Dec 10, 2008 | Laboratory News, Laboratory Pathology
Today Dark Daily wants to introduce you to the emerging medical discipline of “multi-modality diagnosis.” Advances in genetics and molecular technologies are actively breaking down the traditional scope of practice for several medical specialists. At ground zero in this new area of medicine are pathology and radiology.
Multi-modality diagnosis can be defined in a simple manner. It is the use of several different types of clinical data-in an integrated fashion-to make a diagnosis. “Integration” is the key concept here, since physicians have always assembled information about the patient from several sources as they proceeded to evaluate the patient and make a diagnosis.
As doctors and researchers learn more about genetics and the role of DNA, RNA, and proteomics in various illnesses and ailments, there are huge increases in the volume of data now relevant in assessing the patient’s condition and determining the most accurate diagnosis. At the same time, medical specialties, particularly those of radiology and pathology, that formerly could work somewhat independently to evaluate the patient and provide the referring clinician with a report that was rather straightforward and simple, now face a new challenge. The expanding knowledge base of genetic and molecular information means that their evaluation of the patient needs to incorporate the findings of other medical specialists if the final assessment is to be accurate and useful to the referring clinician.
In other words, genetic medicine is the active catalyst that is already motivating different medical specialties to interact more closely to assess and diagnose certain types of diseases. At the forefront of this trend are progressive radiologists and pathologists-specifically those working with molecular imaging and molecular pathology. For example, in leading academic centers, it is growing ever more common for the neuropathologist and the neuroradiologist to review each other’s images before signing out their respective cases. In some laboratory settings, these two subspecialists are already developing a single, integrated report that goes to the referring physician.
Healthcare informatics is another channel of innovation propelling multi-modality diagnostics forward. Independent of pathology and radiology, there are informaticians pulling together disparate sets of patient data, then running this data through sophisticated software algorithms to develop diagnostic information that gives the patient’s physician new knowledge. Within the field of healthcare informatics, these innovators constantly describe their work as bringing together multiple modalities of data. Dark Daily readers should note that this effort is happening outside of the pathology and radiology specialties. It is an external trend to both professions.
Those interested in learning more about multi-modality diagnosis have two resources. In a recent issue of The Dark Report, a detailed intelligence briefing was published on this topic under the title “Multi-Modality Diagnosis Heading for Lab Medicine.” Dark Daily subscribers who would like a complementary copy of this intelligence briefing should contact Ron Martin at rbmatin@darkreport.com.
The second resource for learning more about multi-modality diagnosis is the upcoming Molecular Summit on the Integration of In Vivo and In Vitro Diagnostics http://www.molecular-summit.com On February 10-11, 2009, national and world leaders in molecular imaging, molecular diagnostics, and integrated informatics will be leading strategic sessions and case studies on this subject. Location is the Sheraton Society Hill Hotel in Philadelphia, Pennsylvania.
Speakers from such organizations as Massachusetts General Hospital, Stanford University Medical Center, MD Anderson Medical Center, UCLA Medical Center, Siemens, and the Institute for Systems Biology will provide the latest innovations in the integration of in vivo and in vitro diagnostics. Last year’s Molecular Summit attracted 225 attendees, along with editors and reporters from 15 healthcare publications. This next Molecular Summit has compelling case studies of how molecular diagnostics, when integrated with molecular imaging and other data sets, is giving clinicians powerful new insights for making diagnoses, identifying appropriate therapies, and monitoring patient progress.
The full agenda and speaker line-up for this year’s Molecular Summit can be viewed here (or paste this URL into your browser: http://www.molecular-summit.com/agenda.htm )
Make your plans to join us at Molecular Summit 2009 to learn how your laboratory can benefit from multi-modality diagnostics.
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Nov 24, 2008 | Laboratory News, Laboratory Pathology
Probably the single most publicized healthcare statistic is “46 million uninsured Americans.” But who are these people? I’ll bet you don’t know, for a simple reason. Television and newspaper stories almost never explain where the 46 million uninsured number originated, nor how it was calculated.
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Nov 19, 2008 | Laboratory News, Laboratory Pathology
In tandem with a recent new state law in Massachusetts mandating that all hospitals be using computerized physician order entry (CPOE) systems by 2012, Blue Cross Blue Shield of Massachusetts (BCBSMA) will similarly require all of its participating hospitals to use a computerized physician order entry (CPOE) system by 2012.
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Oct 28, 2008 | Laboratory Management and Operations, Laboratory Pathology
Federal officials underestimated the costs and time needed to implement the complex new codes for ICD-10, according to a new study released last week on October 14. As a result, laboratories and physician groups can expect to incur significantly higher costs to convert from the current International Classification of Diseases, Ninth Revision (ICD-9), to ICD-10.
