emerging developments and your future in pathology jared n. schwartz, md, phd, fcap president,...
Post on 22-Dec-2015
213 views
TRANSCRIPT
Emerging Developments and Your Future in PathologyEmerging Developments and Your Future in PathologyJared N. Schwartz, MD, PhD, FCAPPresident, College of American PathologistsPresbyterian HealthCharlotte, NC
John Winbern Turner, MD, FCAPJohnston-Willis HospitalRichmond, VA
Emerging Developments and Your Future in Pathology
• What is happening in healthcare?
• How will that affect your career as a pathologist?
• What are the emerging technologies?
• What can you do to better prepare yourself?
• What is the College doing to help you along the way?
Traditional trial-and-error method of care is no longer acceptable
Patient presents with
symptoms
Doctor makes a “most likely” diagnosis, may order tests to confirm,
and prescribes a treatment plan (usually drugs and/or surgery)
Weight & age may affect drug
selection & dosage or other
intervention
Plan works or doesn’t work, +/-
side effects?
Treatment plan success
Doctor revises treatment plan
The occasional result: sub-optimal treatment, prolonged periods of trial and error, medical noncompliance, and increased cost—factors that can increase patient morbidity and mortality
In spite of all the money and effort devoted to biomedical research, the outcomes are not very satisfying
• Over 60% of patients diagnosed with Type II diabetes have blood sugars that exceed the recommended target level
• Only 17% of patients with heart disease ever reach the national guidelines treatment goals for cholesterol management
• Among patients diagnosed with depression, only half report a 50% improvement in symptoms after using antidepressant medications– 32% of patients who received a placebo also experienced a 50%
improvement in symptoms!
Patient response rates to a major drug in selected categories of therapy
Category of Disease % who respond to therapy
Analgesics for pain (Cox-2 inhibitors) 80%
Asthma 60%
Cardiac Arrythmias 60%
Schizophrenia 60%
Migraine (acute) 52%
Migraine (prophylaxis) 50%
Rheumatoid Arthritis 50%
Osteoporosis 48%
HCV 47%
Alzheimer’s Disease 30%
Oncology 25%Source: Physicians’ Desk Reference
What does the consumer want?
• High quality• Reasonable cost• Delivery as fast as
possible• Minimal inconvenience• Access to care with the latest technology• Reduced risk• Confidence and trust
Help!• Fast and accurate results• Understandable and
useful information• Direction on therapy• Low costs--may not be as
important
What does the patient’s treating physician want?What does the patient’s treating physician want?
Market demand and emerging technologies are accelerating the shift to “Precision” medicine
• Provision of care for diseases which can be precisely diagnosed and subsequently treated with predictably effective rules-based therapies– Precision technologies driving the disruption of existing
healthcare business models– Precise diagnosis must precede predictably
effective therapy
• Requires technology progress on two fronts– Understanding the cause of disease– Ability to detect those casual factors Patient
presents with symptoms
Doctor makes a “most likely” diagnosis, may order tests to confirm,
and prescribes a treatment plan (usually drugs and/or surgery)
Weight & age may affect drug selection &
dosage or other intervention
Plan works or doesn’t work,
+/- side effects?
Treatment plan success
Doctor revises treatment plan
Patient presents with
symptoms
Doctor makes a “most likely” diagnosis, may order tests to confirm,
and prescribes a treatment plan (usually drugs and/or surgery)
Weight & age may affect drug selection &
dosage or other intervention
Plan works or doesn’t work,
+/- side effects?
