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Copyright © 2009 Siemens Medical Solutions USA, Inc. All rights reserved.
Copyright © 2009 Siemens Medical Solutions USA, Inc. All rights reserved.
Pathology 2.0 A New Perspective on Clinical Practice
Keith J. Kaplan, MDDivision of Anatomic PathologyMayo Clinic
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DisclosuresDisclosuresAperioAperioApollo PACSApollo PACSBioImageneBioImageneCarl ZeissCarl ZeissDefiniensDefiniensObjective PathologyObjective PathologyOmnyxOmnyxSlidePathSlidePathMedtingMedting
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GoalGoal
Discuss new tools/technologies and potential Discuss new tools/technologies and potential for use in practice of surgical pathologyfor use in practice of surgical pathologyImplications for pathology practiceImplications for pathology practiceConsumerConsumer--drivendrivenDelivery of pathology services/informationDelivery of pathology services/information
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What is 2.0?What is 2.0?Popular suffix attached to a familiar word or Popular suffix attached to a familiar word or concept to signify a major shift or evolutionconcept to signify a major shift or evolutionWeb 1.0 Web 1.0 –– users following contentusers following contentWeb 2.0 Web 2.0 –– users comment, edit and create contentusers comment, edit and create content
““UploadingUploading”” one of the most disruptive forcesone of the most disruptive forcesAllows content by users, for usersAllows content by users, for usersBest content immediately availableBest content immediately availableHarness Harness ““collective intelligencecollective intelligence””Digital pathology wellDigital pathology well--suitedsuited
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Web 1.0 Web 1.0 Web 2.0Web 2.0
Tags Tags -- De.licio.usDe.licio.us, Share This, Share ThisDirectoriesDirectories, Favorites , Favorites
Google Google AdSenseAdSenseAds, like Ads, like DoubleClickDoubleClickGoogle docsGoogle docsMS WordMS Word
FlickrFlickrOfotoOfoto/Kodak Gallery/Kodak Gallery
WikipediaWikipediaBritannicaBritannica Online Online
SSyndication, yndication, RSS, RSS, Podcasts, Podcasts, website follows youwebsite follows you
Stickiness, stay on the website Stickiness, stay on the website
Participation (Participation (blogsblogs, comments), comments)PublishingPublishing ((websiteswebsites) ) Search, like Search, like GoogleGooglePortal, like Portal, like Yahoo Yahoo Web 2.0Web 2.0Web 1.0 Web 1.0
Source: What Is Web 2.0 - Tim O'Reilly, modified
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Word of mouthAdvertising
Cost per clickPages view
AdvertainmentGoogleNetscape
User engagementTagging (“folksonomy”)Directories (taxonomy)
iGoogle, NetVibesApplicationsWeb forms
User behavior (“me-onomy”)XML, RSSHTML, portals
Widgets, drag & drop mashupsWikipediaBrittanica online
Semantic webSharing contentOwning content
Consolidating dynamic contentBlogsHome pages
LifestreamFocused on communitiesFocused on companies
Focused on the individual1 billion+ global users (2006)45 million global users (1996)
“the portable personal web”“the mostly read-write web”“the mostly read only web”
Web 3.0Web 2.0Web 1.0
Allows for increased meaning of data (semantic web), personalization & behavioral advertising
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Digital Pathology
Telepathology
Image analysis &
CAD
ResearchEducation
Imaging & Archiving
Virtual microscopy
PACS sign out Virtual IHC Consultation
Diagnosis Consultation
Targeted therapies
Image based
searches
Reporting Links to images Digital archive
Undergraduate GME/CME
TMA Comparative analysis
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Pathology 2.0Pathology 2.0
Biomarkers, targeted therapies, dedicated Biomarkers, targeted therapies, dedicated chemotherapychemotherapyThe The ““tissue is the issuetissue is the issue”” –– remains at the centerremains at the centerPathology 2.0 allows for sharing of images, Pathology 2.0 allows for sharing of images, collaborative diagnoses, education forums, collaborative diagnoses, education forums, tumor boards, etctumor boards, etc……Convergence of improved pathology and Convergence of improved pathology and advanced communicationadvanced communication
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Image AnalysisImage Analysis
Image analysis for quantitative Image analysis for quantitative immunohistochemical stainsimmunohistochemical stains
