The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Ronald S Weinstein - One of the best experts on this subject based on the ideXlab platform.
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Invention and early history of Telepathology (1985-2000)
Wolters Kluwer Medknow Publications, 2019Co-Authors: Ronald S Weinstein, Michael J Holcomb, Elizabeth A KrupinskiAbstract:This narrative-based paper provides a first-person account of the early history of Telepathology (1985–2000) by the field's inventor, Ronald S. Weinstein, M. D. During the 1980s, Dr. Weinstein, a Massachusetts General Hospital-trained pathologist, was director of the Central Pathology Laboratory (CPL) for the National Cancer Institute-funded National Bladder Cancer Project, located at Rush Medical College in Chicago, IL. The CPL did post therapy revalidations of surgical pathology and cytopathology diagnoses before outcomes of the completed clinical trials were published. The CPL reported that interobserver variability was invalidating inclusion of dozens of treated bladder cancer patients in published reports on treatment outcomes. This problem seemed ripe for a technology-assisted solution. In an effort to solve the interobserver variability problem, Dr. Weinstein devised a novel solution, dynamic-robotic Telepathology, that would potentially enable CPL uropathologists to consult on distant uropathology cases in real-time before their assignment to urinary bladder cancer, tumor stage, and grade-specific clinical trials. During the same period, universities were ramping up their support for faculty entrepreneurism and creating in-house technology transfer organizations. Dr. Weinstein recognized Telepathology as a potential growth industry. He and his sister, Beth Newburger, were a successful brother–sister entrepreneur team. Their PC-based education software business, OWLCAT™, had just been acquired by Digital Research Inc., a leading software company, located in California. With funding from the COMSAT Corporation, a publically traded satellite communications company, the Weinstein-Newburger team brought the earliest dynamic-robotic Telepathology systems to market. Dynamic-robotic Telepathology became a dominant Telepathology technology in the late 1990s. Dr. Weinstein, a serial entrepreneur, continued to innovate and, with a team of optical scientists at The University of Arizona's College of Optical Sciences, developed the first sub-1-min whole-slide imaging system, the DMetrix DX-40 scanner, in the early 2000s
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the empirical foundations of Telepathology evidence of feasibility and intermediate effects
Telemedicine Journal and E-health, 2017Co-Authors: Rashid L Bashshur, Ronald S Weinstein, Elizabeth A Krupinski, Matthew R Dunn, Noura BashshurAbstract:Abstract Introduction: Telepathology evolved from video microscopy (i.e., “television microscopy”) research in the early 1950s to video microscopy used in basic research in the biological sciences to a basic diagnostic tool in telemedicine clinical applications. Its genesis can be traced to pioneering feasibility studies regarding the importance of color and other image-based parameters for rendering diagnoses and a series of studies assessing concordance of virtual slide and light microscopy diagnoses. This article documents the empirical foundations of Telepathology. Methods: A selective review of the research literature during the past decade (2005–2016) was conducted using robust research design and adequate sample size as criteria for inclusion. Conclusions: The evidence regarding feasibility/acceptance of Telepathology and related information technology applications has been well documented for several decades. The majority of evidentiary studies focused on intermediate outcomes, as indicated by com...
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Telepathology and digital pathology research
2016Co-Authors: Elizabeth A Krupinski, Achyut K Bhattacharyya, Ronald S WeinsteinAbstract:Telepathology, the practice of pathology at a distance, is a service component of digital pathology. The design and development of Telepathology imaging systems has been a multi-disciplinary enterprise, involving software and hardware engineers, optical scientists, computer scientists, and others. Clinical translational research has had a role in evaluating each new wave of innovations in Telepathology device design, testing, clinical trials and service implementations. Telepathology innovators have been disadvantaged by the very nature of their goal, that is, to create a means for pathologists to carry out their ordinary surgical pathology and cytopathology diagnostic service duties at a distance, equaling or surpassing the diagnostic performance and efficiency that they ordinarily achieve using conventional light microscopy. Unlike other novel medical imaging modalities, such as CT or MRI scans in diagnostic radiology, which offer the visualization of structures not seen with traditional x-ray radiography, the best that telepathologists can hope to do is equal the performance of a medical imaging technology, light microscopy, that is already a “gold standard” for medical diagnoses. This is challenging, especially when a robotic component is imposed between a digital imaging device in one location and the pathologist system operator in another. Nevertheless, many technical problems have been overcome and Telepathology is beginning to enter the mainstream of pathology laboratory practice.
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2014 american telemedicine association clinical guidelines for Telepathology another important step in support of increased adoption of Telepathology for patient care
Journal of Pathology Informatics, 2015Co-Authors: Andrew Evans, Ronald S Weinstein, Elizabeth A Krupinski, Liron PantanowitzAbstract:The updated clinical guidelines for Telepathology released in August 2014 by the American Telemedicine Association (ATA) define Telepathology as a form of communication between medical professionals that includes the transmission of pathology images and associated clinical information for various clinical applications including, but not limited to, primary diagnoses, rapid cytology interpretation, intraoperative and second opinion consultations, ancillary study review, archiving, and quality activities.[1] The modalities that can be used in Telepathology include static imaging, static-dynamic robotic microscopy, video microscopy, whole slide imaging (WSI), and combinations of the above, all of which represent forms of digital pathology. Well-known barriers to the adoption of Telepathology have included the cost of implementing and operating the technology, information technology-related challenges, pathologist perception of inferior performance relative to light microscopy, insufficient speed of these systems for high-volume clinical environments, as well as regulatory and licensure issues.[2] Another major challenge to the widespread adoption of Telepathology has been a lack of standards and best practice guidelines from governing bodies of pathology. However, these barriers are being steadily addressed. During the last 2 years, we have witnessed the release of clinical guidelines from several sources including the College of American Pathologists (CAP) on the validation of WSI systems for diagnostic purposes,[3] Guidance on Telepathology from the Royal College of Pathologists in the United Kingdom,[4] Guidelines from the Canadian Association of Pathologists on establishing Telepathology services in anatomic pathology,[5] and most recently, the revised clinical guidelines for Telepathology from the ATA.[1] In 2005, guidelines were established for practical Telepathology in Japan.[6] While the Food and Drug Administration in the United States has not yet approved WSI systems for primary diagnosis, Health Canada has granted Class II Medical Device Licensure to two WSI vendors for creating, managing, storing, annotating, measuring, and viewing digital images for routine pathology use including primary diagnosis.[7] The appearance of guidelines based on published evidence and current experience, the emergence of regulatory approval, and a growing body of literature showing that WSI is not inferior to light microscopy[8,9,10,11] represent major steps forward with respect to enhancing the adoption of Telepathology for patient care. The development of initial guidelines on any new technology necessarily draws heavily on the experience of early adopters. While such guidelines are not “standards of care” and are by no means all-encompassing, they nonetheless provide new and prospective users with a helpful list of issues, duties, and responsibilities to consider when implementing and using the technology of interest in their own practice. It also follows that such guidelines will need to be revised over time to accommodate advances in technology and the experience of an increased number of adopters. The 2014 clinical guidelines for Telepathology released by the ATA are an update to guidelines originally developed in 1999. A committee comprised primarily of pathologists with extensive experience in various aspects of Telepathology/digital pathology was assembled by the ATA in 2012. The committee also included a vendor representative with experience implementing clinical Telepathology systems and senior ATA personnel to ensure proper guideline development protocols were followed. Several ATA committee members were also involved in the development of other Telepathology guideline documents.