Treatment plan success
Doctor revises treatment plan
Source: Christensen/Hwang
Precision medicine is not new; consider the history of infectious disease therapy
• Earliest categorization schemes: immorality, weakness of faith
• Unsanitary conditions in the city• Exposure to affected individuals; contact with certain
insects and animals • Microscopes and various staining techniques
– Identification of microbes that caused disease with overlapping symptoms offering clues to the aggressiveness and spread of disease and the prognosis
– Tailored antibiotic therapy based on the species of organism– Molecular subtype and resistance profile of the involved strain
It took centuries of significant events to get us to this point
Leeuwenhoek observes “little animals” under
microscope
Fleming discovers Penicillin
Reed proves mosquitoes are vector
for yellow feverEhrlich introduces the acid-
fast staining technique
Pasteur explores Germ Theory of Disease
Jenner administers smallpox vaccine
Koch proves Germ Theory with discovery
of B. anthracis Semmelweis proposes
handwashing to prevent spread of disease
Lister adopts antiseptic technique in surgery
1670 19201870182017701720
The cost of diagnosing and treating infectious diseases
has declined 5% per year since 1940
The cost of diagnosing and treating infectious diseases
has declined 5% per year since 1940
Source: Christensen/Hwang
Today, Cancer is experiencing a similar shift toward precision medicine
1920 1930 1940 1950 1960 1970 1980 1990 2000 2010
Disease of the blood
2 types: leukemia & lymphoma
Farber develops 1st chemotherapy
for leukemia
3 types of leukemia (acute, chronic, preleukemia) and 2 types of lymphoma (indolent,
aggressive)
Novartis launches Gleevec, the 1st molecular targeted drug, to
treat myeloid leukemia
38 types of leukemia; 51 types
of lymphoma
Source: Mara Aspinall, Genzyme
Precision medicine implies personalization and all its benefits• Diagnosis predicting risk of
disease• Determining whether a treatment
is working • Monitoring healthy people to
detect early signs of disease• Producing safer drugs by
predicting potential for adverse effects earlier
• Targeting groups of people most likely to benefit from a drug, while keeping its use from those who may be harmed by it
• Producing better medical products• Ready access to information• Decreasing health care costs
Diagnostic tests and data integration are the critical links to the success of personalized medicine
Industry recognizes the opportunity and are willing to work with anyone
Are diagnostics the Are diagnostics the newnew wonder drug wonder drug on Wall Street?on Wall Street?
Practice of medicine is moving from the treatment of illness to the aggressive promotion of wellness
DATA & SYSTEMS INTEGRATION
EVOLUTIONARY PRACTICES
DIS
TR
IBU
TE
D H
IGH
-TH
RO
UG
HP
UT
AN
AL
YT
ICS
REV
OLU
TIO
NA
RY
TEC
HN
OLO
GIE
S
Automated systems
Organized(error-reduction)
Nonspecific(treat symptoms)
1st generation diagnostics
Information Correlation
Personalized(disease prevention)
HEALTHCARE TODAY
HEALTHCARE TODAY
TRANSITIONAL MEDICINETRANSITIONAL MEDICINE
PERSONALIZED HEALTHCARE
Genetic Predisposition TestingGenetic Predisposition Testing
Clinical Clinical GenomicsGenomics
Molecular MedicineMolecular Medicine
CACA--diagnosisdiagnosis
Lifetime TreatmentLifetime Treatment
PrePre--symptomatic Treatmentsymptomatic Treatment
Digital ImagingDigital Imaging
Episodic TreatmentEpisodic Treatment Artificial Expert SystemArtificial Expert SystemElectronic HealthElectronic Health
RecordRecord
Moving from the treatment of illness to the aggressive
promotion of wellness
SOURCE: IBM LIFE SCIENCES SOLUTIONS
DATA & SYSTEMS INTEGRATION
EVOLUTIONARY PRACTICES
DIS
TR
IBU
TE
D H
IGH
-TH
RO
UG
HP
UT
AN
AL
YT
ICS
REV
OLU
TIO
NA
RY
TEC
HN
OLO
GIE
S
Automated systems
Organized(error-reduction)
Nonspecific(treat symptoms)
1st generation diagnostics
Information Correlation
Personalized(disease prevention)
HEALTHCARE TODAY
HEALTHCARE TODAY
TRANSITIONAL MEDICINETRANSITIONAL MEDICINE
PERSONALIZED HEALTHCARE
Genetic Predisposition TestingGenetic Predisposition Testing
Clinical Clinical GenomicsGenomics
Molecular MedicineMolecular Medicine
CACA--diagnosisdiagnosis
Lifetime TreatmentLifetime Treatment
