Jul 5, 2017 | Instruments & Equipment, Laboratory Instruments & Laboratory Equipment, Laboratory News, Laboratory Operations, Laboratory Pathology
Demonstration project to move lab specimens by drone was successfully conducted in this alpine nation by Swiss Post and an eight-hospital health system
Delivering clinical laboratory specimens from point A to point B while maintaining the quality and integrity of critical samples is an ongoing issue for medical laboratories and pathology groups worldwide. This is especially true in countries prone to long winters and large amounts of snow. Ground transportation in those areas often experience delays, which can prevent hospitals from receiving needed test results and progressing with treatments that could save lives.
Switzerland is now taking the lead in using drones to transport medical laboratory specimens. In what is believed to be a global first, Ticino EOC, an eight-hospital medical group in Lugano, Switzerland, partnered with Swiss Post (Switzerland’s postal service) and transportation technology manufacturer Matternet of Menlo Park, Calif., to successfully transported laboratory samples between two of Ticino EOC’s hospitals by air using unmanned aerial vehicles (UAVs), commonly called drones. The samples arrived in good conditions after sailing high above blocked roadways. This demonstration project showed that drones can be used to safely deliver much needed lab specimens in both urban and remote rural medical settings.
Drones Present Opportunities for Medical Providers
The Ticino EOC group consists of eight hospital locations:
- Lugano Regional Hospital;
- Three locations of the Regional Hospital of Bellinzona and Valli (Bellinzona, Faido and Acquarossa);
- Mendrisio Regional Hospital;
- Locarno Regional Hospital;
- Novation Rehabilitation Clinic; and
- Oncological Institute of Italian Switzerland.
Matternet’s M2 drone is a quadcopter that travels up to 12 miles on a single battery charge. At just over 2.5 feet in diameter, the M2 can transport parcels up to 4.4 pounds. It cruises at about 22 miles/hour at an altitude of approximately164 to 328 feet above the ground.
According to Matternet’s website, the M2 is “engineered with encrypted communications, a parachute, precision landing, and a host of other safety features” and is “designed to be safe around people and infrastructure.”
Matternet received certification from the Swiss Federal Office for Civil Aviation (FOCA) to fly the drones at any time of the day. FOCA, along with Swiss Post, handle any regulatory issues involved in transporting human blood tissue and other medical laboratory specimens by drone and over public spaces.
“This is a big milestone for us. It means we can operate our technology throughout Switzerland. This will open a big opportunity in medical and e-commerce,” stated Andreas Raptopoulos, Matternet’s cofounder and CEO, in a TechCrunch article.
Matternet’s M2 drone (above) has been used to deliver biological samples between two hospitals in the town of Lugano, Switzerland. (Photo copyrights: Matternet/Swiss Post.)
An additional safety certification is still needed before Swiss Post adds medical drone deliveries to their official services. The packaging that will contain blood samples or any other biohazard materials still requires approval. Swiss Post hopes to be using the drone service regularly for the transportation of lab samples by 2018.
Each drone can be launched using a smartphone application. The launching and landing sites transmit an infrared signal that the drone homes in on. It then delivers the specimens to their predetermined destinations. In the event of an in-flight failure, the drone discharges a parachute and lands.
Delivery by UAV Not New to Healthcare
This is not the first venture to use drones in the field of healthcare. Zipline, a logistics company based in Silicon Valley, is working with the Rwandan government to deliver blood supplies to rural clinics by drone. The company’s website states that, as of May 2017, they have completed over 350 deliveries of blood products to hospitals in Rwanda.
An article appearing in the scientific journal PLOS ONE, highlighted how important drones can be in serving people in rural and economically impoverished areas. Drones can provide healthcare workers with fast access to lab specimens for diagnosis and treatment in areas where roads are impassable or do not exist.
Researchers for that study proved that the movement of the drones does not have any effect on blood samples, which is a crucial element in transporting medical laboratory specimens.
In a Johns Hopkins Medicine news release, one of the authors of the paper, Timothy Kien Amukele, MD, PhD, Assistant Professor of Pathology at Johns Hopkins University, noted the research team had initial concerns about the effects the acceleration and jostling of the drones would have on the laboratory specimens.
“Such movements could have destroyed blood cells or prompted blood to coagulate and I thought all kinds of blood tests might be affected. But our study shows they weren’t, so that was cool,” Amukele stated.
Pathologist Timothy Amukele, MD, PhD (above left), teamed with engineers at Johns Hopkins to develop a drone courier system capable of transporting blood to clinical laboratories. (Photo copyright: Johns Hopkins Medicine.)
