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Discussion in 'Pathology' started by becausepath, May 25, 2017.
Whole slide imaging for primary diagnosis: ‘Now it is happening’ - CAP TODAY
I read this. What are people's thoughts? I don't think my microscope is going anywhere any time soon, and I don't want it to.
I will read from my bedroom, $5/slide. Have fun with your microscope.
It's about bloody time.
So far I much prefer glass slides. The time it takes to scroll around and scan a digital slide is just far too long still. It may change, and I'm sure this will lead to some disruption in the field, especially when it comes to consults and sharing cases. But for my daily caseload glass is the way to go.
Pathologist looking at slides under microscope at 10X without the stage is and will be the fastest way to do the work. Have been hearing whole slide imaging for years. It may have some utility under special circumstances. Its like a plane on an autopilot. First you needed a pilot to fly a plane. Now you need a pilot and a dog(Pilot in case autopilot doesn't work, dog to make sure pilot doesn't keep fingering anything while sitting idle).
Cool. Costs $5, at most, to make a glass slide taking all your fixed costs into account.
What's it going to cost to have a dedicated IT support team, site and off-site licenses for proprietary viewing software, and routine server expenses and maintenance for these very large files? In addition, what's the difference in turn around time between just making the slide and reading it the old fashioned way versus loading it into the machine to be scanned and uploaded for review? And last time I checked, you still need to make the glass slide for this big deal of a digital wonder to happen.
This is a neat concept, but won't supplant the microscope any time soon because the one time cost of a $20,000 microscope (and that's if you get fancy) over a pathologist's career is far cheaper than running a whole IT operation just to read the same slide digitally. I'd just like to see a group trying to get their hospital administrator to approve this one.
Depends on who controls the specimens and the practice setting. Slide scanning can be quite fast and automated, and there doesn't have to be a capital investment on the part of a practice or a hospital. Send the slides to a scanning company and for a cost per slide they will scan and store them for remote access. At that point you could have the lowest bidding state-licensed pathologist read it. It may be cost effective for pod lab-type specimens. For small hospital systems, as you point out, it doesn't make financial sense.
Sure in some settings this will be they way to go. Most settings I don't see this as helpful. The cost benefit is not yet here.
I agree the cost is way too much.
practicality limits how quickly this tech might replace glass. Unfortunately, I don't think it will replace glass in the next decade, but it may exist alongside glass slides for purposes of archiving and consultation.
In the future though, slide scanning has the capability of increasing the speed of specimen processing - machines may be able cut, stain, and scan tissue specimens right as the come off the block. Couple this with newer and fast optical modalities that enable things like optical sectioning or 3-D imaging, and we could cut thicker specimens so that more information were available.
Hopefully this ultimately translates to improvements in diagnostic capability and of course patient care.
Still, most pod-lab setups require that the pathologist sign out the case at the physical location where the billing takes place. In most of those instances the TC is already outsourced to a lab somewhere, and the PC is all that happens at the pod lab office. The pod lab already essentially hires pathologists at the lowest going rate. I don't see how this would lower that rate for the PC component.
It can't really "replace" glass since you need to make the glass slide either way in order to scan it. That may change with technology and image processing and such. It's different than radiology since you don't need to make the plain film in order to digitize it. So right now digital path is a "cost plus" problem - it's taking an extra step so that you can look at the slide from somewhere else. That might save some money in certain circumstances but probably not for routine stuff yet.
I'm being a bit ridiculous here for the sake of discussion, but if scanned slides can be used for diagnosis, then wouldn't I be billing where I am reading the slide which would be at my computer? I agree that most of those pathologists are earning only a small fraction of the revenue they generate, but it would allow an even larger cohort of pathologists to be available to sign out a given case which could possibly contribute to the "race to the bottom". If I wanted to make money a few hours on the weekend or on sleepless night, instead of being an Uber driver, I could log in and sign out a few dozen cases?
As far as creating digital slides and bypassing glass, that is not what this story is about, though I am certain it will be done in the future somehow...FDA approval for that would probably be much more challenging.
Remote reading does not benefit all pod , GI labs or other situations trying split PC. Clearly it can help some practices.
In these situations, the pathologist can only work off site if they are more less full time (at least 75% of their time is devoted to that practice).
If you intend to read MC or government cases. Otherwise they have to be on site.
I suspect a few clever business folks will now do this only for the commercial insurance. The lab makes TC and Bills.
The pathologist is merely is off site for the PC and the split the PC.
I call it the new style client billing. In some states this could be illegal especial if the are not providing space and equipment.
Also, I believe you must get CLIA certificate for high complexity testing at each location even if you read commercial insurance.
This means you are going be inspected as lab. Not so Uber IMO.
I'm doubtful about the practicality of putting this in place. I look at the quality of the people trying to do this at my institution and, I must say, it's like a high school AV club. I wouldn't trust these people to read at a 3rd-grade level, much less pathology slides. I think most competent pathologists will want to see glass slides for a myriad of reasons.
I'd also point out that it's really hard for the Russians (or anyone else for that matter) to hack into a slide storage room (although why anyone would want to hack into and grab a bunch of tissue slides is beyond me, but still, I think after the 25,000 HIPPA training videos I've watched, I have the right to use that law in a way that actually benefits my argument, be it as absurd as it may be). Cybersecurity is probably going to limit implementation of this anyway.
The point is that for most pod labs the only way they make money off pathologists is if the pathologist reads the slide on site. That's the letter of the law. So you can't read the slides at home on your computer for them, it wouldn't be legal in most instances if they are billing for your services at their site. That's why this makes sense from a TC angle but not a PC angle. If you still have to physically read the slides at the pod lab, it doesn't matter whether they're glass or virtual.
Labs in the US are required to keep the slides 10 years. I think it is the same for the digital images.
So I don't think digital storage is the best argument for adoption of digital in this country.
How large are the file sizes for the images this app makes? Does it save to your phone or upload to a cloud service?