PrePre--symptomatic Treatmentsymptomatic Treatment
Digital ImagingDigital Imaging
Episodic TreatmentEpisodic Treatment Artificial Expert SystemArtificial Expert SystemElectronic HealthElectronic Health
RecordRecord
Moving from the treatment of illness to the aggressive
promotion of wellness
SOURCE: IBM LIFE SCIENCES SOLUTIONS
IVDs will become increasingly vital components of the health care system
• High value Dx provide critical information to help physicians make clinically relevant decisions
• Molecular Dx and AP are fastest growing segments – AP market is growing at 15% CAGR and moving towards
automation and digitalization– Continued growth of Pap is likely to slow down when MDx
assays start gaining acceptance
• Other high growth segments– ICH, ISH and special stains– Digital pathology– Tissue microarrays
Source: Scientia
Molecular diagnostics is at the core of the personalized medicine vision
Diseases will be diagnosed long before the patient begins to manifest any evidence using traditional tools
In vitro Laboratory
Tests
In vitro Laboratory
Tests
In vivo Imaging
Techniques
In vivo Imaging
Techniques
Signs & SymptomsSigns & Symptoms
Molecular DiagnosticsMolecular
Diagnostics…and biomarkers willbe a primary tool
Compression of the biomarker development timeline is accelerating progress
Preclinical exploratoryClinical assay
& validationRetrospective
longitudinalProspective
screeningCancercontrol
1977: FDA approves PSA for patients
already diagnosed
1996-7: 4 new chemical entity therapeutics
approved for prostate cancer
2002-04: Period and retrospective
analyses on survival
1994: PSA approved as predictive indicator
2007: “220 therapeutics emerging”; 100 in Phase II;
20 on market
Source: Bartsch, et al, IBM (Imaging) Biomarker Summit III, Jan 2007
PSA Biomarker development: 30 years
Circulating Tumor CellsWhat is the impact of CTC assays on pathology?
Technology Overview• Potentially powerful predictors of
progression-free survival• Assays count rare events – epithelial
tumor cells in the peripheral bloodstream and compare to established frequency profiles
• May predict treatment response more quickly than usual clinical practice with radiologic imaging (2-3 days vs 2-3 months), allowing rapid therapy modification
• FDA-approved for patients with metastatic breast cancer; tool for predicting progression-free and overall survival, monitoring disease progression
• Ongoing research evaluating efficacy for other tumor types
Pro
bab
ility
of
Ad
op
tio
n in
to C
linic
al U
se Technology Curve:CTC Assay
0Pre-
Clinical
3Consensus Adopters
2Early
Adopters
1Innovators
5Late
Adopters
4Cautious Adopters
Other
Metastatic Breast Cancer
• Expected rate of adoption: Slow• Barriers: Only clinical evidence is in therapy
monitoring for metastatic breast cancer• Accelerators: FDA approval of additional
applications/tumor types
Impact may be dramatic…or not
2006 2008 20122010 20162014
Impact Timing
Screening N/A
Diagnosis & Staging 2014
Treatment Planning 2010
Therapy Monitoring 2008
High Medium Low
35
30
25
20
15
10
5
0
Tests (Thousands)
CTC Assays for Therapy MonitoringOP Test Volumes, US Market *
• Current utilization almost exclusively limited to research
• As clinical benefits are established, utilization will grow significantly
* Source: Sg2 Analysis, 2007
Potential Impact by Indication
Screening Virtual Colonoscopy What is the impact of Screening VC on pathology?
Technology Overview• VC uses CT technology as an
alternative to optical screening colonoscopy
• VC digitally reconstructs the CT image into 2D and 3D pictures of colonic luminal surfaces (achievable, manipulatable, post procedure review)
• Early studies indicate VC offers sensitivity and specificity similar to OC; VC does not require sedation
• Patients with suspicious VC exams immediately referred for an optical colonscopy, often on same day, for possible biopsy and/or polyp excision
Pro
bab
ility
of
Ad
op
tio
n in
to C
linic
al U
se Technology Curve:Screening VC
0Pre-
Clinical
3Consensus Adopters
2Early
Adopters
1Innovators
5Late
Adopters
4Cautious Adopters
• Expected rate of adoption: Moderate• Barriers: Public preference; Payment—
must be driven by provider• Accelerators: Publicity for screening, public
preference
Destructive or positive impact?