Machines are good at countingMachines are good at countingThey are not very good at thinkingThey are not very good at thinkingGood reproducibilityGood reproducibilityBetter informationBetter informationAssociated increase in billing codes relative to Associated increase in billing codes relative to manual IHCmanual IHC
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ConclusionsConclusions
CPT 88360 CPT 88360 –– Morphometric analysis, tumor Morphometric analysis, tumor immunohistochemistry (e.g. HER2, estrogen/ immunohistochemistry (e.g. HER2, estrogen/ progesterone receptor), quantitative, progesterone receptor), quantitative, semiquantitativesemiquantitative, , each antibody; manualeach antibody; manual
PC+TC=$147.95PC+TC=$147.95
CPT 88361 CPT 88361 –– Morphometric analysis, tumor Morphometric analysis, tumor immunohistochemistry (e.g., HER2 estrogen/ immunohistochemistry (e.g., HER2 estrogen/ progesterone receptor), progesterone receptor), quantitativequantitative, semiquantitative, , semiquantitative, each antibody; using computer assisted technologyeach antibody; using computer assisted technology
88361 PC+TC=$229.16 88361 PC+TC=$229.16 ΔΔ(TC+PC)=$81.21(TC+PC)=$81.21
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Order HER2Order HER2
Perform IAPerform IA
TranscribeResults
TranscribeResults
Sign out caseSign out case
Office MolecularIA Workstation
Perform FISH?Perform FISH?1 & 2+
0 or 3+
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Medicine 2.0 and Medicine 2.0 and Digital PathologyDigital Pathology
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Source: Social media demographics – RapLeaf Study July 2008
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thinkingthinkingthin
king?
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What about twittering diagnoses?What about twittering diagnoses?
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The Industry Standard has pointed to its lack of revenue as limiting its long-term viability."Twitter: Fanatical users help build the brand, but not revenue".
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Mayo Clinic and Word of MouthMayo Clinic and Word of Mouth
91% of patients surveyed say they have said 91% of patients surveyed say they have said ““good thingsgood things”” to an average of 40 people to an average of 40 people following a Mayo visitfollowing a Mayo visit85% say they have recommended Mayo to a 85% say they have recommended Mayo to a friendfriend
Advised an average of 16 to comeAdvised an average of 16 to come5 actually came5 actually came
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Mayo Clinic Social Media Mayo Clinic Social Media ProgresionProgresion
Reach people directlyReach people directlyMedical EdgeMedical Edge
Provide platforms for sharingProvide platforms for sharingCreate outposts on popular sites (podcasts on iTunes)Create outposts on popular sites (podcasts on iTunes)Energize word of mouthEnergize word of mouth
Leverage social media with mass media and vice Leverage social media with mass media and vice versa versa Sharing Mayo ClinicSharing Mayo Clinic
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Cost and PotentialCost and Potential
Twitter, Twitter, FacebookFacebook & YouTube: $0& YouTube: $0Sharing Mayo Clinic Blog: $75Sharing Mayo Clinic Blog: $75Marketing potential that exceeds budget to do so otherwiseMarketing potential that exceeds budget to do so otherwise
500,000 annual unique visitors500,000 annual unique visitors50,000 employees as ambassadors50,000 employees as ambassadors
More efficient care deliveryMore efficient care deliveryPatient support groupsPatient support groupsChronic disease managementChronic disease managementWorkplace collaborationWorkplace collaboration
Free versions allow you to prove conceptFree versions allow you to prove concept
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Why is this important?Why is this important?
mayoclinic.orgmayoclinic.org receives 1 million visitors a monthreceives 1 million visitors a monthee--Cleveland Clinic website receives about 1 million Cleveland Clinic website receives about 1 million visitors per yearvisitors per yearDailyKosDailyKos has nearly that many page views on an has nearly that many page views on an average dayaverage dayAbout 10About 10--15% of users become patients 15% of users become patients
Getting the word out for Centers of ExcellenceGetting the word out for Centers of ExcellenceAttracting eAttracting e--consumers to patientsconsumers to patients
Source: Hospitals use websites to attract out-of-town patients – USA Today 11/14/2005
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What does it all mean?What does it all mean?