For the study, Amukele and his team collected blood samples from 56 healthy volunteers and drove the samples to a drone launching field. Half of the samples were then driven to a clinical laboratory for processing and the other half were placed on the drones for flights lasting from six to 38 minutes.
Comparison of Clinical Lab Specimens Transported by Ground and by Drone
Both the flown and the non-flown samples underwent 33 common medical laboratory tests. The test results showed almost no difference between the two groups of samples. A test for carbon dioxide was the only one that generated different results, but the team did not know if that was due to the movement of the drones or the fact that the samples sat for up to eight hours before being tested.
Amukele is taking part in a collaboration between Johns Hopkins and Makerere University in Uganda. He noted that they would like to perform a study in a more remote location, possibly in Africa, where clinical laboratories can sometimes be more than 60-miles from clinics.
“A drone could go 100 km [approximately 62 miles] in 40 minutes,” noted Amukele in the Johns Hopkins news release. “They’re less expensive than motorcycles, are not subject to traffic delays, and the technology already exists for the drone to be programmed to ‘home’ to certain GPS coordinates, like a carrier pigeon.”
Opportunities for Clinical Laboratories
Use of drones is subject to each country’s laws and regulations. In the US, drone use is regulated by guidelines established by the Federal Aviation Administration (FAA). In some cases, the drone must be registered with the FAA and the operator must have a remote pilot certificate to legally fly a drone.
These projects highlight the critical need for cost-effective, safe, dependable transportation of biological materials in a timely manner. For pathologists and clinical laboratories, drones could prove to be another opportunity to provide high-quality, value- added services to healthcare consumers and other medical professionals.
—JP Schlingman
Related Information:
Swiss Post Using Drones to Transport Medical Samples between Hospitals
Medical Drones Poised to Take Off
Doctors Test Drones to Speed Up Delivery of Lab Tests
Drones Can Be Used to Fly Blood Samples to Remote Medical Clinics
Drones Deliver Healthcare
Medical Drones Will Thrive in Healthcare: A Safe Road to Health
Meet Matternet, the Drone Delivery Startup That’s Actually Delivering
Matternet Cleared to Fly Blood Samples in Delivery Drones over Swiss Cities
Swiss Post Drone to Fly Laboratory Samples for Ticino Hospitals
Proof-of-Concept Study Shows Successful Transport of Blood Samples with Small Drones
Blood from the Sky: Zipline’s Ambitious Medical Drone Delivery in Africa
Jun 28, 2017 | Instruments & Equipment, Laboratory Instruments & Laboratory Equipment, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Management & Operations
As our population continues to age, the demand increases for more clinical services and medical laboratory tests that cater to the growing needs of senior citizens
Elderly patients represent the fastest growing healthcare demographic in America. Thus, it is no surprise that healthcare professional in the field of Elderly Care are interested in technologies that enable them to remotely monitor the senior citizens under their care.
Telehealth devices, for example, that monitor a patient’s condition and transmits reports/alerts to primary care doctors and clinical laboratories when biomarkers deviate from set parameters, are becoming frontline tools for ambulatory and home-health practices.
Even emergency departments (EDs) are adopting remote-healthcare, as Dark Daily reported in “Community Paramedicine Brings Emergency Care into Patients’ Homes, Could Increase Clinical Laboratory Specimens Collected in These Settings.”
Healthcare and the Aging Consumer
According to the American Association of Retired Persons (AARP), there are more than 108 million people in the United States over the age of 50. This figure includes over 76 million baby boomers, those born between 1946 and 1964. The number of people over the age of 50 is expected to grow by 19 million over the next decade.
At the latest Aging 2.0 OPTIMIZE conference in San Francisco, Jaana Remes, PhD, economist and partner at the McKinsey Global Institute stated, “In healthcare, there is a clear shift in consumption, and its mainly from a consumer we don’t hear a lot about: the aging consumer. There are a lot of attitudes of stereotypes, and they are still less well known,” noted a MobiHealthNews article. “There is more equality, more diversity, they are more likely to be working later, more likely to be single, they are the most educated older generation yet, and they are much more likely to be tech savvy.”
Remes added it is important that new technology—such as apps, remote-monitoring systems, and platforms for care teams—are designed with the understanding that seniors will use them. “We need to make things that are suitable, particularly for the 75 and older crowd, to customize their needs,” she stated. “Fewer younger people are taking care of their parents.”
Elderly Care is Four-Five Times More Costly
A report by the National Center for Biotechnology Information (NCBI) states that healthcare costs rise exponentially after a person reaches age 50. According to the report, annual healthcare costs for the elderly are four to five times higher than individuals in their teens.
