The business case for digital pathology
This presentation is the property of its rightful owner.
Sponsored Links
1 / 40

The “Business Case” for Digital Pathology PowerPoint PPT Presentation


  • 79 Views
  • Uploaded on
  • Presentation posted in: General

The “Business Case” for Digital Pathology. A work in progress . . . Luke Perkocha, UCSF. What will I talk about today?. WSI mainly, though static and dynamic telemed; gross imaging; teleconferencing; other IT applications, AP-LIS systems, maybe as important, as enabling technologies

Download Presentation

The “Business Case” for Digital Pathology

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


The business case for digital pathology

The “Business Case” for Digital Pathology

A work in progress . . .

Luke Perkocha, UCSF


What will i talk about today

What will I talk about today?

  • WSI mainly, though static and dynamic telemed; gross imaging; teleconferencing; other IT applications, AP-LIS systems, maybe as important, as enabling technologies

  • Clinical, educational apps. – not research

  • A couple of basic business principles

  • The “drivers” for digital radiology/PACS

  • Some “niche” business cases now

  • ? Catalysts for more rapid adoption


Who am i my perspective

Who am I?(My perspective)

  • Interested novice

  • Career in Private Practice

  • Dot-com Vet

  • Recent career change – Academics

  • “Thought experiments” – no data!

  • Disclosure – Aperio MAB


Where am i

Where am I?

  • Academic medical center

  • Competitive market environment

  • Only limited digital pathology now

    • Gross photos, not stored in LIS

    • Robotic scope for FS at home, Tx service, very limited daytime use for consultation on FS

    • Manual quantification of ER/PR Her2

    • WSI Images used in teaching, still have scopes

    • No document management

    • No images in reports or LIS

    • No WSI imager in-house


Business principles

Business principles:


Business principles1

Business principles:

Things that don’t work


We re losing money on every case we can make it up on volume

“We’re losing money on every case – we can make it up on volume”

  • Example: UCSF Teledermatology

  • Store and forward model

  • Underserved (under-insured) population

  • Phone calls, secretarial time, paperwork, coordination, billing problems

  • Recognized and being addressed

  • Digital Pathology Dream: “The world is our market!” – make sure it doesn’t take longer and cost more than mailed-in slides.


I think this is the coolest thing everyone will want it just as much as i do

“I think this is the coolest thing – everyone will want it just as much as I do!”

  • Corollary: Everyone will be willing to pay (extra) for it.

  • Developing the market for something new and different is within the financial capacity of the organization.


Business principles2

Business principles:

Things that work


Potential profit mechanisms

Potential Profit Mechanisms

  • Increase revenue:

    • More $ for same thing: New CPT, extra pay for digital “enhancement” of what we do now (Thin Prep)

    • More $ for new thing on same spec: New CPT, extra pay for digital analysis (extrapolation / quantification / CAD), what we can’t do now, but on same specimen (HPV)

    • Virtualization expands geographic market: $ from new customers, increased volume from a new business channel

  • Lower costs:

    • Lab benefit - Increased productivity (↓cost/unit lab svc); create capacity

    • Institutional benefit – in a dispersed multi-specialty department, ↓TAT (even if ↑lab cost) may save $ on overall care delivery (Mayo model)

    • Reduce non-productive costs (errors, losses, redos)


Looking at radiology early drivers

Looking at radiology – Early drivers

  • Lost films – legal; staff time; re-do; patient care; lost revenue

  • X-sectional images – radiologists quickly overwhelmed – PACS enabled “stack mode”

  • Radiologist shortage


The business case for digital pathology

Source: Dreyer, et. Al. PACS, 2nd ed. 2006


The business case for digital pathology

Source: Dreyer, et. Al. PACS, 2nd ed. 2006


The business case for digital pathology

Source: Dreyer, et. Al. PACS, 2nd ed. 2006


The business case for digital pathology

Sunshine and Meghea. AJR 187: November 2006

Q:


The business case for digital pathology

Hypotheses Investigated

  • Growth of imaging abated – No, up 23%

  • Non-radiologists doing more – No, rads up 15%

  • More offshore outsourcing – Yes, but Americans

  • Radiologists retiring later – No

  • More residents turned out – No

  • Fewer residents take fellowships – No

  • Radiologists working more hours – No

“CONCLUSION. Increased productivity is the predominant explanation of how the radiologist shortage eased. The contribution of other factors was, in comparison, small or even in the opposite direction.”

A:


The business case for digital pathology

How is it that productivity increased enough between 2000 – 2003 to not only handle the increased workload, but ease the shortage of radiologists?

  • Hi tech – digital imaging and PACS, other technology (telephony, EMR results delivery, etc.)