The report by Nachimson Advisors, LLC, estimated that every provider will incur conversion costs in at least six ways. The report detailed and projected these costs for physician groups of small, medium, and large. It calculated that the typical small group of three physicians would incur costs of $83,290 to comply with ICD-10. A typical medium-sized group of 10 physicians would spend $285,195, and a typical large physician practice of 100 providers would spend $2,728,780. These costs include expenses for: 1) education; 2) process analysis; 3) changes to superbills; 4) information technology; 5) documentation; and, 6) cash flow disruption. Detailed coverage of the impending conversion to ICD0-10 is provided in the current issue of The Dark Report that was published on October 20, 2008.
One large laboratory with operations nationwide estimated that it will spend about $40 million to convert to ICD-10, including costs for information technology and staff education. This national lab further stated that implementation of ICD-10 code sets is projected to be twice as expensive as implementing the National Provider Identification (NPI) system that caused severe cash-flow problems for labs earlier this year.
A group of organizations representing physicians and laboratories, including the American Medical Association (AMA) and the American Clinical Laboratory Association (ACLA), commissioned the report. The deadline for compliance with ICD-10 is October 1, 2011, but physician trade groups are lobbying Congress to order the federal Department of Health and Human Services (HHS) to delay implementation. One reason the conversion is complicated is because ICD-10 uses 155,000 seven-digit codes, compared to the existing 17,000 codes in ICD0-9. Conversion will be particularly complex for laboratories because of the extensive system changes and the need to train not only staff, but the physicians who refer specimens to the laboratory.
“We have known this transition was going to be a big problem for a few years,” said ACLA President Alan Mertz. “The Nachimson study confirms that belief. ACLA has also consulted with our members and some of the larger labs tell us the costs for transitioning to the new codes and then the ongoing costs to use the new codes will be quite high. It will be costly for lab billing personnel to have to go back to the referring physicians to get the right diagnosis codes.”
Joseph M. Heyman, M.D., Board Chair of the AMA, said, “The AMA is deeply concerned that HHS is rushing head-first into the transition to a complex coding system without fully recognizing the impact on the health care system. Physicians, insurers, medical labs and others are raising the alarm that the costs, documentation and training required by ICD-10 will be significantly greater than HHS now recognizes.”
Medical laboratories and pathology group practices will need to develop a strategy for handling the transition from ICD-9 to ICD-10. Although providers are already pressuring federal health policymakers to delay the October 1, 2011 implementation date for ICD-10, there are many reasons why the United States must move to ICD-10. These reasons are detailed in current issue of The Dark Report.
Related Information:
Sep 15, 2008 | Laboratory News, Laboratory Pathology
Having jumped feet first into the in-store rapid clinic/minute clinic concept, Wal-Mart Stores, Inc. (NYSE:WMT) is introducing telemedicine services in selected Wal-Mart stores. This may put the company just steps away from an interest in providing appropriate diagnostic tests to customers coming into its in-store medical clinics.
This summer, Wal-Mart announced a joint operating agreement with two companies for the purpose of running telemedicine clinics in selected stores. This pilot project is taking place in Houston, Texas. Collaborating are My Healthy Access, Inc. (OTC:MYHA) and NuPhysicia, LLC . Both companies are based in Houston, Texas. Since August, the partners have opened telemedicine clinics in several Wal-Mart Supercenter stores. The service is marketed as “Walk-In Telemedicine Health Care.” It connects patients with physicians via a telemedicine arrangement. In response to the physician’s directions, medical professionals with the patient at the clinic site provide the appropriate care.
The first telemedicine location was a Wal-Mart store in Pearland, Texas, which opened with two other telemedicine clinics during August. “Changing to a Telemedicine based health care delivery system allows us to substantially decrease the overhead per patient, while simultaneously increasing the level of care each patient receives,” said Kathleen Delaney, President of My Healthy Access, Inc. This telemedicine arrangement allows one physician to provide care to multiple clinic sites. This addresses one criticism of the rapid clinic/minute clinic concept, which was the limited range of services offered to customers. These clinics, located in retail locations, are generally staffed with a nurse practitioner, who is only allowed to diagnose and treat a limited number of clinical conditions.
Over the past year, Wal-Mart has also been shifting its strategy for developing in-store, rapid clinics. It has decided to partner with regional hospitals, health systems, and physicians. Local hospitals and health systems like this approach, because it gives them access to patients. Dark Daily observes that this type of arrangement shows the rapid acceptance of the medical clinic located in a retail store. Healthcare providers are recognizing that, in order to reach more customers, they will need to offer services in non-traditional settings where today’s customers spend their time (and money).
Dark Daily further predicts that, as Wal-Mart gains more understanding about the opportunities to provide medical services in their retail stores, laboratory testing is likely to come on the radar screen. After all, with the growing number of point of care tests (POCT) and rapid tests, this diagnostic service would increase the customer-friendly and fast service offered by these in-store medical clinics. Should Wal-Mart decide that the telemedicine concept is a clinical and financial winner, then one logical path to expanding the clinical services of the retail store rapid clinic is to offer selected laboratory tests on site.
Related Information:
My Healthy Access Announces Grand Opening of Wal-Mart Based Telemedicine Clinic
My Healthy Access Announces Opening Schedule of Wal-Mart Based Telemedicine Clinics