The Daily Scan

ePathology

After more than a decade of Aperio development, what started as virtual microscopy has advanced to create a new Digital Pathology market.  Aperio products are now used in healthcare to support direct patient care and are also used in research to facilitate more rapid investigations that support the development of biomarkers.  Starting in 2012, our goal is to reach a broader audience including those that are not directly involved in pathology, histology or research.  To do this, we have adjusted our language to be more familiar.

Now, we are introducing ePathology Solutions. 

Our solutions leverage all of the Aperio products.  We have simplified our language and have focused our communications on how we can solve our customers’ goals.  From the moment that glass slides become eSlides, our NETWORK enables remote simultaneous, real-time viewing and immediate distribution for consults and collaboration.  Our PRECISION tools provide pathologists with easy to use, automated analytic capability. 

You'll here more from us about this, but one visible difference is our logo.  We have rotated our "swoosh" to be a lower case "e", as in ePathology.  If you're attending the USCAP meeting in Vancouver please drop by our booth and we'll be delighted to tell you more.

Some things won't change.  We continue to be focused on helping pathologists deliver improved patient care.  And we will continue to work hard to deliver excellent products and services.  Please let us know how we're doing, and how we can help YOU.

Parts of healthcare are moving to the cloud

I live in two worlds, digital pathology, and technology, and while there are intersections it is interesting to see that these worlds are converging.  For example Brian Ahier is a tech blogger; he attended HIMSS and has been intrigued by the potential for cloud-based servers and storage to improve healthcare.  In a recent post he notes parts of healthcare are moving to the cloud:

Healthcare providers are increasingly required to do more with less. Regulations, HIPAA, Meaningful Use, recovery audit contractor (RAC) audits and decreasing revenues are motivating providers to consider cloud computing as a solution to potentially help them cut costs, maintain quality, meet regulations, and increase productivity.

Some electronic health record (EHR) vendors are offering solutions as a cloud-based offering. This offers an approach intended to help providers better manage the IT investments that need to be made to support EHR implementations. And just as we've seen in other industries, there is an ongoing debate within healthcare as to the viability of cloud-based solutions given the care needed for patient privacy and sensitive personal information.

Providers' trust in the public cloud is still relatively weak, but increasing numbers are considering using private clouds. However, EHR applications hosted in the cloud do seem to be gaining traction.

Along with electronic health records we're going to see more about electronic pathology records; after all, about 70% of the diagnostic information in a particular case comes from pathologists.  A mere pathology report isn't the whole story, there will be increasing demand for the primary data, just as there has been with other medical imaging disciplines like radiology, so we can see more digital pathology adoption ahead to support this important use case.

ScanScope helps Mentalist on prime time TV

Wow, Aperio doesn't do any television advertising but we can be seen on prime-time TV anyway.  I was watching an episode of “The Mentalist”, which aired on CBS this past Friday.  As the camera panned past the star of the show, the real star was clearly visible on the desk behind him.  The scene took place in a cancer clinic.

Enterprise imaging project tops 1,200 terabytes

This was an eye-catching headline from the recent HIMSS conference: Enterprise imaging project tops 1,200 terabytes.  Wow that's a lot of data:

Cleveland Clinic is building an enterprise imaging repository that allows physicians to visualize everything that happens to the patient, including radiology images, tissue pathology, digital photos and more, according to Louis M. Lannum, director of enterprise imaging at Cleveland Clinic, who detailed the organization’s progress toward an enterprise repository during a Feb. 21 session at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS).

...

Cleveland Clinic’s analysis has shown that legacy images from more than three years ago are accessed less than 5 percent of time and after four years retrieval drops to less than 1 percent. However, policies dictate that images must be held seven years. Intelligent, cloud-based storage could help the clinic tame its ever-expanding data center.

It is fascinating how the supply and demand teeter totter is playing out with storage; the more demand there is for storage, the more economies of scale kick in and prices go down, which increases demand, which lowers prices.  The cost of cloud-based storage in particular has dropped dramatically.  Which enables people to think about storing ... 1,200 terabytes of data!