  • Lo tech – improvements in workflow, use of physician extenders – enabled by technology


Radiology unexpected drivers

Radiology – Unexpected drivers

  • Productivity gain from digital + PACS workflow improvement ~ overall 30%

  • Growth capacity with same staff   technical and pro fee revenue:a real ROI for radiologists, hospitals AND industry

    • Medicare: “contemporaneous reading requirement”

    • Nighthawks – lifestyle issue


Tracked costs eliminated

Digital Radiology

Labor: developing, storing, retrieving, 24/7 staffing

Capital: Developers, Film alternators, misc.

Consumables: film, developer chemicals, film jackets

Disposal: chemical waste, recycling

Space: darkroom, film storage

Digital Pathology

Labor: ? courier

Capital: ? cars

Consumables: ? recuts for lost slides

Disposal: ?

Space: ? glass slide storage (legal to be solved)

Tracked Costs Eliminated


Glass based pathology untracked costs

Glass-based Pathology: Untracked Costs

  • Pathologist productivity loss from “batch mode” operation, bad workflow – will pathology PACS fix this?

  • Wasted staff time looking for lost tumor board slides; pulling old bx for compare, etc.

  • Delay in diagnosis, waiting for sub-specialty consultation; courier slide transport from remote lab

  • Patient safety / errors (if PACS forces machine tracking of assets)

  • “Opportunity costs” of lost business due to slow TAT


The business case for digital pathology

“Perfect storm” for adoption of digital radiology and PACS

X-S Data Expl

Lost Films

Rad Shortage

DICOM

Overt Cost Reduction

Comp Pwr, Cost

Profit Potential


The business case for digital pathology

“Perfect storm” for adoption of digital pathology and PACS?

+ / -

IPOX Data Expl

Lost Slides

Path Shortage

SOON

Standard

Overt Cost Reduction

YES

Comp Pwr, Cost

Profit Potential


The business case for digital pathology

  • “Digital pathology is no longer a dream. Doctors have begun to diagnose diseases by using computers like microscopes… Pathology is just beginning to enter the digital era… It’s a change that promises faster diagnoses for patients and potential cost savings for hospitals.”

    • Story on PBS’s Nightly Business Report, July 10, 2008


The business case for digital pathology

  • “Doctors in the US and other countries have long practiced variations in telemedicine to provide care to …underserved locations. But in the future, telemedicine will be practiced more as a way of distributing work loads and lowering costs…Outsourcing and offshoring of medical services will increase, providing more …cost-effective healthcare.”

    • Wall St. Journal, Oct. 20, 2008


The business case for digital pathology

  • “In the future, there will be three often overlapping modes of delivering healthcare services: …performed in person by humans … performed by people at a remote location … performed by computers without direct human involvement.”

    • Wall St. Journal, Oct. 20,2008


Storm clouds gathering in pathology

Storm clouds gathering in pathology?

  • Patient safety  media focus  a “brand” issue for the institution

  • Histotechnologist shortage  “breakthrough” robotics (continuous flow)… or skip the glass …

  • Path PACS perceived as a “growth market” by mega-technology companies?

  • DICOM – 26 or other; bar code effort APIII

  • Demographics: newpath @ home

  • Disruptive biz models: off-shoring; e-Bay for biopsies; “virtual” practice models


Applications considered at ucsf

Applications Considered at UCSF

  • Medical Education: Students, residents, CME, remote learning

  • Remote FS – nights, expert at other hospital

  • Virtual Consultation – distributed practice (may have clinical ROI)

  • QC – IPOX

  • Tumor Boards – Spinosa study, requires PACS to realize full potential cost savings

  • Quantitative image analysis

  • Other CAD applications

  • Routine digitization of all cases ???

  • New business models, enabled by virtualization


Education

Education

  • Med Student Histology / Pathology courses: improved quality, inexpensive, but no cost savings; other places get rid of scopes

  • Resident frozen section / teaching archive: improved quality, inexpensive, but trivial cost savings from current system

  • CME: cases distributed virtually, some cost savings w/o glass slides, improved revenue if attractive to registrants

    • Competitive advantage  price of entry


A big hairy audacious business case

A “Big Hairy Audacious Business Case”

Dot-com era justification to ask for ridiculous sums of money to commercialize a hair-brained idea


Summary

Summary

  • No compelling business case now for full digitization of routine cases in most labs

  • Niche business cases exist now

    • Education, Remote FS / Consultation, IHC Quantification

    • Tumor Boards, QC

  • These may not apply in all settings – local cost/benefit must be assessed

  • Routine digital path probably will make business sense in the future, but when?

  • “Catalysts” that bring this about may not be the ones we now predict


Thanks

Thanks !!

  • Ron Arenson, David Avrin, Radiology UCSF, ASNR

  • Paul Chang, Rads and Path, U Chicago

  • APIII Faculty

  • Bruce Wintrobe, Ilona Frieden, Dermatology, UCSF

  • Abul Abbas, Linda Ferrell, Pathology, UCSF


  • Login