2006 2008 20122010 20162014
9
8
7
6
5
4
3
2
1
0
# of Procedures (Millions)
Growth in Virtual and OpticalColonoscopy, US Market *
• VC will increase colorectal cancer screening and therapeutic volumes
• Pathology volumes for colon biopsy will mirror therapeutic colonoscopy volumes
* Source: Sg2 Analysis, 2007
Optical Colonoscopy (Screening)
Optical Colonoscopy (Therapeutic)
Virtual Colonoscopy (Screening)
-9%
+59% >200%
Q1 ‘04 Q3 ‘04Q2 ‘04 Q1 ‘05Q4 ’04
3000
2500
2000
1500
1000
500
0
# of Procedures
Virtual
Optical
Total Colonoscopies (Virtual & Optical)University of Wisconsin *
UW Clinical Experience Year 1
VC patients referred for OC (size ≥ 10 mm) 4%
VC patients who would be referred if all patients with lesions ≥ 6 mm were sent for an OC
11%
Patients in VC study 1,110
1680s: English Tripod Microscope
1595: 1st Compound Microscope
Mid-1700s: Cuff-style microscope; 1st to provide ease of use and accurate focusing mechanisms
It has taken us 500 years to get to this point…It can’t just be about making pretty pictures!
It has taken us 500 years to get to this point…It can’t just be about making pretty pictures!
What is virtual microscopy?
1998: State of the art contains accessories for DIC, fluorescence, polarized light, phase contrast, and photomicrography
1899: Ernst Leitz Compound Binocular Microscope
Digitalization offers both advantages and challenges
Digitalization offers both advantages and challenges
It’s just a matter of time
40-sec20x scan
20-second40x multi-angle
scan
20-sec20x scan
Multispectral imagingIm
ag
ing
Pathology PACS
Enterprise image management
100 PetabytesPetabytes100 Terabytes
Sto
rag
e
Subspecialistwork flow
triage
Rapidsecondary
consultations
Computer-aided detection
Computer-aided diagnosis
Ap
pli
ca
tio
ns
2007 2012 2017
* Source: Sg2 T3 Virtual Slide Imaging
ImagingImaging
Prognosis & TreatmentPrognosis & Treatment
Predisposition, Signs, SymptomsPredisposition,
Signs, Symptoms
The value of traditional pathology has not diminished.
It simply will no longer be sufficient.
Pathologist
Gene ExpressionPharmacogenomics
Gene ExpressionPharmacogenomics
BiomarkersBiomarkers
TraditionalPathologyTraditionalPathology
Each pathologist and organization has a place on the Technology Adoption Curve
Early Adopters—target for leadership and
resource committees
Innovators—target for foundation grants
Consensus Adopters—Primary target for education and accreditation products
Late Adopters—Members at the
sunset of their careers
1 2 3 4 5
Early Adopters—target for leadership and
resource committees
Innovators—target for foundation grants
Consensus Adopters—Primary target for education and accreditation products
Late Adopters—Members at the
sunset of their careers
1 2 3 4 5
Where is the specialty of pathology?
Cautious Adopters—Target for technology education
Cautious Adopters—Target for technology education
We’re interested in your thoughts…
1. In 5 years, what will be your primary role as a clinician? How about 10 years?
2. What technology would you like for your program to teach but it doesn’t? Why?
3. What current technologies in pathology could be absorbed by other specialties and what technologies could pathology absorb?
4. How does the concept of personalized medicine affect pathology?
We’re interested in your thoughts…
5. How can the testing and certification programs in pathology training be re-oriented to the changing field of medicine?
6. What is the real difference between clinical and anatomic pathology anyway?
7. If your first job out of training required you to read a PET scan, could you / would you be willing to do it and how would you go about learning how?
8. How do other specialists view pathologists, and does that perception need improvement?
Do you feel powerless as a trainee, or are you using your status as a crutch to avoid challenging the status quo?
But I’m just a resident…
How to prepare yourself for the future now…
• In training• How you choose a job or fellowship• In early practice
But I am just a resident…
During training
• Take advantage of pioneers in your facility• Get exposure out of your training program• Insert yourself into the flow of patient care
(e.g. projects, sign out)
Leaving training
PATHOLOGISTS WANTED
• Choose a job that will allow you to pursue your learning and practice goals– Ask about opportunities to be
involved in new technologies and new activities
– Find out what innovations have recently been implemented
– Ask about decision-making processes
– Get involved
In early practice
• Re-learn skills of systems-based knowledge and challenge peers
• “Keep your head up” for additional challenges/ opportunities
Yes…but CAP is implementing strategies to ensure you have the tools, education and advocacy necessary for a successful, relevant career in pathology
Vision of PathologistsPathologists are physicians who take an active role in patient care, utilizing all available tools to integrate and interpret diagnostic information to provide an accurate diagnosis of disease. Pathologists work closely with other members of the medical team to assess the patient condition and prognosis in order to determine optimum therapy alternatives.