“Life expectancy has changed dramatically in the US, but while people are living longer, they aren’t necessarily living healthier,” stated Bruce Chernof, MD, President and CEO, The SCAN Foundation, in the MobiHealthNews article. “Maybe they are living with higher function and longer, but they are living with more chronic diseases. Where could tech play a role?” The SCAN Foundation is an independent public charity dedicated to improving care for older adults.
Critical Need for Home Health Monitoring Tools
As America’s population ages, the demand for home healthcare services is escalating at significant rates. According to a report from Zion Market Research, the global market for home healthcare services was valued at $229 billion in 2015. The report also states that that number should reach $391 billion by 2021.
Because families are becoming smaller, and a higher percentage of older adults are single than in the past, there is a greater need for caregivers who provide in-home care. Approximately two thirds of persons receiving home healthcare obtain that care from unpaid relatives and friends.
“The need for technology-enabled caregivers and care support goes up,” noted Chernof in the MobiHealthNews article. “So, we have to look mainly at ‘what is the problem I am trying to solve?’”
Fujitsu Laboratories Limited and Fujitsu Ireland Ltd. ran the KIDUKU Project from 2013-2016. The research initiative was designed to “provide monitoring services and assisted independent living for senior citizens and patients who live in smart houses.” (Graphic copyright: Fujitsu Laboratories Limited.)
Since the largest group of healthcare consumers are seniors, it is crucial to create tools that improve their quality of life and the effectiveness of the healthcare they receive. These tools include monitoring services for both healthcare and home care providers.
“On the pure technology side, it’s simple things like a dashboard report that family members can access that indicate what sensors at home they can interact with, enabling them to track patterns at home, so we can have the family get together and talk, rather than having to bring someone in every few weeks or months and try to figure out the problem moving backwards,” stated Lily Sarafan in the MobiHealthNews article. Sarafan is President and CEO of Home Care Assistance in San Francisco.
According to Sarafan, a significant part of senior care and monitoring is creating technology that tracks patient health and includes a personalized approach to care.
“Collecting better data that we can share with our 10,000 referral partners around the country on what’s happening in that white space, what happens in between when someone sees their healthcare provider two or three times per year because of an emergency or a check-up, and now we’re potentially interacting with a patient 24/7 for months or even years,” she stated. “That’s what puts us in the best possible situation to share data across players in the ecosystem and prevent preventable hospital admissions.”
Clinical Laboratories Could Provide Services; Earn Revenue
It might seem like science fiction now, but there may come a day soon when chronic disease sufferers can opt to have sensors implanted that monitor their conditions 24/7 and collect data that gets transmitted automatically to primary care doctors and other healthcare professionals.
When that happens, some innovative medical laboratories will likely develop business models for monitoring remote devices and collecting revenue for providing the service. By combining the collected data from those devices with a patient’s lab test data, they could identify for medical professionals when interventions are needed for certain conditions.
—JP Schlingman
Related Information:
What the Senior and Aging Care Industry Wants from Digital Health Innovators
A Snapshot of Global Innovation in Aging and Senior Care
How to Help Your Elderly Patients Adapt to Healthcare Technology
Community Paramedicine Brings Emergency Care into Patients’ Homes, Could Increase Clinical Laboratory Specimens Collected in These Settings
From Micro-hospitals to Mobile ERs: New Models of Healthcare Create Challenges and Opportunities for Pathologists and Medical Laboratories
Jun 14, 2017 | Digital Pathology, Instruments & Equipment, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Management & Operations
New discoveries about the genetics of prostate cancer could lead to better tools for diagnosing the disease and selecting effective therapies based on each patient’s specific physiology
In recent decades, the biggest challenge for urologists, and for the pathologists who diagnosed the prostate tissue specimens they referred, has been how to accurately differentiate between non-aggressive prostate cancer, which can exist for decades with no apparent symptoms, and aggressive prostate cancer that kills quickly.
Thus, a research study that has identified unique genetic features within prostate cancer that can help determine if the cancer is aggressive or not, and whether certain drugs may be effective, is good news for men, for urologists, and for the clinical laboratories that will be called upon to perform testing.
These types of breakthroughs bring precision medicine ever closer to having viable tools for effective diagnosis of different types of cancer.
Genetic Fingerprints of Cancer Tumor Types
One such study into the genetic pathways of prostate cancer is bringing precision medicine ever-closer to the anatomic pathology laboratory. Researchers from the Princess Margaret Cancer Centre, which is associated with the University of Toronto Faculty of Medicine, have discovered that some tumors in prostate cancer have a genetic fingerprint that may indicate whether or not the disease will become more aggressive and less responsive to treatment.