[3,5] The process began with a review of the 1999 ATA document to define the scope of the 2014 update, specific elements to be covered and terms for a literature search for relevant publications. A guideline consensus workshop was held on October 5, 2013 in Washington DC-where individual committee members developed guideline statements for accepted outline elements. These were discussed, revised, and voted upon by the group. To enhance the efficiency of the workshop, the meeting was led by professional facilitators who employed ThinkTank software (Group Systems, Denver, CO) and a local computer network allowing the committee to build the guideline as the workshop proceeded. This 1-day workshop resulted in the production of an advanced first draft that was shaped into a final guideline with supporting Telepathology literature by E-mail and follow-up teleconferences. The final draft was subject to open public review and commentary, endorsed by several other organizations (CAP, Association for Pathology Informatics, Digital Pathology Association), and subsequently approved by the ATA Board of Directors prior to its official release in August 2014. Compared to the 1999 ATA Telepathology Guideline, the 2014 version standardizes terms that have been used interchangeably in Telepathology and includes newer technology such as WSI that was not commercially available in 1999. The 2014 update also provides detailed advice on many different clinical applications of Telepathology, highlights the need for user training and system validation, identifies facility responsibilities for sending and receiving sites, discusses regulatory, legal and patient confidentiality issues as well as the use of mobile viewing devices such as smartphones and tablets. Table 1 compares the elements covered in the 2014 ATA, 2013 Royal College of Pathologists in the United Kingdom and 2013 Canadian Association of Pathologists Guidelines on Telepathology. While the same core elements are covered in each of these documents, there are notable differences. The ATA and Royal College of Pathologists Guidelines both represent revised versions while the Canadian Guideline is the first such document developed in Canada. The Canadian Guideline focuses only on WSI, as the committee members felt that WSI was the most promising modality for certain Telepathology applications.[5] The ATA guideline is unique for its inclusion of a comprehensive glossary of terms. It also provides important advice on technical specifications and the use of mobile viewing devices, as well as addressing the use of Telepathology for rapid assessment of cytologic samples such as fine-needle aspiration specimens. The ATA and Canadian Guidelines were developed by committees, whereas the Royal College of Pathologists’ document has a single author supported by input from a Royal College committee and general members during a 1-month online consultation period. The ATA and Canadian Guidelines emphasize the importance of system validation before using Telepathology in live patient-care situations. The Royal College Guideline discusses the need for double reporting of representative proportions of cases by conventional microscopy and Telepathology. Unlike the ATA Guideline, the Royal College of Pathologists and Canadian guidelines provide more extensive discussion on the benefits of Telepathology, recognized problem areas, and the communication responsibilities for all stakeholders in Telepathology encounters. All guidelines cover legal liability issues specific mainly to practicing in the countries where they were developed. Table 1 Comparison of the ATA, UK and Canadian Telepathology guidelines There will certainly be more topics to address in revised versions of these Telepathology guidelines. It is likely that there will be a need for specific guidance concerning the retention of images used clinically in Telepathology. Specifically, should all images be retained or only those deemed to be diagnostically relevant by the consultant pathologist? For how long should these images be retained? No guideline to date offers advice on the use of third party commercially-operated cloud solutions to share protected health information, such as scanned slides and clinical notes with patient names and/or barcodes, between pathologists. Widely publicized “hacking” episodes in recent years illustrate the potential vulnerability of these solutions and underscore the importance of security in our current “upload-it-to-the-cloud” culture. The venues where Telepathology activities are carried out, particularly when mobile viewing devices are involved, represents another potential topic for refining of guidelines. Hopefully, common sense dictates that activities involving protected health information like Telepathology should be carried out in venues with some semblance of privacy as opposed to open public areas such as the food court at a shopping mall or an airport departure lounge. Guidelines from other clinical specialties such as radiology and psychiatry have already started dealing with these issues both from the technological and security/privacy perspectives so revisions to the Telepathology guidelines will have other documents to refer to. Finally, there will likely be situations when a pathologist would feel more confident if he/she could review the glass slides along with Telepathology images. A dilemma is created if the institution or country requesting the Telepathology diagnosis has policies prohibiting the release of the original glass slides. As these and other issues surface, pathologists will certainly look to future iterations of Telepathology guidelines for advice in these situations. The three guideline documents discussed above provide an excellent resource for those considering the use of Telepathology in their practice. The development and revision of these guidelines are an obligation for early adopters whose collective experience (good and bad) is crucial for the safe evolution of Telepathology. This is especially true in an era where medical practice is becoming increasingly anchored to evidence-based guidelines.[12]
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subspecialty surgical pathologist s performances as triage pathologists on a Telepathology enabled quality assurance surgical pathology service a human factors study
Journal of Pathology Informatics, 2014Co-Authors: Beth L Braunhut, Elizabeth A Krupinski, Anna R Graham, Fangru Lian, Achyut K Bhattacharyya, Phyllis Webster, Ronald S WeinsteinAbstract:Background: The case triage practice workflow model was used to manage incoming cases on a Telepathology-enabled surgical pathology quality assurance (QA) service. Maximizing efficiency of workflow and the use of pathologist time requires detailed information on factors that influence telepathologists' decision-making on a surgical pathology QA service, which was gathered and analyzed in this study. Materials and Methods: Surgical pathology report reviews and Telepathology service logs were audited, for 1862 consecutive Telepathology QA cases accrued from a single Arizona rural hospital over a 51 month period. Ten university faculty telepathologists served as the case readers. Each telepathologist had an area of subspecialty surgical pathology expertise (i.e. gastrointestinal pathology, dermatopathology, etc.) but functioned largely as a general surgical pathologist while on this Telepathology-enabled QA service. They handled all incoming cases during their individual 1-h Telepathology sessions, regardless of the nature of the organ systems represented in the real-time incoming stream of outside surgical pathology cases. Results: The 10 participating telepathologists' postAmerican Board of pathology examination experience ranged from 3 to 36 years. This is a surrogate for age. About 91% of incoming cases were immediately signed out regardless of the subspecialty surgical pathologists' area of surgical pathology expertise. One hundred and seventy cases (9.13%) were deferred. Case concurrence rates with the provisional surgical pathology diagnosis of the referring pathologist, for incoming cases, averaged 94.3%, but ranged from 88.46% to 100% for individual telepathologists. Telepathology case deferral rates, for second opinions or immunohistochemistry, ranged from 4.79% to 21.26%. Differences in concordance rates and deferral rates among telepathologists, for incoming cases, were significant but did not correlate with years of experience as a practicing pathologist. Coincidental overlaps of the area of subspecialty surgical pathology expertise with organ-related incoming cases did not influence decisions by the telepathologists to either defer those cases or to agree or disagree with the referring pathologist's provisional diagnoses. Conclusions: Subspecialty surgical pathologists effectively served as general surgical pathologists on a Telepathology-based surgical pathology QA service. Concurrence rates with incoming surgical pathology report diagnoses, and case deferral rates, varied significantly among the 10 on-service telepathologists. We found no evidence that the higher deferral rates correlated with improving the accuracy or quality of the surgical pathology reports.