Roche Gains Clearance for Companion Diagnostic for New Skin Cancer Drug

The DarkDaily reports: Roche Molecular Gains FDA Clearance for Its Companion Diagnostic Test for New Skin Cancer Drug.

Recently, the Food and Drug Administration (FDA) cleared two products for market, one of which may be of particular interest to anatomic pathologists. The first product is a therapeutic drug for the treatment of late-stage skin cancer. The second product is a companion clinical laboratory test that will be used to identify skin cancer patients most likely to benefit from this new drug.

This development is attracting attention by experts watching the molecular diagnostics marketplace. That’s because both products were developed by the same company on a tight timeline and this process is likely to be much studied by other pharma companies and genetic test developers.

For years we've all been reading about the promise of these kinds of drugs coupled with these kinds of tests, but only Herceptin / Her2 stood out as a success story.  It is great to see more of these therapies and tests reaching the market.

Groundhog Day and digital pathology

Today is Groundhog Day, and I must tell you when I think about it I don't think about a large hibernating ground squirrel nor six more weeks of winter, I think about the awesome 1993 film starring Bill Murray, in which he is relives the same day over and over hundreds of times before he changes and ends up with Andie MacDowell.  He finds out the hard way that unless he approaches things differently, the results remain the same.

The same thing is true of many pathology labs.  They do the same thing over and over every day, with the same results.  The consistency is good, it leads to accurate and predictable medicine and good patient care.  But you have to change in order to improve.  In today's healthcare environment there is pressure to do more with less, improve efficiency and patient care at the same time.  Adoption of new technology requires change but leads to new results.

Digital pathology is a promising technology which is being used successfully today by many labs to improve efficiency and patient care, for healthcare applications such as secondary consultation, QA overreads, decision support, intra-operative consults, archival for risk management, tumor board preparation, clinican communication, and quantification of prognostic markers like IHC.

How about your lab, are you reliving Groundhog Day every day?  Or are you ready to change, adopt digital pathology, and achieve better results?

Healthcare missing from State of the Union

Like you, I watched the State of the Union address, and like you, I was amazed... Healthcare was missing!  The centerpiece of President Obama's plans, the thing he would say he was most proud of as an accomplishment, and yet it was not mentioned at all.  Of course it is a contentious subject and many healthcare organizations are waiting to see whether Obama will be reelected, in which case implemention of Obamacare will press forward, or whether a Republican challenger will take his place, and most probably work to repeal much of the legistlation.

For an interesting perspective you might enjoy this discussion on MedScape: Healthcare gone missing: The State of the Union Address.

Where you surprised by the omission?  What do you think that means for President Obama's second term?  Comments welcome...

CAP Today: Regulators scanning the digital scanners

Of the FDA’s decision to regulate whole-slide imaging systems as Class III devices, Aperio president Dirk Soenksen says, “They’ve made up their mind.... You’re talking five years at the earliest when someone’s going to get approval.” How broad will Aperio's submission be? “As broad as FDA allows,” he says.

Hi y'all.  You're probably familiar with CAP Today already - it's a great publication for anyone interested in Pathology, and it's available free online - but today's new issue has great article about the FDA panel discussion held at Pathology Visions in October: Regulators scanning the digital scanners:

A recent panel on whole-slide imaging launched a clear message from the Food and Drug Administration: The agency views WSI systems as Class III medical devices and plans to regulate them as such.

Depending on one’s view, the news will slow efforts to bring WSI for primary diagnosis into U.S. laboratories, with some vendors looking to Europe for regulatory relief; have virtually no impact on large vendors, who, while not necessarily enamored of the FDA’s decision, concede it’s one they can live with; kill the market completely; choke innovation among vendors, especially component makers; possibly put laboratories in jeopardy if they try to validate these systems as laboratory-developed tests under CLIA; or encourage laboratories to use WSI for other, already approved purposes, readying themselves for the inevitable day when whole-slide imaging transforms surgical pathology.

It's an interesting article, please check it out.  Among other things it makes the point that while regulators and industry leaders debate the future of digital pathology for primary diagnosis, the technology is in active use today for many other clinical applications, such as QA, secondary consultations, and image analysis.

