future of pathology
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
Future of Pathology
Jared N. Schwartz, MD, PhD FCAPPresident, College of American Pathologists
Digital Pathology Solutions ConferenceOctober 2007 · San Diego, CA
PATHOLOGYVISIONS2
007
The struggle of today, is not altogether for today—it is for a
vast future also.
The struggle of today, is not altogether for today—it is for a
vast future also.
~ Abraham Lincoln
Technology is transforming the delivery of patient care
Clinical transformationis occurring
Time
Episodic
Treatment of
Disease
Reactive Care
Personalized
Medicine; Disease
Prevention
Proactive Health
Management
Variation
Between Styles
Chaotic Flux
Medicine
Why now?
Tumor
Cell
Chromosome
Proteins
Genes
DNA
Tumor
Cell
Chromosome
Proteins
Genes
DNA
Dramatic technology advancements provide new insight and the ability to answer the vital questions that drive diagnosis, and prognosis and therapy
• 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?
• Minimally invasive/incision-less surgery
• Tissue characterization and imaging (virtual histology; microendoscopy)
• Molecular medicine
• Tumor-specific in vivo biomarkers
• Proteomics
• Virtual colonoscopy
• Integrated information systems
• HPV and other vaccines
What happens if there is What happens if there is no tissue to look at?no tissue to look at?
And this transformation has implications for pathology
Digital imaging has already progressed on the technology adoption curve
SaferInvestment
Market-ShapingOpportunity
High-Risk Investment
InnovatorsEarly
AdoptersConsensus
AdoptersCautiousAdopters
LateAdopters
1 2 3 4 5
Very SafeInvestment
SaferInvestment
Market-ShapingOpportunity
High-Risk Investment
InnovatorsEarly
AdoptersConsensus
AdoptersCautiousAdopters
LateAdopters
1 2 3 4 5
Very SafeInvestment
Market-ShapingOpportunity
High-Risk Investment
InnovatorsEarly
AdoptersConsensus
AdoptersCautiousAdopters
LateAdopters
1 2 3 4 5
Very SafeInvestment
Beta and early production models available; not FDA approved
Devices available & FDA approved; reimbursement not wide spread. Trials focused on patient mgmt
Becoming standard of care; patient guidelines established and applied. Reimbursement established with major players
Accepted Standard
Pro
bab
ilit
y o
f A
do
pti
on
in
to C
lin
ical
Us
e
0Pre-Clinical
3Consensus Adopters
2Early
Adopters
1Innovators
5Late
Adopters
4Cautious Adopters
Pyrosequencing
Proteomics for cancer screening
POCT PLT fn testing
Pharmacogenetics for DMEs
Microwave tissue processors
Laser capture microdissection
Lab automation
Intraoperative PCR
InVivo Histology
HR HPV PAP adjunct
HPV vaccine
Genetic risk assessment
Continuous monitoring
Comparative genomic
hybridization
Companion DxWaived CBC test
Circulating tumor cell
assay
CAD for Pathology
Digital imaging for path
Screening virtual colonscopy
Sample to answer PCR
Gene expression assays
Positive Impact
Magnitude of Impact--UNSURE
Tech Curve Position-- UNSURE
Color Key
Technology Curve
Imaging for tissue characterization
Robotic telepathology
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
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
40-sec20x scan
20-second40x multi-angle
scan
20-sec20x scan
Multispectral imaging
Subspecialistwork flow
triage
Rapidsecondary
consultations
Computer-aided detection
Pathology PACS
Enterprise image management
100 PetabytesPetabytes100 Terabytes
Computer-aided diagnosis
Ima
gin
gS
tora
ge
Ap
pli
ca
tio
ns
2007 2012 2017
* Source: Sg2 T3 Virtual Slide Imaging
Each pathologist and organization has a place on the Tech Curve
Early Adopters—target for leadership and
resource committees
Innovators—target for foundation grants
Consensus Adopters—Primary target for education and accreditation products
Late Adopters—Members at the
sunset of their careers
Cautious Adopters—Target for technology education
1 2 3 4 5
Early Adopters—target for leadership and
resource committees
Innovators—target for foundation grants
Consensus Adopters—Primary target for education and accreditation products
Late Adopters—Members at the
sunset of their careers
Cautious Adopters—Target for technology education
1 2 3 4 5
Where is the specialty of pathology?
“Never, ever, think outside the box.”
If pathologists don’t step up, others will battle over the turf
The Battle of the Barbers and Surgeons, 18th c. caricature
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 exceptionPathology is no exception
ABR Board exams address pathologyDiagnostic radiology now encompasses a variety of diagnostic and image-guided therapeutic techniques, including all aspects of radiological diagnosis, nuclear radiology, …molecular diagnostics and morphology…Integrating pathologic assessment into your radiology reports requires effective management of pathology technicians and adequate quality control. New Board exams address the technical and management skills needed.
ABR Board exams address pathologyDiagnostic radiology now encompasses a variety of diagnostic and image-guided therapeutic techniques, including all aspects of radiological diagnosis, nuclear radiology, …molecular diagnostics and morphology…Integrating pathologic assessment into your radiology reports requires effective management of pathology technicians and adequate quality control. New Board exams address the technical and management skills needed.
Reluctance to train in new technologies opens the door to others to seize the opportunity
Main Topic at ACR’s 2007 ForumLeadership 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?
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…
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!”
ImagingImaging
Prognosis & TreatmentPrognosis & Treatment
Predisposition, Signs, SymptomsPredisposition,
Signs, Symptoms
The value of traditional pathology has not diminished.
It is simply no longer sufficient.
Pathologist
Gene ExpressionPharmacogenomics
Gene ExpressionPharmacogenomics
BiomarkersBiomarkers
TraditionalPathologyTraditionalPathology
Pathologists can generate test results…
OR
provide answers that guide the treatment team with diagnosis and therapy
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
Pathologists are not defined by the tools they use, but the
knowledge they share
…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?”
So, what’s it going to take?
Get back to being a physician!
Get back to being a physician!
“It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.”
~ Charles Darwin