Elizabeth A Krupinski - One of the best experts on this subject based on the ideXlab platform.
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Invention and early history of Telepathology (1985-2000)
Wolters Kluwer Medknow Publications, 2019Co-Authors: Ronald S Weinstein, Michael J Holcomb, Elizabeth A KrupinskiAbstract:This narrative-based paper provides a first-person account of the early history of Telepathology (1985–2000) by the field's inventor, Ronald S. Weinstein, M. D. During the 1980s, Dr. Weinstein, a Massachusetts General Hospital-trained pathologist, was director of the Central Pathology Laboratory (CPL) for the National Cancer Institute-funded National Bladder Cancer Project, located at Rush Medical College in Chicago, IL. The CPL did post therapy revalidations of surgical pathology and cytopathology diagnoses before outcomes of the completed clinical trials were published. The CPL reported that interobserver variability was invalidating inclusion of dozens of treated bladder cancer patients in published reports on treatment outcomes. This problem seemed ripe for a technology-assisted solution. In an effort to solve the interobserver variability problem, Dr. Weinstein devised a novel solution, dynamic-robotic Telepathology, that would potentially enable CPL uropathologists to consult on distant uropathology cases in real-time before their assignment to urinary bladder cancer, tumor stage, and grade-specific clinical trials. During the same period, universities were ramping up their support for faculty entrepreneurism and creating in-house technology transfer organizations. Dr. Weinstein recognized Telepathology as a potential growth industry. He and his sister, Beth Newburger, were a successful brother–sister entrepreneur team. Their PC-based education software business, OWLCAT™, had just been acquired by Digital Research Inc., a leading software company, located in California. With funding from the COMSAT Corporation, a publically traded satellite communications company, the Weinstein-Newburger team brought the earliest dynamic-robotic Telepathology systems to market. Dynamic-robotic Telepathology became a dominant Telepathology technology in the late 1990s. Dr. Weinstein, a serial entrepreneur, continued to innovate and, with a team of optical scientists at The University of Arizona's College of Optical Sciences, developed the first sub-1-min whole-slide imaging system, the DMetrix DX-40 scanner, in the early 2000s
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the empirical foundations of Telepathology evidence of feasibility and intermediate effects
Telemedicine Journal and E-health, 2017Co-Authors: Rashid L Bashshur, Ronald S Weinstein, Elizabeth A Krupinski, Matthew R Dunn, Noura BashshurAbstract:Abstract Introduction: Telepathology evolved from video microscopy (i.e., “television microscopy”) research in the early 1950s to video microscopy used in basic research in the biological sciences to a basic diagnostic tool in telemedicine clinical applications. Its genesis can be traced to pioneering feasibility studies regarding the importance of color and other image-based parameters for rendering diagnoses and a series of studies assessing concordance of virtual slide and light microscopy diagnoses. This article documents the empirical foundations of Telepathology. Methods: A selective review of the research literature during the past decade (2005–2016) was conducted using robust research design and adequate sample size as criteria for inclusion. Conclusions: The evidence regarding feasibility/acceptance of Telepathology and related information technology applications has been well documented for several decades. The majority of evidentiary studies focused on intermediate outcomes, as indicated by com...
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Telepathology and digital pathology research
2016Co-Authors: Elizabeth A Krupinski, Achyut K Bhattacharyya, Ronald S WeinsteinAbstract:Telepathology, the practice of pathology at a distance, is a service component of digital pathology. The design and development of Telepathology imaging systems has been a multi-disciplinary enterprise, involving software and hardware engineers, optical scientists, computer scientists, and others. Clinical translational research has had a role in evaluating each new wave of innovations in Telepathology device design, testing, clinical trials and service implementations. Telepathology innovators have been disadvantaged by the very nature of their goal, that is, to create a means for pathologists to carry out their ordinary surgical pathology and cytopathology diagnostic service duties at a distance, equaling or surpassing the diagnostic performance and efficiency that they ordinarily achieve using conventional light microscopy. Unlike other novel medical imaging modalities, such as CT or MRI scans in diagnostic radiology, which offer the visualization of structures not seen with traditional x-ray radiography, the best that telepathologists can hope to do is equal the performance of a medical imaging technology, light microscopy, that is already a “gold standard” for medical diagnoses. This is challenging, especially when a robotic component is imposed between a digital imaging device in one location and the pathologist system operator in another. Nevertheless, many technical problems have been overcome and Telepathology is beginning to enter the mainstream of pathology laboratory practice.