Pathology will assume a critical role in health care delivery
Pathology will assume a critical role in health care delivery
• Have a unique knowledge of disease processes
• Are knowledge integrators• Can get access to all the
diagnostic data necessary• Are responsible for the
testing that is driving therapy
Pathologists
CAP is ready to pursue a transformational role for the specialty and pathologists
Mission
The CAP, the leading organization of board-certified pathologists, serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine.
Vision
The CAP is the primary driver in the transformation of the specialty of pathology and pathologists. As the transformation agent, CAP will greatly strengthen and evolve its position into:– The leading organization guiding
pathologists– The leader in promoting quality patient
care– The primary resource for information and
education – The most influential advocate for
pathologists
While maintaining a solid foundation, the CAP is pursuing change
• Broad initiatives: The Four “Big Things”
• Laboratory Quality & Improvement for the 21st Century (LQI-21) Ad Hoc Committee
• Technology Assessment Committee
• Personalized Medicine Committee
• Diagnostic Database Initiative
Strategic Planning identified 4 initiatives that would contribute most significantly to the transformation of the specialty
• Institute• Laboratory Quality & Patient Safety Center• Personalized Healthcare• EBIDA
CAP Institute will deliver multifaceted leading-edge programs that provide you what they WANT today and what you will NEED in the future
• Programs to support MOC, MOL and hospital privileging
• Certificate programs in emerging technologies, organ systems, etc.
• Practice management tools• Research studies and
publications• Virtual and on-site practicums
with an “Institute-approved” curriculum
• Education programs targeting system-based practice
• Re-training programs for qualified individuals interested in re-establishing active practice status
• Guidelines for “best practice” residency programs
• Program Director tools to assess resident medical knowledge and ability to apply this knowledge
• Comprehensive branding
Education combined with the standards, best practice and policy to support pathology
CAP Laboratory Quality & Patient Safety Center Clearly define and develop programs that ensure quality in Dx medicine, its linkage with patient outcomes, and the role of the pathologist in improving quality and contributing to patient care
Personalized HealthcareDevelop and implement a comprehensive College-wide plan to maximize influence on the ongoing development of public policies designed to support current needs and the transformation of the specialty including a focus on personalized health care
And a solid foundation to ensure we can do everything we want to accomplish
EBIDA from ongoing operationsTo ensure that the CAP has the resources to support the other three Big Things in addition to our normal operations, the College intends to maintain a positive cumulative EBIDA from ongoing operations for every three-year rolling period.
‘Big Thing’ plan development and implementation has already begun
• Establish member/staff planning team(s)• Identify strategies that help define the Big
Things• Determine current operations that already fit;
determine things that don’t fit• Develop high-level Institute plan for Board
review in May• Launch Institute at CAP ’08• Initiate Center plans• Ensure integration of ‘Big Things’
What happens if, and when CLIA ’88 is finally cracked open?
Evaluate current and future patient safety initiatives, laboratory oversight legislation and regulations, and other related issues in the development of specific CAP position recommendations that give consideration to the scientific, medical and economic implications for patients, laboratories, pathologists, and the College. Recommendations will be presented to the Board of Governors in February 2009 or sooner if necessary.
Chair: E. Randy Eckert, MD, FCAP
What is pathology and the CAP’s role in the new world of personalized healthcare?
Initial charge: Develop a white paper to define the issues, opportunities and challenges for the College to position the specialty to maximize the effectiveness of its input into the government initiative to transform the health care system
Chair: Louis Wright, MD, FCAP
Integrating the information about patients, and their body tissue and fluids, that is necessary for diagnosis, assessing prognosis and defining treatment alternatives
Will the future EHR adequately address our needs and the value of the information we provide?
• Information derived from specimens and specimens themselves
• Patient data about history and outcome• Requisitions and orders• Lab, pathology and radiology results and reports• Collections of similar, related and derivative
information used for interpretation• Knowledge integration, interpretation and
communication
Will we be prepared to harness the influx of emerging technologies affecting today’s practice?
