RT: Hospitals Embrace Twitter

23 04 2009

PathTalk links to an ABC story about the rise in hospital use of social networking for productive/educational purposes.

Where’s the ‘Like’ Button?

Check out the post over at PathTalk: http://pathtalk.org/archives/700

Someone call Netter…

23 04 2009

Human Atlas‘ has been unleashed on the iPhone App store.  It is basically a collection of medical animations useful for explaining disease processes and treatments to patients.


The Blausen Human Atlas iPhone digital resource tool is derived from Blausen’s proprietary medical animation library, containing over 7,000 individual animations and 13,000 illustrations. The atlas is available in ten languages and is internationally recognized as unequaled in the field of medical illustration. 

The Human Atlas covers 15 general medical topics including Cancer, Circulatory, Digestive, Ear, Endocrine, Eye, Immune, Muscular, Nervous, Pediatric, Reproductive, Respiratory, Skeletal, Skin and Urinary, each with an average of ten animations.


The animations are narrated and are explained on a 6th-grade reading level.  Not particularly useful for the practicing pathologist, but I’ll support any educational tool that teaches patients a thing or two about anatomy!  Educational pamphlets, you better watch out!

An additional thought, it would be cool if you could transfer the animations specific for the patient’s condition to the patient’s iPhone for them to take home with them (idea (c)2009 Karl Robstad!)… ;)


[via Medgadget]


UPDATE: Add another anatomy iPhone app to the gathering heap:

Cerebrii Neuroanatomy Learning Tool

I always hated those Weigert’s anyway… ;)

2009 Medical Design Excellence Awards

23 04 2009


Ventana Benchmark Ultra

Ventana Benchmark Ultra

The winners of the 2009 Medical Design Excellence awards were recently announced at the Medical Design & Manufacturing East 2009 Conference and Exposition in New York.  Winning designs spanned everything from dental to lab equipment including a Benchmark IHC/ISH automated stainer and a specialized MRSA agar (because ‘design’ includes more than just looks).


Cool side note, you can also check out previous year’s winners too.




Check it out:



[via Core77 / thanks to Randy for passing this along]

What do you do when your hands are tied with a crappy LIS?

23 04 2009

Where it all happens

I started at Albany Medical Center on July 1, 2007, bright-eyed and bushy-tailed, primed to make a difference in the department.  Like many other small to medium-sized institutions, I had noticed that the department was somewhat lacking in the technology department.  The reason for this, I was assuming was a reluctance on the department’s end, because, let’s face it, most people enjoy the comfort of the status quo.  Well, I thought that this was something I would be able to overcome with a little spirit and some enthusiasm.  While that may have been true, it turns out, the real reason AMC is technologically lagging has to do with the hospital administration-at-large and not with my department.  Part of it is due to our situation- the path lab is owned and operated by the hospital while the pathologists technically practice privately.  As a result, all of the major purchases for pathology are handed down from the institution’s higher management; and while the pathologists have some input in the decision making for their livelihood, it is most certainly not absolute.

It was then that I realized how naive I was; I am still not disheartened, just a little surprised at how off-guard I was caught.  I have no idea why I thought that I was perpetually carrying around  magical red-tape scissors.  Needless to say, I still have not figured out a way of getting through to the administration.  I’m just a doctor, what do I know about IT? Yea, thanks.

The inciting topic was our AP LIS (the vendor  shall rename nameless).  Talking to various vendors at this year’s USCAP, I had many interesting and clever solutions pitched to me, from automated processors to WSI education tools.  Cool stuff.  But the rubber really hit the road when I told them what LIS we used.  The most hopeful response was a tacit pause followed by a “Well, we can make that work if you want to…” Super.

Well, I went home feeling sorry for my department and its apparent self-handicapping.  At that time, I was attributing the decision to choose our particular LIS as a cost-saving measure; perhaps AMC just chose an inexpensive system to save some money.  And then I heard how much installation and monthly maintenance actually costs.  As a pathology n00b, it took me a minute or two to get over the sheer sticker shock of medical solutions in general, but then when I calmed myself and placed things in perspective, I was left with a quizzical look upon my face.  Implementation of our LIS cost more than double than a quote I got from a popular major competitor.  Sure, I’m sure I was under-quoted at the conference, and I’m sure that our LIS came in over-budget in the end, but I had to wonder if this was truly common-place.  And for the astronomical price we pay for a service contract, it’s bewildering: (1) how often there are crippling system-wide crashes (2) how long it takes for these issues to be resolved by the company representative.