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2014 american telemedicine association clinical guidelines for Telepathology another important step in support of increased adoption of Telepathology for patient care
Journal of Pathology Informatics, 2015Co-Authors: Andrew Evans, Ronald S Weinstein, Elizabeth A Krupinski, Liron PantanowitzAbstract:The updated clinical guidelines for Telepathology released in August 2014 by the American Telemedicine Association (ATA) define Telepathology as a form of communication between medical professionals that includes the transmission of pathology images and associated clinical information for various clinical applications including, but not limited to, primary diagnoses, rapid cytology interpretation, intraoperative and second opinion consultations, ancillary study review, archiving, and quality activities.[1] The modalities that can be used in Telepathology include static imaging, static-dynamic robotic microscopy, video microscopy, whole slide imaging (WSI), and combinations of the above, all of which represent forms of digital pathology. Well-known barriers to the adoption of Telepathology have included the cost of implementing and operating the technology, information technology-related challenges, pathologist perception of inferior performance relative to light microscopy, insufficient speed of these systems for high-volume clinical environments, as well as regulatory and licensure issues.[2] Another major challenge to the widespread adoption of Telepathology has been a lack of standards and best practice guidelines from governing bodies of pathology. However, these barriers are being steadily addressed. During the last 2 years, we have witnessed the release of clinical guidelines from several sources including the College of American Pathologists (CAP) on the validation of WSI systems for diagnostic purposes,[3] Guidance on Telepathology from the Royal College of Pathologists in the United Kingdom,[4] Guidelines from the Canadian Association of Pathologists on establishing Telepathology services in anatomic pathology,[5] and most recently, the revised clinical guidelines for Telepathology from the ATA.[1] In 2005, guidelines were established for practical Telepathology in Japan.[6] While the Food and Drug Administration in the United States has not yet approved WSI systems for primary diagnosis, Health Canada has granted Class II Medical Device Licensure to two WSI vendors for creating, managing, storing, annotating, measuring, and viewing digital images for routine pathology use including primary diagnosis.[7] The appearance of guidelines based on published evidence and current experience, the emergence of regulatory approval, and a growing body of literature showing that WSI is not inferior to light microscopy[8,9,10,11] represent major steps forward with respect to enhancing the adoption of Telepathology for patient care. The development of initial guidelines on any new technology necessarily draws heavily on the experience of early adopters. While such guidelines are not “standards of care” and are by no means all-encompassing, they nonetheless provide new and prospective users with a helpful list of issues, duties, and responsibilities to consider when implementing and using the technology of interest in their own practice. It also follows that such guidelines will need to be revised over time to accommodate advances in technology and the experience of an increased number of adopters. The 2014 clinical guidelines for Telepathology released by the ATA are an update to guidelines originally developed in 1999. A committee comprised primarily of pathologists with extensive experience in various aspects of Telepathology/digital pathology was assembled by the ATA in 2012. The committee also included a vendor representative with experience implementing clinical Telepathology systems and senior ATA personnel to ensure proper guideline development protocols were followed. Several ATA committee members were also involved in the development of other Telepathology guideline documents.[3,5] The process began with a review of the 1999 ATA document to define the scope of the 2014 update, specific elements to be covered and terms for a literature search for relevant publications. A guideline consensus workshop was held on October 5, 2013 in Washington DC-where individual committee members developed guideline statements for accepted outline elements. These were discussed, revised, and voted upon by the group. To enhance the efficiency of the workshop, the meeting was led by professional facilitators who employed ThinkTank software (Group Systems, Denver, CO) and a local computer network allowing the committee to build the guideline as the workshop proceeded. This 1-day workshop resulted in the production of an advanced first draft that was shaped into a final guideline with supporting Telepathology literature by E-mail and follow-up teleconferences. The final draft was subject to open public review and commentary, endorsed by several other organizations (CAP, Association for Pathology Informatics, Digital Pathology Association), and subsequently approved by the ATA Board of Directors prior to its official release in August 2014. Compared to the 1999 ATA Telepathology Guideline, the 2014 version standardizes terms that have been used interchangeably in Telepathology and includes newer technology such as WSI that was not commercially available in 1999. The 2014 update also provides detailed advice on many different clinical applications of Telepathology, highlights the need for user training and system validation, identifies facility responsibilities for sending and receiving sites, discusses regulatory, legal and patient confidentiality issues as well as the use of mobile viewing devices such as smartphones and tablets. Table 1 compares the elements covered in the 2014 ATA, 2013 Royal College of Pathologists in the United Kingdom and 2013 Canadian Association of Pathologists Guidelines on Telepathology. While the same core elements are covered in each of these documents, there are notable differences. The ATA and Royal College of Pathologists Guidelines both represent revised versions while the Canadian Guideline is the first such document developed in Canada. The Canadian Guideline focuses only on WSI, as the committee members felt that WSI was the most promising modality for certain Telepathology applications.[5] The ATA guideline is unique for its inclusion of a comprehensive glossary of terms. It also provides important advice on technical specifications and the use of mobile viewing devices, as well as addressing the use of Telepathology for rapid assessment of cytologic samples such as fine-needle aspiration specimens. The ATA and Canadian Guidelines were developed by committees, whereas the Royal College of Pathologists’ document has a single author supported by input from a Royal College committee and general members during a 1-month online consultation period. The ATA and Canadian Guidelines emphasize the importance of system validation before using Telepathology in live patient-care situations. The Royal College Guideline discusses the need for double reporting of representative proportions of cases by conventional microscopy and Telepathology. Unlike the ATA Guideline, the Royal College of Pathologists and Canadian guidelines provide more extensive discussion on the benefits of Telepathology, recognized problem areas, and the communication responsibilities for all stakeholders in Telepathology encounters. All guidelines cover legal liability issues specific mainly to practicing in the countries where they were developed. Table 1 Comparison of the ATA, UK and Canadian Telepathology guidelines There will certainly be more topics to address in revised versions of these Telepathology guidelines. It is likely that there will be a need for specific guidance concerning the retention of images used clinically in Telepathology. Specifically, should all images be retained or only those deemed to be diagnostically relevant by the consultant pathologist? For how long should these images be retained? No guideline to date offers advice on the use of third party commercially-operated cloud solutions to share protected health information, such as scanned slides and clinical notes with patient names and/or barcodes, between pathologists. Widely publicized “hacking” episodes in recent years illustrate the potential vulnerability of these solutions and underscore the importance of security in our current “upload-it-to-the-cloud” culture. The venues where Telepathology activities are carried out, particularly when mobile viewing devices are involved, represents another potential topic for refining of guidelines. Hopefully, common sense dictates that activities