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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Dec 4, 2008 | Laboratory News, Laboratory Pathology
California is often a national leader for innovations in managed care contracting, as well as new approaches for delivering healthcare. So when your Dark Daily editor visited the laboratory at the UCLA Medical Center this week, he was quite curious about the ways in which clinical laboratory testing and anatomic pathology services are being used at this respected national academic center.
For one thing, UCLA has recently moved into a brand new hospital building. The Ronald Reagan Medical Center is a 525 bed facility (all single patient rooms) and is designed to be state-of-the-art. The UCLA Medical Center is also a world-class institution. It is proudly flying banners throughout the campus which recognize its selection by U.S. News and World Report as the nation’s number 3 best hospital. (Are you interested in which hospitals are ranked 1 and 2? We provide a list of U.S. News & World Report’s Top Ten Best Hospitals at the end of this e-briefing.)
Exciting things are unfolding at the Department of Pathology and Laboratory Medicine. In a briefing session with Scott W. Binder, M.D., Senior Vice Chair, Pathology Clinical Services and Chief, Dermatopathology, your Dark Daily editor learned about a collaborative effort with the Department of Radiology and the Department of Molecular and Medical Pharmacology to develop integrated patient care pathways in several different types of cancers. The particular focus is on lung cancer, melanoma, and breast cancer. The goal is to develop an integrated report which incorporates the radiology components with the pathology report. Molecular assays will be used so that the report emphasizes information about prognostic genes and the most appropriate therapeutic options for the patient. This is an effort to integrate in vivo and in vitro diagnostics to advance patient care.
Over in the clinical laboratory, there were several interesting things that are unique to the UCLA Medical Center. At the 10-story Ronald Reagan Medical Center building, there is a new core laboratory. However, competition for space within the facility meant that the clinical laboratory did not get all the square footage it required to centralize all laboratory testing activities across the campus into one site. Consequently, there are at least four different locations where significant laboratory testing activity takes place.
For example, a medical building next to the new hospital holds a large patient drawing center (serving an average of 500 patients per day). This space also has the accessioning center for routine specimens, along with a fully automated pre-analytical line supplied by Beckman Coulter that includes specimen sorting, de-capping, centerfuging, aliquotting, and re-capping. Prepped specimens are then sent next door to the new core laboratory in the Reagan Medical Center for testing. At the core laboratory, different academic experts supported their “best of breed” choices for analyzers. Thus, the automated line is by Beckman Coulter, while Roche and Olympus supplied chemistry and immunoassay analyzers. PT/PTT testing is done on a system by Siemens (Dade Bering), and hematology is performed on a Sysmex automated line. The clinical laboratory performs tests for inpatients, outpatients, and outreach patients.
Dark Daily summarizes this day of site visits and learning with two observations. First, UCLA’s Department of Pathology and Laboratory Medicine is proactively crossing traditional medical specialty silos to support collaboration with a goal to advancing personalized medicine. For that reason, expect to see some interesting research breakthroughs, particularly in the areas of molecular and genetic testing, from the UCLA pathology department.
Second, the competition for limited resources in healthcare was visible at the new Ronald Reagan Medical Center. Even in a new, state-of-the-art facility, demand for space by all the clinical services was so intense that the clinical laboratory had to settle for a space allotment that made it impossible for them to consolidate all major laboratory testing facilities into a single location.
Related Information:
U.S. Hospitals Honor Roll
Top Ten Hospitals as Ranked by U.S. World & News Report in 2008:
1. Johns Hopkins Hospital, Baltimore
30 points in 15 specialties
2. Mayo Clinic, Rochester, Minn.
28 points in 15 specialties
3. Ronald Reagan UCLA Medical Center, Los Angeles
25 points in 14 specialties
4. Cleveland Clinic
25 points in 13 specialties
5. Massachusetts General Hospital, Boston
24 points in 12 specialties
6. New York-Presbyterian Univ. Hosp. of Columbia and Cornell
22 points in 12 specialties
7. University of California, San Francisco Medical Center
21 points in 11 specialties
8. Brigham and Women’s Hospital, Boston
18 points in 11 specialties
9. Duke University Medical Center, Durham, N.C.
18 points in 11 specialties
10. Hospital of the University of Pennsylvania, Philadelphia
18 points in 10 specialties
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
Jun 27, 2008 | Laboratory Management and Operations, Laboratory Pathology
Patient-centric e-health services, including personal and electronic health records, remote monitoring of patients, electronic physician-patient communication, and patients seeking health information on-line, represent a new vision of healthcare’s future according to a recent position paper from the American College of Physicians (ACP), in Philadelphia, Pennsylvania. (more…)