So why is this OK? Polling of the lab staff and the attendings reveals a near-universal “I hate our LIS”, yet nothing changes! Is there a solution for me? What can I do? Queries to IT result in dismissal; we are committed to this particular LIS come hell or high-water, apparently.  I suppose the best advice is to just take a deep breath, forge ahead, and make the best with what you have got…

I just wish I had known that coming into the game.  Well, I suppose I have since learned to pick my battles, and have instead decided to focus my efforts where they have a chance of being fruitful- by working to update things on the private side of the practice. Life lesson, learned.

UPDATE: Ha! Bruce Friedman over at LabSoft News posted this today. Interesting companion to this post! Thanks!

Sometimes, You Just Have to Step Back to Figure Out Where You Are…

23 04 2009

A colleague of mine passed this along to me today.  It’s a short essay from an MIT student about his experience at a pathology lab in India.  At least to me, it was a little eye-opening.  Perhaps it’s easy to get caught up in the excitement of bleeding edge technology and novel academic pursuits and forget just how good most of us in the states have it.

This article serves not only to remind you of the kind of compromises our colleagues are forced to deal with in under-served areas, but it also reminds us of the clinical and epidemiological consequences of our day-in day-out.

[Source: http://www.technologyreview.com/article/22453/]

No Posts this week.

10 04 2009

I’ll be outside the US for the duration of this coming week, so no new posts, sry.

Happy Easter!


Will Obama’s Health Care Plan Work?

9 04 2009

I know we just met, so why am I talking about religion, politics, or money?  Well, regardless of your specialty, the much talked-about future health care dream has the potential to effect us all; therefore it needs to be discussed.  Sure, we’ve all heard the droning of pundits on the 24-hour cable news networks, but what about us?  What about the people that will be directly effected by the proposed sweeping change in American health care policy? I’ll try and be (1x) objective…

First, let’s take what the president said: here in speech form, and here in pdf bullet points.  The plan is broken into three main parts: lowering costs, universal coverage, and primary prevention.

Lowering Costs.  I think it’s impossible to argue that health care in America is cost-efficient, but I’m not writing to decry capitalism; actually, quite to the contrary.  This country is built on capitalism, the land of opportunity, and I think it is important that this be maintained.  That being said, pro-business does not equal anti-regulation, ever.  In fact, regulation is key to the success of capitalism.  Why?  Well, if people are allowed to cut corners, they will; it is only human nature.  So the government’s contribution should be closing the loopholes and making sure people are getting compensated appropriately.  Clearly that is not happening right now.  Most egregious has to be HMO’s and insurance companies.  The fact that the CEO’s of one of the first HMO’s could be one of the richest men in the world is at least a little bit sickening.  That’s not to say that we don’t need insurance companies or that insurance should be handled by the government (as we all know government also equals overhead), it does mean that competition is very important.  The problem is that people are essentially tied into the health care plan offered by their jobs.  One of Obama’s bullet points promises to change this.  This only works if either insurance is similarly and competitively priced, or if there is a set amount of reimbursement expected from the employer.  We’ll see.  

The first bullet point is actually about EMR’s.  This is some nifty forward-thinking.  Of course nobody would really be against this, but I am glad it is a priority.  Apparently, at least one estimation quotes an annual savings of $77 billion.  I’m sure everyone reading this is behind that one.

He also talks about allowing importing of cheap meds, and reducing the overall cost of brand-name meds.  My only qualm with this is if it would stifle R&D by removing some incentive to push the limits of science.  Realistically, I don’t think this will stop anyone, but I think it’s something worth keeping an eye on.

Finally, Obama’s plan includes tort reform (a no-brainer), and a soft “general cleaning” of the system. 

Universal Health care.  I’ll come clean at the get-go.  Health care should be a right.  For whatever reason, you can agree or disagree, that’s just how I call it.  However, a single-payer system is NOT the answer.  Health care should be available to everyone, and to some degree everyone should do their part to support their fellow American.  This is not only important morally, but fiscally.  A tremendous amount of health care dollars are wasted in the ER.  If everyone had health care, these pro-bono ER check-ups should decrease significantly.  I remember in medical school, the administration essentially told us that 30% of our $50,000 tuition went to pay for treatment of those without health care; they could have been lying, but I’ll never forget that.  So, available care would not only get everyone covered, but it would also decrease cost.  But why not a single payer?  Well, that is a monopoly.  We physicians already have a difficult time with reimbursement.  With a single payer, there’s no competition and we’d be forced to accept whatever was offered as payment.  FAIL.  Obama’s plan is clever in this way.  He would create coverage for everyone, but allow you to keep your own health care if you have it.  That may stratify treatment into a two-tier system, but anything is better than no health care at all. In his own words:

“The Obama-Biden plan both builds on and improves our current insurance system, which most Americans continue to rely upon, and leaves Medicare intact for older and disabled Americans. Under the Obama-Biden plan, Americans will be able to maintain their current coverage, have access to new affordable options, and see the quality of their health care improve and their costs go down. The Obama-Biden plan provides new affordable health insurance options by: (1) guaranteeing eligibility for all health insurance plans; (2) creating a National Health Insurance Exchange to help Americans and businesses purchase private health insurance; (3) providing new tax credits to families who can’t afford health insurance and to small businesses with a new Small Business Health Tax Credit; (4) requiring all large employers to contribute towards health coverage for their employees or towards the cost of the public plan; (5) requiring all children have health care coverage; (5) expanding eligibility for the Medicaid and SCHIP programs; and (6) allowing flexibility for state health reform plans.”