involving protected health information like Telepathology should be carried out in venues with some semblance of privacy as opposed to open public areas such as the food court at a shopping mall or an airport departure lounge. Guidelines from other clinical specialties such as radiology and psychiatry have already started dealing with these issues both from the technological and security/privacy perspectives so revisions to the Telepathology guidelines will have other documents to refer to. Finally, there will likely be situations when a pathologist would feel more confident if he/she could review the glass slides along with Telepathology images. A dilemma is created if the institution or country requesting the Telepathology diagnosis has policies prohibiting the release of the original glass slides. As these and other issues surface, pathologists will certainly look to future iterations of Telepathology guidelines for advice in these situations. The three guideline documents discussed above provide an excellent resource for those considering the use of Telepathology in their practice. The development and revision of these guidelines are an obligation for early adopters whose collective experience (good and bad) is crucial for the safe evolution of Telepathology. This is especially true in an era where medical practice is becoming increasingly anchored to evidence-based guidelines.[12]
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human factors and human computer considerations in teleradiology and Telepathology
Healthcare, 2014Co-Authors: Elizabeth A KrupinskiAbstract:Radiology and pathology are unique among other clinical specialties that incorporate telemedicine technologies into clinical practice, as, for the most part in traditional practice, there are few or no direct patient encounters. The majority of teleradiology and Telepathology involves viewing images, which is exactly what occurs without the "tele" component. The images used are generally quite large, require dedicated displays and software for viewing, and present challenges to the clinician who must navigate through the presented data to render a diagnostic decision or interpretation. This digital viewing environment is very different from the more traditional reading environment (i.e., film and microscopy), necessitating a new look at how to optimize reading environments and address human factors issues. This paper will review some of the key components that need to be optimized for effective and efficient practice of teleradiology and Telepathology using traditional workstations as well as some of the newer mobile viewing applications.
Anna R Graham - One of the best experts on this subject based on the ideXlab platform.
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subspecialty surgical pathologist s performances as triage pathologists on a Telepathology enabled quality assurance surgical pathology service a human factors study
Journal of Pathology Informatics, 2014Co-Authors: Beth L Braunhut, Elizabeth A Krupinski, Anna R Graham, Fangru Lian, Achyut K Bhattacharyya, Phyllis Webster, Ronald S WeinsteinAbstract:Background: The case triage practice workflow model was used to manage incoming cases on a Telepathology-enabled surgical pathology quality assurance (QA) service. Maximizing efficiency of workflow and the use of pathologist time requires detailed information on factors that influence telepathologists' decision-making on a surgical pathology QA service, which was gathered and analyzed in this study. Materials and Methods: Surgical pathology report reviews and Telepathology service logs were audited, for 1862 consecutive Telepathology QA cases accrued from a single Arizona rural hospital over a 51 month period. Ten university faculty telepathologists served as the case readers. Each telepathologist had an area of subspecialty surgical pathology expertise (i.e. gastrointestinal pathology, dermatopathology, etc.) but functioned largely as a general surgical pathologist while on this Telepathology-enabled QA service. They handled all incoming cases during their individual 1-h Telepathology sessions, regardless of the nature of the organ systems represented in the real-time incoming stream of outside surgical pathology cases. Results: The 10 participating telepathologists' postAmerican Board of pathology examination experience ranged from 3 to 36 years. This is a surrogate for age. About 91% of incoming cases were immediately signed out regardless of the subspecialty surgical pathologists' area of surgical pathology expertise. One hundred and seventy cases (9.13%) were deferred. Case concurrence rates with the provisional surgical pathology diagnosis of the referring pathologist, for incoming cases, averaged 94.3%, but ranged from 88.46% to 100% for individual telepathologists. Telepathology case deferral rates, for second opinions or immunohistochemistry, ranged from 4.79% to 21.26%. Differences in concordance rates and deferral rates among telepathologists, for incoming cases, were significant but did not correlate with years of experience as a practicing pathologist. Coincidental overlaps of the area of subspecialty surgical pathology expertise with organ-related incoming cases did not influence decisions by the telepathologists to either defer those cases or to agree or disagree with the referring pathologist's provisional diagnoses. Conclusions: Subspecialty surgical pathologists effectively served as general surgical pathologists on a Telepathology-based surgical pathology QA service. Concurrence rates with incoming surgical pathology report diagnoses, and case deferral rates, varied significantly among the 10 on-service telepathologists. We found no evidence that the higher deferral rates correlated with improving the accuracy or quality of the surgical pathology reports.
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reconciliation of diverse Telepathology system designs historic issues and implications for emerging markets and new applications
Apmis, 2012Co-Authors: Ronald S Weinstein, Elizabeth A Krupinski, Anna R Graham, Fangru Lian, Beth L Braunhut, Gail R Barker, Achyut K BhattacharyyaAbstract:Telepathology, the distant service component of digital pathology, is a growth industry. The word "Telepathology" was introduced into the English Language in 1986. Initially, two different, competing imaging modalities were used for Telepathology. These were dynamic (real time) robotic Telepathology and static image (store-and-forward) Telepathology. In 1989, a hybrid dynamic robotic/static image Telepathology system was developed in Norway. This hybrid imaging system bundled these two primary pathology imaging modalities into a single multi-modality pathology imaging system. Similar hybrid systems were subsequently developed and marketed in other countries as well. It is noteworthy that hybrid dynamic robotic/static image Telepathology systems provided the infrastructure for the first truly sustainable Telepathology services. Since then, impressive progress has been made in developing another Telepathology technology, so-called "virtual microscopy" Telepathology (also called "whole slide image" Telepathology or "WSI" Telepathology). Over the past decade, WSI has appeared to be emerging as the preferred digital Telepathology digital imaging modality. However, recently, there has been a re-emergence of interest in dynamic-robotic Telepathology driven, in part, by concerns over the lack of a means for up-and-down focusing (i.e., Z-axis focusing) using early WSI processors. In 2010, the initial two U.S. patents for robotic Telepathology (issued in 1993 and 1994) expired enabling many digital pathology equipment companies to incorporate dynamic-robotic Telepathology modules into their WSI products for the first time. The dynamic-robotic Telepathology module provided a solution to the up-and-down focusing issue. WSI and dynamic robotic Telepathology are now, rapidly, being bundled into a new class of Telepathology/digital pathology imaging system, the "WSI-enhanced dynamic robotic Telepathology system". To date, six major WSI processor equipment companies have embraced the approach and developed WSI-enhanced dynamic-robotic digital Telepathology systems, marketed under a variety of labels. Successful commercialization of such systems could help overcome the current resistance of some pathologists to incorporate digital pathology, and Telepathology, into their routine and esoteric laboratory services. Also, WSI-enhanced dynamic robotic Telepathology could be useful for providing general pathology and subspecialty pathology services to many of the world's underserved populations in the decades ahead. This could become an important enabler for the delivery of patient-centered healthcare in the future.
