e., FDG). However, the "juice plant" need to be close to the hospitals that have installed the imaging devices. Most IVD reagents are relatively stable and can manufactured and then shipped anywhere in the world. (Source: Lab Soft News)

Arup laboratories boosts prize money for resident research contest

Digital Pathology Blog — Tue, 22 Apr 2008 04:00:00 +0100

(Source: Digital Pathology Blog)