Robert Bristow, MD, PhD, and Paul Boutros, PhD, conducted a study of nearly 500 Canadian men who had prostate cancer. Published in the journal Nature, the researchers examined the genetic sequences of those tumors, looking for differences between those that responded to surgery or radiation and those that did not.
In the video above, Dr. Robert Bristow, clinician-scientist at Princess Margaret Cancer Centre, discusses the findings of a key piece in the genetic puzzle that explains why men born with a BRCA2 mutation develop aggressive prostate cancer. (Caption and photo copyright: University Health Network/Princess Margaret Cancer Centre.)
According to a FierceBiotech article, approximately 30% of men who have a type of prostate cancer thought to be curable eventually develop an aggressive metastatic type of the disease. About half of the men who developed a metastatic form of cancer had mutations to three specific genes:
“This information gives us new precision about the treatment response of men with prostate cancer and important clues about how to better treat one set of men versus the other to improve cure rates overall,” stated Bristow in a University Health Network (UHN) press release.
In another study, researchers looked at 15 patients with BRCA2-inheritied prostate cancer and compared the genomic sequences of those tumors to a large group of sequences from tumors in less-aggressive cancer cases. According to a ScienceDaily news release, they found that only 2% of men with prostate cancer have the BRCA2-inherited type.
Knowing what type of cancer a man has could be critically important for clinicians tasked with prescribing the most efficient therapies.
“The pathways that we discovered to be abnormal in the localized BRCA2-associated cancers are usually only found in general population cancers when they become resistant to hormone therapy and spread through the body,” noted Bristow in the ScienceDaily release. If clinicians knew from diagnosis that the cancer is likely to become aggressive, they could choose a more appropriate therapy from the beginning of treatment.
Genetic Mutations Also Could Lead to Breast and Brain Cancer Treatments
BRCA mutations have also been implicated in breast, ovarian, and pancreatic cancers, among some other types. The knowledge that BRCA1 and BRACA2 mutations could indicate a more aggressive cancer is likely to spark investigation into whether poly ADP ribose polymerase (PARP) inhibitors could be used as an effective therapy.
PARP inhibitors are increasingly of interest to scientists. In addition to being used to treat some BRCA1/BRCA2-implicated cancers, two recent studies show that it could be effective in treating brain cancer with low-grade gliomas that involve a mutation to the gene isocitrate dehydrogenase (IDH), according to an article published by the National Cancer Institute and the National Institutes of Health (NIH).
Researchers of the study published in the journal Clinical Cancer Research investigated how PARP inhibitors impact DNA repair in gliomas.
Researchers of the study published in the journal Science Translational Medicine stated that they “demonstrate mutant IDH1-dependent PARP inhibitor sensitivity in a range of clinically relevant models, including primary patient-derived glioma cells in culture and genetically matched tumor xenografts in vivo.”
According to the UHN press release, the next step in using the knowledge that BRCA1 and BRCA2 may indicate a more aggressive prostate cancer is for researchers to create a diagnostic tool that can be used to determine what type of prostate cancer a man has. They expect the process to take several years. “This work really gives us a map to what is going on inside a prostate cancer cell, and will become the scaffold on which precision therapy will be built,” Boutros stated in a Prostate Cancer Canada news release.
Unlocking Knowledge That Leads to Accurate Diagnoses and Treatments
Research that furthers precision medicine and allows clinicians to choose the most appropriate treatment for individuals shows how quickly scientists are applying new discoveries. Every new understanding of metabolic pathways that leads to a new diagnostic tool gives clinicians and the patients they treat more information about the best therapies to select.
For the anatomic pathology profession, this shows how ongoing research into the genetic makeup of prostate cancer is unlocking knowledge about the genetic and metabolic pathways involved in this type of cancer. Not only does this help in diagnosis, but it can guide the selection of appropriate therapies.
On the wider picture, the research at the Princess Margaret Cancer Centre is one more example of how scientists are rapidly applying new knowledge about molecular and genetic processes in the human body to identify new ways to more accurately diagnose disease and select therapies.