What the Healthcare Industry Can Learn From Technology Start-Ups

This is an interesting post on The Health Care Blog, by David Shaywitz: What the Healthcare Industry can learn from Technology Start-ups:

I’ve been struck by some of the profound differences between a tech start-up (even one ostensibly in the healthcare space) and a biopharma start-up. In the standard biopharma model, you spend years developing a product, without having any real idea of (a) whether it will work, (b) whether it will be safe and well-tolerated, and (c) whether by the time you’ve demonstrated (a) and (b), anyone will care, or pay you for your efforts.

In contrast, [tech startup] MassiveHealth has managed to get a product in customer hands after a few months of work. True, they’ve probably not made any money thus far, and (not insignificantly) it’s entirely unclear whether they have, or will ever impact anyone’s health, massively or otherwise. Nevertheless, they have an extraordinarily powerful opportunity, at this very early stage, and after spending (I suspect) very little money, to learn, gather feedback, iterate, and explore.

The ability to launch early with a minimum viable product and immediately get feedback and iterate is so valuable.  This is one of the things that has allowed online services to flourish, they can change must faster than desktop software.  A key trend and most interesting to watch.

The $1,000 genome

The Wall Street Journal reports Soon, $1,000 will map your genes:

The quest to harness the power of DNA to develop personalized medicine is on the threshold of a major milestone: the $1,000 genome sequencing.

Life Technologies Corp., a Carlsbad, Calif., genomics company, plans to introduce Tuesday a machine it says will be able to map an individual's entire genetic makeup for $1,000 by the end of this year. Moreover, the machine and accompanying microchip technology, both developed by the company's Ion Torrent unit, will deliver the information in a day, the company says.

That's pretty amazing.  The cost of mapping an entire genome is rapidly approaching the cost of individual genetic tests; you can imagine that soon it will be just as inexpensive to sequence an entire genome as to look for a particular gene locus.  (Of course, for cancer treatment it will still be necessary to sequence the genome of a tumor, as well as the normal genes, to determine the defects that caused the cancer and guide treatment.)

The role of pathologists in interpreting these tests and working with oncologists and other clinicians to determine treatment will likely expand, and perhaps genetic subspecialties will form.

Five years of iPhone

As the iPhone and iPad become an ever bigger and more important tool for physicians - including pathologists - it is interesting to ponder five years of iPhone:

Five years ago today, Steve Jobs unveiled the new iPhone at Macworld Expo. The company has since delivered five generations of new hardware and iOS software as its mobile competitors have scrambled to defend their positions and take share back.

Jobs started his keynote with the words, "We're going to make some history together today...  This is a day I've been looking forward to for two and a half years.".

"Every once in a while a revolutionary product comes along that changes everything. One is very fortunate if you get to work on just one of these in your career. Apple has been very fortunate that it's been able to introduce a few of these into the world. In 1984 we introduced the Macintosh. It didn't just change Apple, it changed the whole industry. In 2001 we introduced the first iPod, and it didn't just change the way we all listened to music, it changed the entire music industry," Jobs said.

"Well today, we're introducing three revolutionary new products! The first one is a widescreen iPod with touch controls," Jobs said to applause. "The second is a revolutionary new mobile phone," he added to even more fervent applause. "And the third is a breakthrough internet communications device," to which the audience continued to applaud with less certainty.

"So, three things," Jobs said, repeating each of the three. He then repeated all three again, as his backdrop animated between an iPod icon, a Phone icon and the Safari icon. "Are you getting it?" Jobs asked. "These are not three separate devices! This is one device. And we are calling it iPhone. Today Apple is going to reinvent the phone. Here it is."

At this point, five years later, to say the iPhone has changed everything is nearly an under-statement; not only are iPhones and iPads everywhere, but the technology has influenced a huge industry of competitors including Google's Android, Microsoft's Windows Phone, RIM's Blackberry, Nokia, and Palm (now HP) just to name a few.  Tablets have become by far the fastest growing segment of the computer industry.  Where will be in five years?  Hard to say, but we can be sure iPhones and iPads are here to stay, and will become ever more promiment in Healthcare applications.