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virtual slide Telepathology enables an innovative telehealth rapid breast care clinic
Seminars in Diagnostic Pathology, 2009Co-Authors: Ana Maria Lopez, Gail P Barker, Lynne Richter, Elizabeth A Krupinski, Anna R Graham, Fangru Lian, Lauren L Grasso, Ashley Miller, Lindsay N Kreykes, Jeffrey T HendersonAbstract:An innovative telemedicine-enabled rapid breast care service is described that bundles telemammography, Telepathology, and teleoncology services into a single day process. The service is called the UltraClinics® Process. Since the core services are at four different physical locations a challenge has been to obtain STAT second opinion readouts on newly diagnosed breast cancer cases. In order to provide same day QA re-review of breast surgical pathology cases, a DMetrix DX-40 ultrarapid virtual slide scanner (DMetrix, Inc., Tucson, AZ) was installed at the participating laboratory. Glass slides of breast cancer and breast hyperplasia cases were scanned the same day the slides were produced by the University Physicians Healthcare Hospital histology laboratory. Virtual slide Telepathology was used for STAT quality assurance readouts at University Medical Center, 6 miles away. There was complete concurrence with the primary diagnosis in 139 (90.3%) of cases. There were 4 (2.3%) major discrepancies, which would have resulted in a different therapy and 3 (1.9%) minor discrepancies. Three cases (1.9%) were deferred for immunohistochemistry. In 2 cases (1.3%), the case was deferred for examination of the glass slides by the reviewing pathologists at University Medical Center. We conclude that the virtual slide Telepathology QA program found a small number of significant diagnostic discrepancies. The virtual slide Telepathology program service increased the job satisfaction of subspecialty pathologists without special training in breast pathology, assigned to cover the general surgical pathology service at a small satellite university hospital.
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virtual slide Telepathology enables an innovative telehealth rapid breast care clinic
Human Pathology, 2009Co-Authors: Ana Maria Lopez, Gail P Barker, Lynne Richter, Elizabeth A Krupinski, Anna R Graham, Fangru Lian, Lauren L Grasso, Ashley Miller, Lindsay N Kreykes, Jeffrey T HendersonAbstract:Summary An innovative telemedicine-enabled rapid breast care service is described that bundles telemammography, Telepathology, and teleoncology services into a single day process. The service is called the UltraClinics® Process . Because the core services are at 4 different physical locations, a challenge has been to obtain stat second opinion readouts on newly diagnosed breast cancer cases. To provide same day quality assurance rereview of breast surgical pathology cases, a DMetrix DX-40 ultrarapid virtual slide scanner (DMetrix Inc, Tucson, AZ) was installed at the participating laboratory. Glass slides of breast cancer and breast hyperplasia cases were scanned the same day the slides were produced by the University Physicians Healthcare Hospital histology laboratory. Virtual slide Telepathology was used for stat quality assurance readouts at University Medical Center, 6 miles away. There was complete concurrence with the primary diagnosis in 139 (90.3%) of cases. There were 4 (2.3%) major discrepancies, which would have resulted in a different therapy and 3 (1.9%) minor discrepancies. Three cases (1.9%) were deferred for immunohistochemistry. In 2 cases (1.3%), the case was deferred for examination of the glass slides by the reviewing pathologists at University Medical Center. We conclude that the virtual slide Telepathology quality assurance program found a small number of significant diagnostic discrepancies. The virtual slide Telepathology program service increased the job satisfaction of subspecialty pathologists without special training in breast pathology, assigned to cover the general surgical pathology service at a small satellite university hospital.
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overview of Telepathology virtual microscopy and whole slide imaging prospects for the future
Human Pathology, 2009Co-Authors: Ronald S Weinstein, Ana Maria Lopez, Gail P Barker, Lynne Richter, Elizabeth A Krupinski, Anna R Graham, Achyut K Bhattacharyya, Kristine A Erps, Yukako Yagi, John R GilbertsonAbstract:Telepathology, the practice of pathology at a long distance, has advanced continuously since 1986. Today, fourth-generation Telepathology systems, so-called virtual slide Telepathology systems, are being used for education applications. Both conventional and innovative surgical pathology diagnostic services are being designed and implemented as well. The technology has been commercialized by more than 30 companies in Asia, the United States, and Europe. Early adopters of Telepathology have been laboratories with special challenges in providing anatomic pathology services, ranging from the need to provide anatomic pathology services at great distances to the use of the technology to increase efficiency of services between hospitals less than a mile apart. As to what often happens in medicine, early adopters of new technologies are professionals who create model programs that are successful and then stimulate the creation of infrastructure (ie, reimbursement, telecommunications, information technologies, and so on) that forms the platforms for entry of later, mainstream, adopters. The trend at medical schools, in the United States, is to go entirely digital for their pathology courses, discarding their student light microscopes, and building virtual slide laboratories. This may create a generation of pathology trainees who prefer digital pathology imaging over the traditional hands-on light microscopy. The creation of standards for virtual slide Telepathology is early in its development but accelerating. The field of Telepathology has now reached a tipping point at which major corporations now investing in the technology will insist that standards be created for pathology digital imaging as a value added business proposition. A key to success in teleradiology, already a growth industry, has been the implementation of standards for digital radiology imaging. Telepathology is already the enabling technology for new, innovative laboratory services. Examples include STAT QA surgical pathology second opinions at a distance and a telehealth-enabled rapid breast care service. The innovative bundling of telemammography, Telepathology, and teleoncology services may represent a new paradigm in breast care that helps address the serious issue of fragmentation of breast cancer care in the United States and elsewhere. Legal and regulatory issues in Telepathology are being addressed and are regarded as a potential catalyst for the next wave of Telepathology advances, applications, and implementations.