—Dava Stewart
Related Information:
Genomic Hallmarks of Localized, Non-Indolent Prostate Cancer
Newly Discovered Genetic Fingerprint for Prostate Cancer Promises to Personalize Treatment
Prostate Cancer Team Cracks Genetic Code to Show Why Inherited Disease Can Turn Lethal
PARP Inhibitors May Be Effective in Brain, Other Caners with IDH Mutations
Chemosensitivity of IDH1-Mutated Gliomas Due to an Impairment in PARP1-Mediated DNA Repair
2-Hydroxyglutarate Produced by Neomorphic IDH Mutations Suppresses Homologous Recombination and Induces PARP Inhibitor Sensitivity
Prostate Cancer Researchers Find Genetic Fingerprint Identifying How, When Disease Spreads
Scientists Identify DNA Signature Linked to Prostate Cancer Severity
Jun 12, 2017 | Instruments & Equipment, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Estimates are that more than three million people miss healthcare appointments each year due to transportation issues; that is true for patients with clinical lab test orders who never visit a patient service center
Patient no-shows, missed appointments, and rescheduling impact not only clinical laboratories and pathology groups but the entire healthcare community in lost time and wages. So, critical is scheduling that patient portal and electronic health record (EHR) developers focused first on implementing those technologies before moving on to billing and other aspects of health information technology (HIT). If patients don’t arrive at their appointments on time, everyone loses.
Thus, Internet and smartphone application (app) developers continue to refine and improve their scheduling software. Now, other companies outside of traditional healthcare also are capitalizing on this opportunity.
One such innovative company is Uber, a San Francisco-based transportation service company created in 2009 that enables people to order a local driver pickup via a free smartphone app. Last year, Uber began collaborating with MedStar Health, the largest healthcare provider in Maryland and Washington, DC, to help address the issue of missed appointments.
Getting Patients to Their Appoints is Half the Battle
An article in the Washington Business Journal noted that estimates place the cost of missed healthcare appointments as high as $150-billion per year in the US alone. And research published by the Journal of the Transportation Research Board suggests that up to 3.6-million people miss or delay appointments annually due to transportation issues. These exorbitant costs, combined with the necessity for patients to receive timely care, are compelling healthcare providers to develop innovative strategies to deal with missed appointments.
All of this is of interest to clinical laboratories, because a substantial number of patients who get medical laboratory test orders from the physicians never come to a patient service center to have their specimen collected. Not only does this mean that the patient (and his or her physician) won’t get the needed lab test results, but it means that the lab loses the opportunity to be paid for performing the tests that were wanted by the patients’ physicians.
“Half our battle is getting the patient to the appointment,” stated Pete Celano, Director of Consumer Health Initiatives for MedStar Institute for Innovation, Healthcare Dive reported. Celano, along with other representatives of the Uber/MedStar Health collaboration, spoke at the Connected Health Conference last December. Lindsay Elin, Director of Federal and Community Affairs at Uber and Daniel Hoffman, Chief Innovation Officer for Montgomery County in Maryland, joined Celano in discussing their shared experiences and insights with the collaboration during a session titled “Cities That Promote Health.”
“For patients who can afford it, we say ‘Please uber if and as you want to,’” Celano stated. “It could be less expensive to go to Georgetown University Hospital for example on an uber from most places than to park there, if we even have parking spots available.”
The Uber/MedStar collaboration may be especially beneficial for patients with disabilities who want to use the Uber to get to healthcare appointments. The Uber Accessibility website features a host of helpful instructions and tools to get patients started using Uber. (Photo copyright: ABC News.)
In the past, MedStar utilized local taxi services to diminish the amount of missed appointments. Celano stated that such services could be cost-prohibitive, cumbersome, and unable to meet the needs of patients who required assistance. Now, Internet technology, such as smartphone apps, can be used by providers in innovative and clever ways to improve the patient experience.
That’s the thinking behind encouraging patients to request an Uber driver for transportation to medical appointments. The pick-up is easily requested through a free smartphone app. Healthcare providers may also arrange and manage transportation for patients who do not own a smartphone. Patients also can order an Uber driver online by selecting the Uber icon on MedStar’s homepage.
The Power of Going Door-to-Door
The partnership has been successful. Celano stated that the cost of an Uber trip is about 60% of the cost of a cab in the DC area and patients can arrange for a car inside an hour time frame. MedStar also can cover the Uber transportation fee for patients with medical and financial needs.
“People ask me how it’s going and I say it’s all about the power of going door-to-door,” Celano stated in the Healthcare Dive article. He added that keeping scheduled appointment times can result in better outcomes for patients as well.
A CrossChx report titled, “The Cost of Now Shows” notes that the most common reasons for patients to miss scheduled appointments are:
- Lack of transportation;
- Amount of time between scheduling and the actual appointment;
- Emotional obstacles; and
- Believing that medical professionals do not respect patients.
Elin stated that other healthcare providers have expressed interest in utilizing Uber for patient transportation and that Uber has established a team to work solely with healthcare providers. Additionally, Uber’s uberASSIST program trains drivers to work with riders who may require specialized attention, such as senior citizens and the disabled.
“We firmly believe [that] with partnerships with healthcare providers, senior centers, [and] transit agencies we can do even more and reach more people,” Elin stated.