Promoting Primary Prevention.  This is another no-brainer and includes educational programs about everything from AIDS to obesity and should not be under-played, but for the purposes of this blog, let’s just agree that it is a good thing, that may or may not actually happen or may or may not impact people and achieve it’s stated goal.  I think it does, however, fulfill the purpose of rounding out a complete plan.

Finally, how do we pay for this? I mean that’s the trillion dollar question.  I can not begin to speculate on this.  Obama says money will come from increased taxes on rich people and repealing of tax cuts and from the reform of the bloated health care administration sector.  I think if anyone claims to know how this will play out is talking out their arse.  There are simply too many variables to calculate with any certainty how much it would cost and how much money would be saved/raised under this plan.  Here’s what Obama said in Illinois:

To help pay for this, we will ask all but the smallest businesses who don’t make a meaningful contribution today to the health coverage of their employees to do so by supporting this new plan. And we will allow the temporary Bush tax cut for the wealthiest Americans to expire. But we also have to demand greater efficiencies from our health care system. Today, we pay almost twice as much for health care per person than other industrialized nations, and too much of it has nothing to do with patient care. That’s why the second part of my health care plan includes five, long-overdue steps we will take to bring down costs and bring our health care system into the 21st century – steps that will save each American family up to $2500 on their premiums. 

First, we will reduce costs for business and their workers by picking up the tab for some of the most expensive illnesses and conditions. … Second, we will finally begin focusing our health care system on preventing costly, debilitating conditions in the first place. … Third, we will reduce the cost of our health care by improving the quality of our health care. … Fourth, we will reduce waste and inefficiency by moving from a 20th century health care industry based on pen and paper to a 21st century industry based on the latest information technology. … Finally, we will break the stranglehold that a few big drug and insurance companies have on the health care market. 

In conclusion, there are big positives and potential big negatives.  I just hope that we get universal care while keep capitalism and competition in play so everyone gets care, and I can still pay my loans back…

Agree? Disagree? Sound off below…

Errors in Surgical Pathology

5 04 2009

Oncopathology has an interesting article about errors in surg path.  from an interview with Dr. Stephen Raab, Professor of Pathology, Vice-Chair for Quality and Director of Anatomic Pathology at the University of Colorado, Denver.

I think its worth checking out…

AMC Press Release: Pathology Receives “Top Three in the World” Honor

3 04 2009

[From Albany Med Today, March 2009]


The department of pathology’s Pathology Residency Research program has garnered Albany Med a “Top Three” designation from the United States and Canadian Academy of Pathology (USCAP), the premier academic society of pathology. The honor comes after Albany Med pathology residents had among the highest number of scientific abstracts accepted for presentation at USCAP’s annual meeting in Boston in March. With seven entries accepted, Albany Med was in the top three in the world. Residents from more than 110 institutions submitted research abstracts. Accepted abstracts will be entered in USCAP’s Stowell-Orbison Awards Competition for Pathologists-in-Training.

“There is an old saying that ‘the great thing about a teacher/mentor is that you never know where their influence ends.’ It is obvious that you and your program have worked hard to mentor this very important group of young pathologists and you should be very proud of this major accomplishment,” wrote Fred Silva, MD, USCAP secretary-treasurer and executive vice president in a letter informing Albany Med of the honor.

AMC Today for March 2009

AMC Today for March 2009

In addition, the pathology department was in the top 10 percent of institutions in terms of general (non-resident) scientific abstracts accepted for presentation. Fifteen abstracts from nine pathologists practicing at Albany Med will be presented at the Boston meeting. Topics include novel pathological findings in dermatology and in several types of cancer. “This is a tribute to the hard work the residents and faculty put into competing for these acceptances and awards. The USCAP Annual Meeting is the world’s largest international pathology congress attracting more than 3,500 academic and practicing pathologists, and we are honored to play a role,” said, Jeffrey Ross, MD, Cyrus Strong Merrill professor and chair of the department of pathology and laboratory medicine. Ross also praised Christine Sheehan, associate director of clinical research for the department of pathology, for the “tireless work and dedication she puts in to aid the department in its research efforts.”