Bruce E Dunn - One of the best experts on this subject based on the ideXlab platform.
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Telepathology networking in visn 12 of the veterans health administration
Telemedicine Journal and E-health, 2000Co-Authors: Bruce E Dunn, Urias A Almagro, Hongyung Choi, Daniel L Recla, Craig W DavisAbstract:The Veterans Integrated Service Network (VISN)-12, headquartered in Chicago, has implemented a Telepathology network between the eight VISN-12 hospital laboratories and Loyola University Medical School linked by an economical, high-speed wide-area network (WAN). Implementation of the WAN has reduced monthly telecommunications costs in VISN-12 by approximately 67%. In addition to Telepathology, the WAN enables real-time teleradiology (general, computer tomography, and ultrasound), telefluoroscopy, telenuclear medicine imaging, telepsychiatry, and other forms of teleconsultation. Current applications of Telepathology in VISN-12 include: primary diagnosis and consultation in surgical pathology, interpretation of serum protein electrophoresis and immunofixation gels, provision of support for consolidated microbiology laboratories, review of problematic peripheral blood smears, and distance learning. We have learned a variety of lessons from Telepathology. The enthusiasm and technical skill of providers are es...
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cost minimization analysis of Telepathology
American Journal of Clinical Pathology, 1999Co-Authors: Zia Agha, Ronald S Weinstein, Bruce E DunnAbstract:Telepathology is gaining acceptance as a mode of providing pathology services to remote sites, but its economic feasibility is unknown. A dynamic robotic Telepathology service between the Veterans Affairs Medical Center, Iron Mountain, MI, and the Veterans Affairs Medical Center, Milwaukee, WI, provides diagnostic services for routine and frozen section surgical pathology cases at Iron Mountain. We conducted a cost minimization analysis of this service by building a model to compare Telepathology and on-site pathology in Iron Mountain and a courier method oftransporting specimens from Iron Mountain to Milwaukee for diagnosis. Base case analysis showed the courier method to be the most economic; Telepathology was less costly than on-site pathology. If the costs of Telepathology equipment and telecommunication are lowered to reflect current cost, then Telepathology becomes the favored option. Telepathology can be an economic mode of providing pathology services to a remote site.
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dynamic robotic Telepathology department of veterans affairs feasibility study
Human Pathology, 1997Co-Authors: Bruce E Dunn, Elizabeth A Krupinski, Anna R Graham, Urias A Almagro, Hongyung Choi, Neela K Sheth, James S Arnold, Daniel L Recla, Ronald S WeinsteinAbstract:Abstract In this retrospective study, we assess the accuracy, confidence levels, and viewing times of two generalist pathologists using both dynamic-robotic Telepathology and conventional light microscopy (LM) to render diagnoses on a test set of 100 consecutive routine surgical pathology cases. The objective is to determine whether Telepathology will allow a pathology group practice at a diagnostic hub to provide routine diagnostic services to a remote hospital without an on-site pathologist. For TP, glass slides were placed on the motorized stage of the robotic microscope of a Telepathology system by a senior laboratory technologist in Iron Mountain, MI. Real-time control of the motorized microscope was then transferred to a pathologist in Milwaukee, WI, who viewed images of the glass slides on a video monitor. The telepathologists deferred rendering a diagnosis in 1.5% of cases. Clinically important concordance between the individual diagnoses rendered by Telepathology and the “truth” diagnoses established by rereview of glass slides was 98.5%. In the Telepathology mode, there were five incorrect diagnoses out of a total of 197 diagnoses. In four cases in which the Telepathology diagnosis was incorrect, the pathologist's diagnosis by LM was identical to that rendered by Telepathology. These represent errors of interpretation and cannot be ascribed to Telepathology. The certainty of the pathologists with respect to their diagnoses was evaluated over time. Results for the first 50 cases served as baseline data. For the second 50 cases, confidence in rendering a diagnosis in the Telepathology mode was essentially identical to that of making a diagnosis in the LM viewing mode. Viewing times in the Telepathology mode also improved with more experience using the Telepathology system. These results support the concept that an off-site pathologist using dynamic-robotic Telepathology can substitute for an on-site pathologist as a service provider.
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use of Telepathology for routine surgical pathology review in a test bed in the department of veterans affairs
Telemedicine Journal, 1997Co-Authors: Bruce E Dunn, Urias A Almagro, Hongyung Choi, Daniel L Recla, Ronald S WeinsteinAbstract:Background Routine surgical pathology review by Telepathology could be an important service component of multi-institutional pathology laboratory systems. Such service networks would increase acces...
Lynne Richter - One of the best experts on this subject based on the ideXlab platform.
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virtual slide Telepathology enables an innovative telehealth rapid breast care clinic
Seminars in Diagnostic Pathology, 2009Co-Authors: Ana Maria Lopez, Gail P Barker, Lynne Richter, Elizabeth A Krupinski, Anna R Graham, Fangru Lian, Lauren L Grasso, Ashley Miller, Lindsay N Kreykes, Jeffrey T HendersonAbstract:An innovative telemedicine-enabled rapid breast care service is described that bundles telemammography, Telepathology, and teleoncology services into a single day process. The service is called the UltraClinics® Process. Since the core services are at four different physical locations a challenge has been to obtain STAT second opinion readouts on newly diagnosed breast cancer cases. In order to provide same day QA re-review of breast surgical pathology cases, a DMetrix DX-40 ultrarapid virtual slide scanner (DMetrix, Inc., Tucson, AZ) was installed at the participating laboratory. Glass slides of breast cancer and breast hyperplasia cases were scanned the same day the slides were produced by the University Physicians Healthcare Hospital histology laboratory. Virtual slide Telepathology was used for STAT quality assurance readouts at University Medical Center, 6 miles away. There was complete concurrence with the primary diagnosis in 139 (90.3%) of cases. There were 4 (2.3%) major discrepancies, which would have resulted in a different therapy and 3 (1.9%) minor discrepancies. Three cases (1.9%) were deferred for immunohistochemistry. In 2 cases (1.3%), the case was deferred for examination of the glass slides by the reviewing pathologists at University Medical Center. We conclude that the virtual slide Telepathology QA program found a small number of significant diagnostic discrepancies. The virtual slide Telepathology program service increased the job satisfaction of subspecialty pathologists without special training in breast pathology, assigned to cover the general surgical pathology service at a small satellite university hospital.