Taking Proactive Steps to Better Patient Care
The Uber/MedStar collaboration shows how internet technology and smartphone apps can be used by healthcare providers in clever ways to improve patient experience. Additionally, it should be understood as a market development that shows how a healthcare provider, attempting to deliver integrated care, recognizes that it must take proactive steps to get certain patients with chronic diseases to their appointments to manage them proactively and help prevent an acute event.
Clinical laboratory leaders should see this story in both dimensions. And then use those insights to identify how they might collaborate with high-tech companies to deliver lab services in different ways that help achieve better patient outcomes.
—JP Schlingman
Related Information:
‘It’s Door-to-Door’: MedStar, Uber Detail Partnership’s Progress
Insight: Tackling Healthcare’s Costly Problem of Missed Appointments
Why MedStar Health Just Teamed Up with Uber
Accessibility at Uber
Cities That Promote Health
MedStar Health Pays for Patients in Need to Get Uber Rides to Appointments
Cost-Effectiveness of Access to Nonemergency Medical Transportation: Comparison of Transportation and Health Care Costs and Benefits
Multi-channel Smartphone Spectrometer Enables Clinical Laboratory Testing Quickly and Accurately in Remote Regions
Jun 7, 2017 | Instruments & Equipment, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Sales and Marketing, Management & Operations
Aging populations and increase in chronic disease fuel worldwide growth in tele-ICU care models that improve patient outcomes, reduce length of ICU stays, and save hospitals money, according to a study
There’s an interesting trend in healthcare that may prove beneficial to clinical pathologists and medical laboratory scientists. It is increased use by hospitals of remotely-monitored intensive care units (ICUs), which creates the opportunity for clinical laboratory specialists to remotely collaborate with their colleagues in real time.
This new approach in how hospitals alter how they monitor their patients’ care and organize their intensive care units is dubbed Tele-ICU. The technology uses “an off-site command center in which a critical care team [made up of intensivists and critical care nurses] is connected with patients in distant ICUs to exchange health information through real-time audio, visual, and electronic means,” according to a study published by AHIMA (American Health Information Management Association) that sought to identify the “possible barriers to broader adoption.”
This approach to emergency care from a distance employs telemedicine technology and has the potential to impact how in-house medical laboratories provide clinical testing services to hospital physicians.
Tele-ICU Gaining Foothold in Healthcare
Tele-ICUs are making speedy inroads into hospitals and healthcare systems. According to a statistic provided to Healthcare Dive by Advanced ICU Care, a provider of remote ICU monitoring services, an estimated 15% to 20% of hospitals currently use tele-ICU programs.
The use of this “second set of eyes” in ICUs is expected to grow. It is encouraged by an increasing number of studies showing:
- Improved patient outcomes;
- Reduced length of ICU stays; and
- Cost savings.
A Global Market Insights report predicts the tele-ICU market will reach $5 billion in 2023. That’s more than four times 2015’s $1.2 billion level. The rise, the report states, will be fueled by an increase in aging populations and chronic conditions such as cancer, neurological disorders, and other chronic diseases.
The graphic above illustrates the wide range of telehealth services available to hospitals for remote critical and in-home ambulatory care. To remain competitive, medical laboratories not yet engaged in providing testing services to remote care programs will need to adopt the technology. (Image copyright: Philips.)
Intermountain Healthcare’s TeleCritical Care program has paid dividends for the not-for-profit health system. Since 2014, Intermountain has introduced tele-ICUs in 12 of its 22 hospitals that have ICUs, and in five non-system hospitals. A pilot project has expanded the program to two rural critical access hospitals that do not have ICUs. Five more rural hospitals are also expected to join Intermountain Healthcare’s tele-ICU program.
“There’s a tremendous amount we can do from this location without being literally present,” William Beninati, MD, Medical Director for TeleCritical Care at Intermountain Healthcare, stated in a Healthcare Dive article.
Intermountain Healthcare’s analysis of 6,500 of its patients indicates tele-ICU implementation has enabled its community hospitals to treat patients with more complex cases and reduce mortality by 33%. An initial cost analysis was equally favorable, with a $4.4 million decrease in the cost of care provided and a $3.3 million decrease in reimbursement amounts.
“We’re seeing a rapid return on investment on a roughly one-year timeframe,” Beninati told Healthcare Dive.
Helping Hospitals Thrive in Value-based Environments
A study published in CHEST Journal in February 2017 by UMass Memorial Medical Center supports the argument for tele-ICU’s financial benefits. According to a Philips press release announcing the UMass Memorial study results, the researchers found the Philips telehealth eICU Program with centralized bed management control increased case volume by up to 44% and improved contribution margins by up to 665%, or $52.7 million.