Pathology Labs Replace Microscopes with Digital Imaging

LabMedica reports on mainstream adoption of digital pathology in Sweden: Pathology Labs Replace Microscopes with Digital Imaging:

Microscopes are being replaced with digital imaging in pathology laboratories in the southern part of Sweden.

Traditional microscope glass slides are turned into digital images, which are then analyzed by pathologists directly from the computer screen, instead of using regular microscopes.

The revolution, which has already occurred in radiology, is now taking place in pathology. The contracted delivery not only digitizes the slides but also will completely renew IT support for all workflows of the pathology laboratories in the Skåne region.

It is interesting to ponder why Sweden has become a world leader in the adoption of digital pathology for clinical applications.  There are many demographic factors which have created demand.  But perhaps a key reason is the close integration between Digital Pathology vendors like Aperio with LIS vendors like Software Point.  Perhaps this can be a model to foster adoption in other countries.

Happy New Year! 2011 was quite a year, and 2012 here we come...

Happy New Year everyone!  Well 2011 was quite a year, and 2012 here we come...  so what do we think will happen this year?  More adoption of digital pathology, more applications, more success stories, and more learning about the best uses of this incredible technology.  And more mainstream acceptance.  What do you think?  Please post your comments to let us know!

Happy Holidays from the Daily Scan

Greatings readers just wanted to wish everyone a Happy Holiday, whatever you may celebrate this time of year.

It's been quite an interesting year, and quite a year for the growth of digital pathology.  Many labs and pathologists have become more comfortable with this technology and are exploring the many ways it can deliver value for them, and adoption seems to be moving from "if" to "when".

And next year should be even more interesting...  I'm tempted to make predictions, but every time I do they are both too optimistic (regarding time) and yet not wild enough (regarding all the possible applications people will uncover).

Happy New Year and stay tuned!

Medscape: most-read Pathology articles of 2011

If you're a Medscape subscriber, you'll find this interesting: the most-read Pathology articles of 2011.  (Subscribing to Medscape is free.)

#3 on the list is FDA approves test to determine Her2 status in breast cancer, about a new ISH genetic test using digital pathology.

#2 on the list is Pathology Consultation: Reporting of Critical Values.  This is typical of the articles indexed by Medscape, a scholarly review article.

#1 on the list is NSCLC: Histology first, then mutation testing, a report from the National Comprehensive Cancer Network annual conference.

Check out the entire list, and Medscape itself if you haven't before, it's a great resource.  I wonder what will be the articles of most interest in 2012?

Skylight turns your smartphone into a microscope camera

This is pretty cool: PC World reports Skylight turns your smartphone into a microscope camera, about a Kickstarter project* to build a hardware mount that lets a smartphone be used to take pictures through a microscope eyepiece.

One of the highlights of science classes in school had to when we got to toy around with microscopes. Of course, while most microscopes in school were fairly basic models, the kits used in professional fields such as microbiology can cost thousands of dollars--money that not everyone has, meaning less access to the technology.

Andy Mill was trying to make a low-cost solution to this issue when he created Skylight, an adapter that can connect most smartphones to a variety of different microscopes. Skylight works by aligning your smartphone's camera with a microscope's eyepiece, allowing you to record a video or snap a photo through the lens.

I love this idea and have contributed to the project.  I look forward to getting one with great interest, and can't wait to play with it!

Stay tuned!

* BTW Kickstarter is a great website where people who have ideas can raise money from other people who like their ideas.  SkyLight has raised over $18,000 exceeding their $15,000 goal, enough for them to take their idea from making prototypes into production manufacturing.

Indolent or aggressive?

I touched on this the other day, with a post about Liron Pantanowitz' views, but The Economist has an article about the Stanford University Science Translational Medicine article: Indolent or Aggressive?  (A computerised pathologist that can outperform its human counterparts could transform the field of cancer diagnosis):

LOOKING for needles in haystacks is boring. But computers do not get bored. Contracting out to machines the tedious business of assessing the dangerousness of cancer cells in histological microscope slides ought thus to be an obvious thing to do. Cervical-cancer smear tests aside, however, such electronic intrusions into the pathology laboratory are limited. Grading cancer cells into “indolent” and “aggressive”, and hazarding an opinion about whether they spell a treatable condition or an untreatable one, has remained the realm of the human expert.