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virtual slide Telepathology enables an innovative telehealth rapid breast care clinic
Human Pathology, 2009Co-Authors: Ana Maria Lopez, Gail P Barker, Lynne Richter, Elizabeth A Krupinski, Anna R Graham, Fangru Lian, Lauren L Grasso, Ashley Miller, Lindsay N Kreykes, Jeffrey T HendersonAbstract:Summary An innovative telemedicine-enabled rapid breast care service is described that bundles telemammography, Telepathology, and teleoncology services into a single day process. The service is called the UltraClinics® Process . Because the core services are at 4 different physical locations, a challenge has been to obtain stat second opinion readouts on newly diagnosed breast cancer cases. To provide same day quality assurance rereview of breast surgical pathology cases, a DMetrix DX-40 ultrarapid virtual slide scanner (DMetrix Inc, Tucson, AZ) was installed at the participating laboratory. Glass slides of breast cancer and breast hyperplasia cases were scanned the same day the slides were produced by the University Physicians Healthcare Hospital histology laboratory. Virtual slide Telepathology was used for stat quality assurance readouts at University Medical Center, 6 miles away. There was complete concurrence with the primary diagnosis in 139 (90.3%) of cases. There were 4 (2.3%) major discrepancies, which would have resulted in a different therapy and 3 (1.9%) minor discrepancies. Three cases (1.9%) were deferred for immunohistochemistry. In 2 cases (1.3%), the case was deferred for examination of the glass slides by the reviewing pathologists at University Medical Center. We conclude that the virtual slide Telepathology quality assurance program found a small number of significant diagnostic discrepancies. The virtual slide Telepathology program service increased the job satisfaction of subspecialty pathologists without special training in breast pathology, assigned to cover the general surgical pathology service at a small satellite university hospital.
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overview of Telepathology virtual microscopy and whole slide imaging prospects for the future
Human Pathology, 2009Co-Authors: Ronald S Weinstein, Ana Maria Lopez, Gail P Barker, Lynne Richter, Elizabeth A Krupinski, Anna R Graham, Achyut K Bhattacharyya, Kristine A Erps, Yukako Yagi, John R GilbertsonAbstract:Telepathology, the practice of pathology at a long distance, has advanced continuously since 1986. Today, fourth-generation Telepathology systems, so-called virtual slide Telepathology systems, are being used for education applications. Both conventional and innovative surgical pathology diagnostic services are being designed and implemented as well. The technology has been commercialized by more than 30 companies in Asia, the United States, and Europe. Early adopters of Telepathology have been laboratories with special challenges in providing anatomic pathology services, ranging from the need to provide anatomic pathology services at great distances to the use of the technology to increase efficiency of services between hospitals less than a mile apart. As to what often happens in medicine, early adopters of new technologies are professionals who create model programs that are successful and then stimulate the creation of infrastructure (ie, reimbursement, telecommunications, information technologies, and so on) that forms the platforms for entry of later, mainstream, adopters. The trend at medical schools, in the United States, is to go entirely digital for their pathology courses, discarding their student light microscopes, and building virtual slide laboratories. This may create a generation of pathology trainees who prefer digital pathology imaging over the traditional hands-on light microscopy. The creation of standards for virtual slide Telepathology is early in its development but accelerating. The field of Telepathology has now reached a tipping point at which major corporations now investing in the technology will insist that standards be created for pathology digital imaging as a value added business proposition. A key to success in teleradiology, already a growth industry, has been the implementation of standards for digital radiology imaging. Telepathology is already the enabling technology for new, innovative laboratory services. Examples include STAT QA surgical pathology second opinions at a distance and a telehealth-enabled rapid breast care service. The innovative bundling of telemammography, Telepathology, and teleoncology services may represent a new paradigm in breast care that helps address the serious issue of fragmentation of breast cancer care in the United States and elsewhere. Legal and regulatory issues in Telepathology are being addressed and are regarded as a potential catalyst for the next wave of Telepathology advances, applications, and implementations.
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the innovative bundling of teleradiology Telepathology and teleoncology services
Ibm Systems Journal, 2007Co-Authors: Ronald S Weinstein, Ana Maria Lopez, Gail P Barker, Michael R Descour, Katherine M Scott, Lynne Richter, Sandra J Beinar, Michael J Holcomb, Elizabeth A Krupinski, P H BartelsAbstract:Teleradiolosy, Telepathology, and teleoncology are important applications of telemedicine. Recent advances in these fields include a preponderance of radiology PACS (Picture Archiving and Communications System) users, the implementation of around-the-clock teleradiology services at many hospitals, and the invention of the first ultrarapid whole-slide digital scanner based on the array microscope. These advances have led to the development of a new health-care-delivery clinical pathway called the ultrarapid breast care process (URBC), which has been commercialized as the UltraClinics® process. This process bundles telemammography, Telepathology, and teleoncology services and has reduced the time it takes for a woman to obtain diagnostic and therapeutic breast-care planning services from several weeks to a single day. This paper describes the UltraClinics process in detail and presents the vision of a network of same-day telemedicine-enabled UltraClinics facilities, staffed by a virtual group practice of teleradiologists, telepathologists, and teleoncologists.
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Telepathology overview from concept to implementation
Human Pathology, 2001Co-Authors: Ronald S Weinstein, Michael R Descour, Katherine M Scott, Lynne Richter, Elizabeth A Krupinski, Anna R Graham, Achyut K Bhattacharyya, Chen Liang, John R Davis, Janusz SzymusAbstract:Abstract Telepathology is the practice of pathology at a distance by using video imaging and telecommunications. Significant progress has been made in Telepathology. To date, 12 classes of Telepathology systems have been engineered. Rapid and ultrarapid virtual slide processors may further expand the range of Telepathology applications. Next-generation digital imaging light microscopes, such as miniaturized microscope arrays (MMA), may make virtual slide processing a routine laboratory tool. Diagnostic accuracy of Telepathology is comparable with that of conventional light microscopy for most diagnoses. Current Telepathology applications include intraoperative frozen sections services, routine surgical pathology services, second opinions, and subspecialty consultations. Three Telepathology practice models are discussed: the subspecialty practice (SSP) model; the case triage practice (CTP) model; and the virtual group practice (VGP) model. Human factors influence performance with Telepathology. Experience with 500 Telepathology cases from multiple organs significantly reduces the video viewing time per case (P UM P ATHOL 32:1283-1299. Copyright © 2001 by W.B. Saunders Company