Philips’ eICU telehealth technology (above) combines A/V technology, predictive analytics, data visualization, and advanced reporting capabilities to deliver critical information to caregivers at remote locations. (Photo copyright: Philips.)
Other investigations have recognized the value intensivist-centric models can play in improved patient outcomes, such as this 2014 HIMSS study, which compared ICU length-of-stay findings among three primary studies of tele-ICU use that were published from 2009 to 2014. The analysis found tele-ICU programs improved patient outcomes, particularly length of stays (from 6.9 days pre-intervention to 4.2 days post-intervention). And there was “strong evidence” that secondary outcomes such as ICU mortality and hospital mortality also decreased as a result of tele-ICU use.
“An ICU bed costs approximately $2 million to build, and this study demonstrates a significant increase in case volume by better utilizing existing resources,” said Tom Zajac, Chief Executive Officer and Business Leader, Population Health Management, Philips, in the Philips press release. “This shift enables care for expanding populations without having to build and staff additional ICU beds, thus helping hospitals thrive in a value-based care environment.”
Alignment of Attitudes Key to Tele-ICU Success
In a Healthcare Dive article, Lou Silverman, CEO of Advanced ICU Care, a provider of tele-ICU services, said the role of a tele-ICU differs based on a hospital’s staffing.
“If intensivists are internally staffed by the hospital, tele-ICU provides a second set of eyes—an additional layer of patient safety in partnership with the bedside team,” Silverman noted. “When intensivists are not readily present, tele-intensivists take a more active role directing patient care, including intervening in urgent situations.”
However, the physician who led the UMass study argues that successful tele-ICU programs requires an alignment of attitudes as well as technology. Craig M. Lilly, MD, Director of the eICU program at UMass Memorial Medical Center, says healthcare providers at the bedside, and those overseeing the ICU from a distance, must communicate well and collaborate on both ends of the telemedicine platform.
“If you apply the technology the way it was designed [to be applied], it can make a difference,” Lilly told mHealthIntelligence. “But if you don’t have collaboration, it’s not going to work. Then you have … relative antagonism.”
As Dark Daily has previously noted, anatomic pathology laboratories were among the first to adopt remote telemedicine models though the use of whole-slide imaging and digital pathology services. As tele-ICU becomes more prevalent, medical laboratories will have the opportunity to use their access to real-time patient lab test data to help the clinicians in tele-ICU centers better manage patient care. This would also be an opportunity for pro-active clinical pathologists to step up with consultative services that contribute to improving patient outcomes.
—Andrea Downing Peck
Related Information:
How Tele-ICUs are Giving Hospitals a Boost
Reducing ICU Length of Stay: The Effect of Tele-ICU Market Size
Tele-Intensive Care
ICU Telemedicine Program Financial Outcomes
Telemedicine Success Requires an Alignment of Incentives (and Attitudes)
New Study Demonstrates Improved Patient Flow and Financial Benefits of Philips eICU Program for Managing Critical Care Populations
Study: Tele-ICU Programs Improve Care While Providing Cost Savings
Survey Reveals US Consumers Choosing PCPs Based on Access to Telehealth Services; Clinical Laboratories Can Capitalize on This Trend
From Micro-hospitals to Mobile ERs: New Models of Healthcare Create Challenges and Opportunities for Pathologists and Medical Laboratories
Wal-Mart Developing Telemedicine Clinics in Selected Stores
Growing Cost of Telemedicine, Telepathology, and Medical Data Transmissions Is a Budget-Buster in Oklahoma
International Telemedicine Gains Momentum, Opening New Markets for Pathologists and Other Specialists
Jun 5, 2017 | Instruments & Equipment, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Management & Operations
While many of the major gains promised by electronic health records (EHRs) and big data remain elusive, Geisinger Health’s Unified Data Architecture demonstrates how big data might help healthcare providers and clinical laboratories optimize care, improve outcomes, and control costs as the technology evolves
Use of big data in healthcare gets plenty of hoopla these days. Many experts predict great things as clinical laboratory test data is pooled with other patient information and demographic data. But there are many technical problems to be overcome before the full potential of healthcare big data can be translated into ways that improve the health of individuals.
Big data in healthcare is essential to the success of both precision medicine and population health management. However, without the ability to consolidate other data sources and provide intuitive ways for healthcare providers to access, analyze, and utilize the data coming from the various sources, such as clinical laboratory and anatomic pathology test results, much of the data can be underutilized or overlooked.
Medical laboratories continue to generate increased amounts of data, much of which often finds its way into electronic health record (EHR) systems and other data silos. A Harvard Business Review (HBR) report from doctors at Geisinger Health in Pennsylvania shows how this data might be used.