Study results also will be published in USCAP’s journals, Modern Pathology and Laboratory Medicine.

Residents presenting will be: Elzbieta Slodkowska, MD; Song Lu, MD; Jacqueline Choate, MD; Karl Robstad, MD; Konstantinos Linos, MD; Yasmin Jalil, MD; AlkexeyGlazyrin, MD; and Li Li, MD.
Medical students presenting include: Stephanie Yang; Mark Donovan; and Michael Dimaio.
Pathologists whose work will be presented include: Ann Boguniewicz, MD; Jeffrey Ross, MD; J. AndrewCarlson, MD; David Jones, MD; Timothy Jennings, MD; Tipu Nazeer, MD; Alida Hayner-Buchan
Hematopathology Fellow Suzanne Homan, PhD, MD.

Sign-Out on your iPhone?

2 04 2009

Would you?

It’s funny to me, actually.  I feel that I am a pretty progressive guy when it comes to the use of informatics in pathology, but there’s an idea that I have heard being tossed around recently that even I silently swore off: telepathology on your phone.

First things, first.  Medgadget had an article the other day about the usability of PDA/Smart Phones in actual clinical practice.  The study quoted was about usability of different phones/OS’s according to nurses.  This is intreaguing to me. I dislike the concept of heavy patient business being conducted on something that receives phone calls. I can just see it now: “Doctor, the patient’s heart rate has dropped to…” RING RING and up pops the nurse’s mother’s face, answer?.  Plus what if you forget to charge it, what about the browser cache, etc. etc.  FAIL.  The alternative is to turn off the phone part while at work (but then why use a phone in the first place?) or use a dedicated non-phone PDA (like we use already here at AMC (running Windows Mobile)).  I just don’t see why phones are the vehicle of interest (other than the dying PDA market, but then again, look at beepers… go figure).  I’m not trying to say that smartphones are useless in the medical setting, however.  Valid uses might include using ePocrates, calculator, or even ordering and signing perscriptions.  But I say nay to their use in the active delivery of care.  For the record, according to the study, Blackberry wone (sorry iPhone).
iPhone Pathology
In pathology, I think the application is very different.  In general, we are not intimately involved in the ongoing direct care of a patient (save for an occasional string of frozens).  So to demand the use of PDAs over smartphones becomes less justified; however, pathology also differs in that the visual information presented requires far more image definition than other specialties.  While the iPhone has a relatively high-resolution screen with good contrast, ultimately, it’s not enough.  I suppose if a colleague wanted to show you a single diagnostic cell in a cytology prep… mayyybe, but to have to navigate a slide at a size that is ledgible on that tiny screen would be completely futile.  Sure there is an MRI app, but, come on, no radiologist is really using that.  So what is the minimal size screen of diagnostic usefulness?  I think netbooks are a great compromise.  Take the Sony Vaio P (not a netbook according to sony); it appears to be the perfect size to fit in a labcoat pocket and it  sports a 1600 x 768 pixel 8-inch screen.; it’s about the same DPI as the iPhone, but is bigger, making it easier on the eyes view as well as easier to unobtrusively navigate; however, you then give up the touch screen aspect.  There are touchscreen netbooks coming down the pipe, soon, though, and those could hold a lot of promise for this application.  Final considerations are bandwidth and storage. iPhones top out at 16GB and run on a 3G network.  It’s not difficult to imagine that both of these are significant bottlenecks as well considering most WSI’s are hundreds of megabytes if not gigabytes.  Even on WiFi (aka with more bandwidth), the number of slides you could store on your device is quite small.

Of course neither of these is a good solution for regular sign out.  Ideally, one would use a hard-wired Microsoft Surface with multi-touch and gestures, or at least that’s how I envision it.  Kind of like John King from CNN, but instead of states, they are biopsies (note: this clip isn’t John King, but it does illustrate playing with images)…


UPDATE: After further thought, and in light of posts on The  Daily Scan via Digital Pathology Blog, I have this to add:

I still remain skeptical of whether or not there is a real niche for this.  I think I harshed on it a little too much above, but in all reality, it’s niche would be for a quick consult to someone in your department: “hey, do you think this is at the margin or not?” or it might enable the attending to stay home if the resident goes in overnight for a simple frozen (although, you’d probably video stream a frozen and not use WSI), but I can see that happening. Nobody, however, will be taking very difficult or simple consults over the phone because it is too dangerous or unnecesary, respectively.  So, it could have its niche, but to me, it’s more of a cool factor than a practical work aid.  Even Aperio played if off a little, “We didn’t plan to have an iPhone viewer, but Room 4 saw a need and filled it, and we all benefit”. I will hail it as a cool proof of concept, though!


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