Of course for those of us who have been working in the field of digital pathology, this idea is nothing new, and in fact simply represents an evoluation of tools; pathologists have been using computer quantification of IHC and other biomarkers for quite a long time. 

Perhaps the thing that is new is this idea is attracting public attention.  Perhaps that will help create the right economic conditions for technologies which provide better outcomes to be adopted.

RSNA: Personal cloud servers offer a low-cost, secure option

HealthImaging reports from RNSA: Personal cloud servers offer a low-cost, secure option:

Commercial cloud computing data sharing such as Evernote and Dropbox are used every day by the general public and offer all the advantages of mobile data retrieval, but they are not appropriate for radiologists to share medical information with one another. One alternative could be the creation of a personal cloud that is maintained by the department that uses it, according to a poster presentation at the 97th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).

The most likely future is a combination, where commercial cloud services are used as a substrate upon which personal clouds are built.  There is little doubt that cloud-based storage is increasingly attractive as an alternative to locally maintained data, especially for large objects such as medical images.

Top pathologist looks at future of technology for breast cancer research

Northwestern University's Medill Reports has a nice article featuring Liron Pantanowitz of UPMC: Top pathologist looks at future of technology for breast cancer research.  He comments on a Stanford study which discussed computer analysis of breast tumors:

Q. Where do you see medicine and technology going from here?

A. While tools like this are definitely helping us move towards practicing better personalized medicine, I do not believe that they will replace the pathologist. Rather, in this new era of digital pathology, pathologists will be able to use more and hopefully better tools. In radiology, for example, even though their images have been converted to digital format for many years now, radiologists are still required to interpret these images, called upon to apply appropriate computerized tools, and are in the best position to interpret the results from these analyses. I think the future of digital pathology is bright and with studies like this I am pleased to see that we are headed in the right direction.

A measured response, I would agree.  As Digital Pathology becomes more accepted for various applications, it is becoming clear that it is a valuable tool for aiding pathologists, but it won't replace them.

Going Viral - the promise of viruses as biotech tools

In TheScientist viologist William McEwan ponders the promise of viruses as biotech tools: Going Viral:

Molecular biology has not achieved its potential. Why do people still die from cancer? Why are there so few effective antivirals? Where is the HIV/malaria/common cold vaccine? Why aren’t genetic diseases routinely treatable with gene therapy? Certainly we can point to plenty of successes—the papilloma virus vaccine made from recombinant pseudovirions and rapid diagnostics for many diseases are two examples—but even the optimists among us must concede that molecular biology is not where we might have hoped 25 years ago. What went wrong?

Simply put, life on the molecular scale is much more complicated than we imagined. Molecular biology roared onto the scene in the mid-20th century when James Watson and Francis Crick illuminated the “too beautiful not to be true” structure of DNA and the deciphering of the genetic code. But the simplicity and elegance ends right there. Biology at the protein level is far removed from the linear, digital code of nucleic acids. Biological organization at the cellular or organismal levels is even less linear. Understanding life on these scales is not impossible, but we have to work it out one interaction, mechanism, and pathway at a time. Making sense of the complexity will surely take the rest of this century (though I’d love to be wrong about that!). As each small piece of biology is understood, we gain something extra to work with, something tractable and, ultimately, engineerable.

...

As a virologist, I may be biased, but I believe the greatest advances in molecular therapies in the near future will involve viruses. Compact biological entities with little more than a handful of genes and a protein coat, viruses lend themselves to engineering. That’s not to say they aren’t also complex: HIV envelope protein for instance is known to associate with 176 human proteins at the last count. But viruses know their hosts well—they can break into cells undetected, switch off alarm systems, and undermine the cell’s authority in deciding which genes get expressed. It is this acuity, acquired by trial and error over millions of years of coevolution with their hosts, that researchers are tapping to design novel therapies.

Cool.  The trojan horse mechanism of cellular level therapy.