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Future of Pathology

Future of Pathology. Jared N. Schwartz, MD, PhD FCAP President, College of American Pathologists. PATHOLOGY VISIONS. Digital Pathology Solutions Conference October 2007 · San Diego, CA. 2007. The struggle of today, is not altogether for today—it is for a vast future also.

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Future of Pathology

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  1. Future of Pathology Jared N. Schwartz, MD, PhD FCAP President, College of American Pathologists PATHOLOGY VISIONS Digital Pathology Solutions Conference October 2007 · San Diego, CA 2007

  2. The struggle of today, is not altogether for today—it is for a vast future also. ~ Abraham Lincoln

  3. Proactive Health Management Personalized Medicine; Disease Prevention Chaotic Flux Medicine Variation Between Styles Reactive Care Episodic Treatment of Disease Time Technology is transforming the delivery of patient care Clinical transformation is occurring

  4. Why now? Dramatic technology advancements provide new insight and the ability to answer the vital questions that drive diagnosis, and prognosis and therapy Tumor Cell Chromosome Proteins Genes DNA • What disease/condition do I have? • Which drug should I use • How much drug do I need? • Is the drug working? • Is my disease gone?

  5. And this transformation has implications for pathology

  6. Digital imaging has already progressed on the technology adoption curve Becoming standard of care; patient guidelines established and applied. Reimbursement established with major players Devices available & FDA approved; reimbursement not wide spread. Trials focused on patient mgmt Beta and early production models available; not FDA approved Accepted Standard

  7. CAD for Pathology HR HPV PAP adjunct Technology Curve Genetic risk assessment Companion Dx Waived CBC test Sample to answer PCR HPV vaccine Gene expression assays Microwave tissue processors Continuous monitoring Screening virtual colonscopy Pharmacogenetics for DMEs Lab automation Imaging for tissue characterization POCT PLT fn testing Robotic telepathology Digital imaging for path Proteomics for cancer screening Probability of Adoption into Clinical Use Comparative genomic hybridization InVivo Histology Circulating tumor cell assay Color Key Intraoperative PCR Positive Impact Laser capture microdissection Magnitude of Impact--UNSURE Tech Curve Position-- UNSURE Pyrosequencing 2 Early Adopters 0 Pre-Clinical 1 Innovators 3 Consensus Adopters 4 Cautious Adopters 5 Late Adopters

  8. Its impact on pathology will increase Accelerators • Decreased cost with ongoing product enhancement • Clinical demand for pathologist sub-specialization • Patient demand for reduced TAT for rapid, advanced diagnostics • Demand for complete EMR, including multimedia Dx data • Hospital demand for rapid TAT and value enhancement for differentiation

  9. 40-sec 20x scan 20-sec 20x scan 20-second 40x multi-angle scan Imaging Multispectral imaging Rapid secondary consultations Subspecialist work flow triage Applications Computer-aided detection Computer-aided diagnosis 100 Terabytes Petabytes 100 Petabytes Enterprise image management Storage Pathology PACS 2017 2007 2012 It is just a matter of time Barriers • High equipment costs and work flow change • Parallel technology developments • Automation • Image acquisition • Standards agreements • Data storage • Communication and clinical applications * Source: Sg2 T3 Virtual Slide Imaging

  10. Consensus Adopters Consensus Adopters — — Primary target for education Primary target for education and accreditation products and accreditation products Early Adopters Early Adopters — — target target Cautious Adopters Cautious Adopters — — Target Target for leadership and for leadership and for technology education for technology education resource committees resource committees Late Adopters Late Adopters — — Members at the Members at the Innovators Innovators — — target target sunset of their careers sunset of their careers for foundation grants for foundation grants 1 1 2 2 3 3 4 4 5 5 Each pathologist and organization has a place on the Tech Curve Where is the specialty of pathology?

  11. “Never, ever, think outside the box.”

  12. If pathologists don’t step up, others will battle over the turf Clinical care has a history of conflict A reluctance to train in new technologies opens the door to others to seize the opportunity. Pathology is no exception The Battle of the Barbers and Surgeons, 18th c. caricature

  13. Reluctance to train in new technologies opens the door to others to seize the opportunity Main Topic at ACR’s 2007 Forum Leadership in Radiology …Forum attendees worked to pinpoint ways in which the ACR and its partners can better identify, cultivate, and empower a new generation of radiology leaders in these increasingly turbulent times… Could it happen?

  14. Myths and rumors about the future may be inhibiting action • Pathology is merging with radiology • There is too much to learn; I don’t have time • Emerging technologies won’t impact my practice • Besides nobody will pay for it • We are turning into dinosaurs • Etc., etc. etc…

  15. Opportunity exists for pathologists that are ready “Opportunity paged me, beeped me, linked me, emailed me, faxed me, and spammed me. But I was expecting it to knock!”

  16. Imaging Gene Expression Pharmacogenomics Biomarkers Traditional Pathology Pathologist Prognosis & Treatment The value of traditional pathology has not diminished. It is simply no longer sufficient. Predisposition, Signs, Symptoms

  17. Pathologists can generate test results… OR provide answers that guide the treatment team with diagnosis and therapy

  18. Pathologists are physicians… …take an active role in patient care, utilizing all available tools to integrate and interpret diagnostic information to provide an accurate diagnosis of disease. Pathologists work closely with other members of the medical team to assess the patient condition and prognosis in order to determine optimum therapy alternatives. Pathologists are not defined by the tools they use, but the knowledge they share

  19. …so, what can you do? • Acknowledge market forces driving changes in practice of pathology • Re-assess your tool kit—all diagnostic tools are available to you • Engage the change—integrate new concepts and technologies • Be life long learners; don’t use the certification exam as the guidepost • Expand beyond the tissue on the slide “I’ll be happy to give you innovative thinking. What are the guidelines?”

  20. So, what’s it going to take? Get back to being a physician!

  21. “It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.” ~ Charles Darwin

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