05 at 1 40 Tawfikpvx Web Conferencing

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INTERACTIVEMULTIDISCIPLINARY WEB

CONFERENCING:The Use of the Aperio and

PolyCom PVX SystemsOssama Tawfik, MD, PhD

ProfessorDirector of Anatomic and Surgical Pathology

The University of Kansas Medical CenterPathology Vision Conf, Oct 2008

OBJECTIVES

1. Why going digital is valuable?2. What is wrong with the current

system?

3. Can we do better? And why do wehave to?

Why Digital Conferencing?

– Problem...

• Medicine is changing.

• Medical Practice and Teaching is moving away

from the Major Medical Centers into CommunitySettings.

• Medical Centers are redesigning themselves -clinics, surgi-centers, nursing homes anddoctor’s practices.

• Great majority of patient care will be outpatient,located outside the main Campus.

Why Telepathology?

– Problem...

• The growing physical separation betweenClinician and Pathologist is problematic incommunication...

• Traditional Pathology Reports will havelimitations in communication.

• How will we communicate with our clients

when they are across town, across the state oracross the world?

Why Telepathology?

– Problem...

• As medicine becomes distributed, it will becomeincumbent upon us as pathologists to find new

ways of communicating for clinical work,research and education.

• The primary mode of communication has alwaysbeen the pathology report.

• We may now have to rethink the way we report...

• Pathologists, radiologists, and surgeons

• digital slide/radiology conferencing on aweekly basis

• 500 breast needle core biopsies

• ERROR REDUCTION!!!!

• Evaluation of significantabnormalities/discrepancies

• Correlation with treatment plans for each

patient

INTERACTIVE MULTIDISCIPLINARY

CONFERENCE

Microcalcifications of the breast:

size matters!

A mammographic-histologic correlation studyX Liu, M Inciardi, JP Bradley, F Fan, P Thomas, W Smith, O

Tawfik

Pathologica 2007;99:5-10

Core Needle Biopsy Protocol

Specimen radiography

Calcification

Absent

Calcification

Present

< 100 um > 100 um

Proceed w Dx

Tissue block

radiography

Radiologically

negative

Radiologically

positive

Malignant DxBenign Dx

Cut deeper in block

Additional

studies are

required!!

Ca Absent Ca Present

Ca SIZE

Medical Error Statistics

• Colorado and Utah s tudy

– Adverse events (AE) in 2.9% of hospitalizations

– 8.8% of AE’s led to death (about 44Kdeaths/annually

• New York study

– AE’s in 3.7% of hospitalizations – 13.6% of AE’s led to death (98K deaths annually)

• Eigh th leading cause of death in USA

Dollar Cost of Medical Error

• Between $17 to $29 billion/year

– Half directly attributable to health care costs

– Other half combination of lost productivity, lostincome and disability

Goals of the IOM report

• Break “cycle of inaction’ concerning patient

safety and medical error

• Enhance knowledge base about medical error• Breakdown legal and cultural barriers which

impede safety improvement

• Shift from blaming individuals for past errors to afocus on preventing future errors by designingsafety into the health care system

Goals of the IOM Report (cont.)

• Improve knowledge base about medicalerror and safety improvement

• Develop tools to improve safety

• Cause significant monetary investments toachieve these goals

Institute of Medicine mandate

• Threshold improvement in quality

– 50% reduction in medical error in five years

“ARE WE LISTENING?”

“OUR PROBLEM”

KU Med Ctr is

Located 3 miles

From Cancer

Center

Man power

Resources

“OUR PROBLEM”

• Aperio ScanScopeSystem

• PolyCom PVX videoconferencing System

“OUR SOLUTION”

• Pathologists, radiologists and surgeons

• Develop a web based pre-diagnostic work-up conference in which the pathologyslides and mammograms could beanalyzed together

• Goals:

– To insure adequate sampling

– To reach a proper diagnosis

– To determine the proper surgical/treatment

Aperio/KUMC Pilot Project

Application Values

Tested Variables Measured

ConfirmationReviews with DigitalConferencing

Quality Concordance between glass

and digital reads Image quality Comfort level with using digital

slides Ease of use with digital slides

Service andEfficiency Pathologist/Radiologist/Surgeon

satisfaction Comparison of actions taken

based on digital consultationsvs. history of actions for thesame type of discrepancy

Telepathology/Teleradiology

• Server with high speed internet connection

• Personal computer w web camera

• Digital pathology system (AperioScanScope XT)

• Spectrum Plus™ digital pathology

information management software

• Web conferencing system (PolyCom PVX)

Values• Pathology side:Remote viewing and conferencing

Simultaneous view of multiple digital slides

Archiving and intelligent retrieval capabilities

• Radiology side:Remote viewing and conferencing

Simultaneous view of multiple digital images

Alive radiologic images w radiologist andpathologist input

• Pathology/Radiology:

Audio and Video conferencing while reviewingimages

No need to leave office

No phone calls or typing required

Values

Cases – Pathologic Diagnosis

• Invasive carcinoma (1 case)

• DCIS (1 case)

• Fibroadenoma (2 cases)

• Fibrocystic changes with microcalcifications (12cases)

• Fat necrosis (1 case)

• Fibrosis (3 cases)

• Intraductal papilloma (1 case)

• Sclerosing adenoma (1 case)

• Microcalcifications (11 cases)

• Abnormal mammogram, mass (6 cases)

• Fibroadenoma (2 cases)• Abnormal ultrasound, mass (2 cases)

• Spiculated mass (1 case)

Cases – Radiologic Diagnosis

Concordance

No Impact

100%concordance

MinorImpact

MajorImpact

13 6 3

• Excise lesion (1)

• Re-biopsy patient (2)

• Follow upmammograms (2)

• X-ray tissue blocks

Teleconferencing Challenges

Challenges

• It requires some training (learning curve)

• Psychological barrier!!!!

• Limitations in technology (view of smallarea of slide, length of transmission ofimages, internet connections, etc.)

• Image resolution, size of files transmitted

Benefits of telepathology

(telemedicine) • Better medical service

• More specialized service

• Primary diagnosis for frozen sections• Second opinion and consultations

(dermatopathology, neuropathology,cytopathology, etc.)

• Quality control

B fit f t l th l

Benefits of telepathology(telemedicine) cont.

• Cost saving/Time saving

• Exchange of ideas

• Improved collaboration with opportunity forresearch

• E-learning, clinicopathological mtg anddiscussion groups

CONCLUSIONS

• It can be cost effective solution to the

our university problem.

– It negated the need for an on-site

pathologist to staff the biopsy cases – Provided at-your-desk Telepath diagnosis

Digital Pathology Applications

Digital

photo-graphs

pathology

(remotely

controlledscopes)

S c o p e o

f U s a g e

Before digital slides After digital slides

Digital Pathology Applications Adoption will Occur in Niches

Tumor Board,

Proficiency

Testing, CME

Archival

Retrieval

Virtual

Peer Review,QA

Analysis

Manual Read

of DigitalSlide

Remote

viewing

Secondary

Consults

AcknowledgmentsMarilyn Davis

Dennis FriesenMark Redick

Ryan Spaulding

Dennis SchuckmanSherri Heffner and Aperio Co.

05 at 1 40 Tawfikpvx Web Conferencing

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