Consolidating Data to Create Cohesive Snapshots of Patient Health
The HBR report attributes Geisinger’s ability to utilize big healthcare data to its Unified Data Architecture (UDA). According to a Healthcare Informatics article, Geisinger’s UDA was based on Hadoop and other open source software. According to the doctors who wrote the HBR report, “… pulling meaningful data aggregated from many sources back out of EHRs has historically been vexingly complex. The potential insight from these data are limited in practice by the shortcomings of traditional data repositories.”
Geisinger’s UDA addresses two key issues the Healthcare Informatics authors see as obstacles to the expanded, easier use of big healthcare data:
- Lack of ways to deal with unstructured patient notes that do not adhere to traditional database organizational structures; and
- Data silos created when multiple departments collect data but use separate storage systems.
Using natural language processing (NLP), the UDA system can pull critical information from long-form written reports or analyses.
Big data graphic above from Nuance, developer of intelligent systems for healthcare and other industries, illustrates the challenges involved in acquiring, sifting, managing, and utilizing big data in healthcare. (Graphic copyright: Nuance.)
Geisinger’s system connects nurses on the floor, medical technologists in the clinical laboratory, and surgeons in operating rooms to the same pools of data. However, it also pulls in data from external sources, such as pathology groups, other reference or medical laboratories, and even patient-worn mobile medical devices. The HBR report states, “The integration of data from Health Information Exchanges, clinical departmental systems (such as radiology and cardiology), patient satisfaction surveys, and health and wellness apps provides us with a detailed, longitudinal view of the patient.”
Big Data Helps Healthcare Professionals Spot Future Worries
Geisinger’s Abdominal Aortic Aneurysm (AAA) Close the Loop Program—named semi-finalists in Healthcare Informatics’ 2016 Innovator Awards Program—is an example of how NLP and data collation offers benefits often overlooked with traditional approaches.
Geisinger doctors found that AAAs typically are discovered during care for another condition. Often, the conditions for which the patient seeks care are more serious than the small AAA and it isn’t mentioned. While AAAs might be noted in patient records, healthcare providers typically do not look for the data. Thus, left untreated, a AAA can develop into a serious condition that could have been prevented.
NLP enables Geisinger doctors to analyze UDA data for warning signs of AAA and create follow-up and treatment plans that might otherwise remain overlooked. According to the HBR report, this program has led to 12 lifesaving operations to date that might otherwise have been missed.
Real-Time, Comprehensive Updates Offer Big Gains in Combating Sepsis
Big healthcare data shows potential for treating many life-threatening conditions, such as sepsis. Prompt treatment is essential to positive outcomes in sepsis cases. Physicians at Geisinger use the company’s UDA data to both pinpoint when sepsis indicators appeared, as well as to consolidate data from across a patient’s care continuum to optimize treatment.
Instead of sorting through disparate streams of data from various operational areas and reports, data is combined into a consolidated dashboard featuring real-time physiologic metrics, such as:
- Blood pressure measurements;
- Blood culture results; and
- Antibiotic administration.
The HBR report notes, “By tracking, aggregating, and synthesizing all sepsis-patient data, we expect we will be able to both reduce the incidence of hospital-acquired sepsis and improve its management.”
Using Big Data to Track Surgical Supply Chains and Waste
With the unique cost and outcome aspects of each surgical case, and the differences in payouts from payers, creating big data for tracking the efficiency and waste of surgeries is difficult without a big picture view of the factors. Using their UDA, Geisinger can track the exact supplies used in an operation along with the outcome, recovery, cost, and follow-up data related to the procedure.
“This gives surgeons and administrators an important new view of how they perform comparatively from both a cost and outcome perspective,” noted the HBR report’s authors.
Big data is still a developing technology. Nevertheless, programs such as at Geisinger Health offer useful lessons into how data streaming from clinical laboratories, pathology assays, operating rooms, intensive care units, and even personal health-tracking devices might be combined to provide a unified patient record. That would make it possible for caregivers to use analytical tools to tailor each patient’s care and treatment to his or her specific conditions and physiology.
—Jon Stone
Related Information:
How Geisinger Health System Uses Big Data to save Lives
How Unleashing Trapped Clinical Data Has Saved Lives at Geisinger Health System
The 2016 Healthcare Informatics Innovator Awards Program: Semifinalists
Unified Data Architecture Allows Patient Insights
At Geisinger Health System, Advanced Analytics Pave the Way to Better Outcomes
New Geisinger Initiative Digs Deep into the Wild, Unstructured World of Big Data
Geisinger Reaps System-wide Benefits with Big Data Approach
