Digital Pathology Blog

The Rule of 70s – Does it Still Apply?

There is a decades-old theorem first derived at the Mayo Clinic that although based on little actual data has been popularized over the years stating:

  • 70% of patients in a hospital have laboratory data.
  • 70% of clinical data points (objective information) come from laboratory data.
  • 70% of clinical healthcare decisions result from laboratory tests.
  • These data account for less than 5-10% of healthcare costs.

This is a lot of bang for the buck. Imagine 70% of objective information assisting in 70% of healthcare decisions for as little as 5% of total healthcare expenditures.

Is There a General Pathologist in the House

Almost 3 years ago I wrote a piece for Advance for Administrators of the Laboratory in their "Perspectives in Pathology" entitled Death of the General (Surgical) Pathologist.

This piece discussed the issues surrounding what is perceived by many as the increasing (and necessary) sub-specialization in pathology.  The model of "everybody doing everything” has evolved into “everybody doing one thing".

Historically, practicing pathologists were solid general surgical pathologists, often times with their own expertise/interest in a particular area, but they prided themselves on being "surgical pathologists" rather than "liver", "hemato-" or "dermato-" pathologists as in today’s world. A number of factors have driven and resulted in this trend.  

First and foremost, the needs of the market.  Dedicated specialists in breast or gastrointestinal diseases are commonplace in medicine including the radiologist, surgeon, oncologist and radiation therapist.  Pathology appropriately responded accordingly. Secondly, pathologists have driven some our own marketing and needs.  The resulting potential problems are paramount and based on many fallacies.

The State of the Pathology Union

Dr. Keith Kaplan, Chief Medical Officer for Corista, LLC, offers his thoughts on “The State of Pathology Today” and some strategies for facing today’s challenges. 

Today, the state of pathology, along with our national leadership and organizations, seems fragmented and without direction. I attended the College of American Pathologists (CAP) and House of Delegates meetings earlier this month, and there seem to be a few issues which we cannot deal with as a group:

  • Needs of academics vs. community-based hospitals: From the need for AP/CP generalists in some settings to the need for sub-specialists in others, how do we best practice our specialty? We seem to be an increasingly heterogeneous group with loss of identity.  

Are There Any Medical Personnel On Board?

As I was trying to sleep, sitting upright in seat 11C, this question came over the public address system. 183 of us were traveling from LA to Boston and it was 4 AM, in whatever time zone is home to Kansas. This was the final leg of a quick halfway around the world trip. Our itinerary started in Charlotte on Friday, then to Shanghai, and finally to Boston by Monday morning. We had already traveled nearly 15,000 miles by car, bus, train and air. Now, just a few hours from completing 6 flights in less than 3 days, we may have hit a snag in our travel plans.

Telepathology and Inspection Readiness

Telepathology and the use of whole slide images (WSI) are becoming accepted in the practice of pathology on a clinical level. While the use of WSI has not been approved for primary diagnosis, it is now a part of many diagnostic applications such as remote specimen evaluations (i.e. frozen sections and assisted fine needle aspirations), quality assurance activities, tumor boards and consultations.

To that end, regulators for laboratory accreditation acknowledge the role this technology plays in the laboratory and are now assessing telepathology and whole slide imaging activities accordingly. The attention and focus of inspections are similar to all other laboratory services; the critical elements of well-defined policies and procedures, documented training, and system validation are all expected of digital pathology/telepathology services.

Dread prepping for Tumor Boards? This might be why. [Infographic]

Tumor boards are a critical component of a patient's diagnostic and treatment processes, and pathology participation in these discussions is vital. However, the traditional process required to prepare pathology data and images can be laborious and time consuming.   

How Many Doctors Does It Take To Change a Light Bulb?

Change?
Why would we want to do that?
 
In 1993, George Halvorsan, Chairman and CEO of Kaiser Permanente from 2002-2013, wrote in his book Strong Medicine:
 
"Rather than taking an overall leadership role in the continuous improvement of the health care delivery system, too many medical professionals either ignore the problems of the system in order to concentrate in their own specific practices or focus their energies and talents on protecting the status quo."
 

Robo-Pathologist Will Still Require Human Intervention

I read with interest a recent article entitled “If A Computer Can Diagnose Cancer, Will Doctors Become Obsolete?”. The discussion in the article has several purely economic points and focus, but what caught my eye of course was being made obsolete by a computer!  

Disruptive, Enabling, or Standard of Care

An old (-er, I mean experienced) pediatric cardiothoracic surgeon once told me, “The heart is not a music box, it is a pump, why should I use a stethoscope to listen to it?” An experienced neurosurgeon once told me, “Neurologists are the tool we used to use before the CT scan” and a critical care intensivist friend has reminded me several times of the value of a stethoscope when you have arterial blood gases, central venous pressure monitoring, and ventilator settings you can adjust for optimum care.  

1st of July: Moving Up Over Black Coffee

I arrived for my away rotation early. I was scheduled to be at the Office of The Chief Medical Examiner (OCME) in Baltimore for the month of July. My first rotation of second year of residency would be spent away from the gross bench and chemistry analyzers. The month was actually fine with me – the OCME office handled deaths from all over the state of Maryland including Baltimore city and county, so there would be a mix of the usual inner city homicides, suicides, drug-related deaths, as well as farming, motor vehicle, and boating accidents at the peak of summer in Maryland. And the OCME was walking distance to Oriole Park and Camden Yards and the Orioles were scheduled to play nearly 20 games that month at home. One of the best smelling ball parks in the country would offset the smells of decomposing bodies pulled from the water or burning buildings.