Information publishing technologies Information publishing technologies Ways to interactWays to interactCDC CDC –– Twitter Twitter –– H1N1 tweets with 160K viewsH1N1 tweets with 160K views
Speeds the news cycleSpeeds the news cycleHudson River plane landingHudson River plane landingTwitPicTwitPic from iPhone to Twitter from ferryfrom iPhone to Twitter from ferryNYT slower to get on website NYT slower to get on website MSNBC interviewed photographer 30 minutes laterMSNBC interviewed photographer 30 minutes later
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www.tissuepathology.com
www.digitalpathologyblog.com
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Why do I blog?Suggestion by a colleagueCover digital pathologyAcademic blogging
Educate & inform
Less personalSocial marketing and networking toolWhite noiseTimely & relevant content – RSSIndependent voiceImpact
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Why do MDs Blog?Why do MDs Blog?Amplify MDs perspective on devices, tests, Amplify MDs perspective on devices, tests, rules, regulations in medicinerules, regulations in medicinePersonal reflections on practicing medicinePersonal reflections on practicing medicine
Patient encounters Patient encounters –– ““Doctor storiesDoctor stories””A Piece of My MindA Piece of My MindPersonal reflections Personal reflections –– death of parent or patientdeath of parent or patient
Expose fraudulent practices or ideas/propose Expose fraudulent practices or ideas/propose and propagate new ideas or concepts in practice and propagate new ideas or concepts in practice of medicine or subspecialtyof medicine or subspecialty
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Academic BloggingAcademic Blogging
Workspace to explore and share new ideas, Workspace to explore and share new ideas, technologies, practicestechnologies, practices
University/hospital employees afforded an University/hospital employees afforded an independent voiceindependent voiceConstraints with clinical duties and respect for Constraints with clinical duties and respect for institutioninstitution
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Academic BloggingAcademic Blogging
Disseminate new ideas for discussionDisseminate new ideas for discussionShort form of journalism/medical publicationShort form of journalism/medical publication# of people helped may outweigh peer# of people helped may outweigh peer--reviewed reviewed manuscripts published on esoterica (1 day/1 year)manuscripts published on esoterica (1 day/1 year)
Synergy between industry and academia for Synergy between industry and academia for collaborationcollaboration
Mainstream media companies will master blogs and other forms of social media as an advertising tool – hospitals advertising on Facebook – services, new technologies, jobs, ratings, etc…
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Academic BloggingAcademic Blogging
Scan horizon for worthy items within your Scan horizon for worthy items within your personal interests and expertisepersonal interests and expertiseFilter and interpreter for other laboratory Filter and interpreter for other laboratory professionals & digital pathology communityprofessionals & digital pathology communityReRe--post items from sources not available to post items from sources not available to public, patients, industry or researchers outside public, patients, industry or researchers outside domaindomain
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Pathologist BlogsPathologist BlogsCreepy Dreadful WonderfulCreepy Dreadful Wonderful Bobbi Pritt MDBobbi Pritt MD
ParasitesParasitesLab Soft NewsLab Soft News Bruce Friedman MDBruce Friedman MDNeuropathology BlogNeuropathology Blog Brian Moore MDBrian Moore MDOncopathologyOncopathology PrashantPrashant JaniJani MDMDPathology Informatics Pathology Informatics Alexis Carter MDAlexis Carter MD
from the Trenchesfrom the Trenchespathtalk.orgpathtalk.org 15 authors15 authorsSpecified LifeSpecified Life Jules Berman MD PhDJules Berman MD PhDThe 1x ObjectiveThe 1x Objective Karl Karl RobstakRobstak MDMDThe Daily SignThe Daily Sign--OutOut Mark Pool MDMark Pool MD
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Bene diagnoscitur, bene curatur.
"Something that is well diagnosed can be cured well."
www.virtualpathology.leeds.ac.uk
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Thank YouThank You
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