To identify, evaluate, and monitor emerging technologies and to develop and monitor processes for communication and program development to ensure that the College is aware of and prepared to respond to technologies that may impact upon patient care, the specialty of Pathology and Laboratory Medicine, and the College of American Pathologists.
Chair: Greg J. Davis, MD, FCAP
TAC serves as core technology investigators and explorers with a long term perspective, complementing CSA committee work
• Accelerate emerging technology investigation; sift through and prioritize
• Translate findings into knowledge and recommend action– Collaborative relationships with sentinel industry organizations
provide knowledge emerging technologies CAP can influence– Visit with key innovators that are “doing it” and have early
demonstrations of how new technologies can impact pathology
• Recommend technology strategy priorities– Define emerging technology strategies CAP should pursue – Recommend who should be doing what– Consider resources necessary to implement action plans– Facilitate cross council discussion on emerging technology
implications
EnvironmentScan
Watch
Analyze
Plan
Execute
Monitor for indication to re-assess a technology or
proceed to the next step
TAC will operationalize a technology assessment
framework to ensure that pathology continues to be
relevant and integral to patient care in a changing technological health care
environment
On the Rise
At the Peak Sliding into the Trough
Climbing the Slope
Entering the
Plateau
Technology Trigger
R&D
Startup companies, 1st round of VC
funding
Lab prototypes
No working products
Mass media hype begins
1st generation products, high price, lots of
customization needed
Negative press begins
Consolidation & failures
2nd/3rd rounds of VC funding
2nd-generation products
Less than 5% adoption
3rd generation products, out of the
box
High-growth adoption starts--~20% of target
audience has or is adopting the technology
TAC will focus on emerging technologies as they move through the Hype Cycle
Emerging Technology Prioritization
0
1
2
3
4
5
6
7
8
9
10
0 1 2 3 4 5 6 7 8 9 10 11 12
Probability of Adoption
Ma
gn
itu
de
of
Imp
ac
t
For emerging technologies with For emerging technologies with the most significant impact and the most significant impact and probability of adoption, what probability of adoption, what should the CAP do?should the CAP do?
…and if it’s the “real deal”
• Action Item recommending completion of a detailed action plan– Council/committee leadership/plan “ownership”– Planning team composition (not specific individuals but rather expertise
needed)– Specific elements that should be addressed by the plan (e.g., value to
be delivered, elements to be analyzed—operations impact, CPT codes, education)
– General timeline for action plan execution based on TAC characterization of impact timing
• SPC and Board approval will instigate plan development with the appropriate expertise
• Execution and monitoring involve TAC and the “owning” Council
Advocacy/Policy
Information, Education & Tools
Standards/Best Practices
Financial Stability & Growth
CAP’s strategy addresses the essential components to ensure the continued relevance and strength of our specialty in the dynamic world of medicine
Engage the change—integrate new concepts and technologies
Early Adopters—target for leadership and
resource committees
Innovators—target for foundation grants
Consensus Adopters—Primary target for education and accreditation products
Late Adopters—Members at the
sunset of their careers
1 2 3 4 5
Early Adopters—target for leadership and
resource committees
Innovators—target for foundation grants
Consensus Adopters—Primary target for education and accreditation products
Late Adopters—Members at the
sunset of their careers
1 2 3 4 5
Where do you intend to be?Where do you intend to be?
Cautious Adopters—Target for technology education
Cautious Adopters—Target for technology education
Re-assess your tool kit—all diagnostic tools are available to you• Acknowledge market forces
driving changes in practice of pathology
• Be life long learners
• Expand beyond the tissue on the slide
• Market your services for consults – Establish and advertise an
open door policy
– Meet with your clinician peers to review slides, case histories and interpretations
• Expand value by influencing prognosis and treatment– Pursue educational
opportunities that demonstrate integration of pathology with the rest of the treatment plan
– Collaborate with others providing diagnostic data
• Go see patients– Actively participate in patient
grand rounds
– Review charts and talk to the attending physicians
The three great essentials to achieve anything worth while are, first, hard work; second, stick-to-itiveness; third, common sense.
~ Thomas Edison
Futurescape 2008
Transforming Pathology: Emerging Technology Driving Practice Innovation
Futurescape 2008
Transforming Pathology: Emerging Technology Driving Practice Innovation
Learn how to harness technology to keep your skills and practice at the forefront of a rapidly advancing health care environment