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Patients are clamoring for convenience and the Arizona Telemedicine Program is answering the call. What will the repercussions be for the healthcare industry?

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Page 1: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Patients are clamoringfor convenience and theArizona TelemedicineProgram is answeringthe call. What will therepercussions be for thehealthcare industry?

Page 2: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,
Page 3: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,
Page 4: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

The S-Curve Framework:Predicting the Future in Anatomic Pathology

Ronald S. Weinstein, M.D., F.C.A.P.Professor and Head

Department of PathologyDirector

Arizona Telemedicine Program

University of ArizonaCollege of Medicine

Tucson, AZ

Disclosures: UltraClinics®, DMetrix, Apollo

Page 5: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

S-Curve of InnovationPe

rfor

man

ce

Effort (funds)

S-CURVE

Thomas W. Lawson 19021 2

3

4

5

6

7

1 2 3 4 5 6 7

Page 6: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Perf

orm

ance

Effort (funds)

S-Curve of InnovationS-CURVE

Over-optimistic

Under-optimistic

One tends to be over-optimistic in the short run and

under-optimistic in the long run,

because we can only extrapolate linearly

and progress is always an

exponential curve.

- Arthur C. Clarke

One tends to be over-optimistic in the short run and

under-optimistic in the long run,

because we can only extrapolate linearly

and progress is always an

exponential curve.

- Arthur C. Clarke

Page 7: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

NATIONAL BLADDER CANCER PROGRAMCentral Pathology Laboratory

4540

643

3530252015105

521 7 8

Major Discrepancy

Minor Discrepancy

186 118

75

154 185

58

7070

INTER-INSTITUTIONAL QA

1983

Page 8: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

College of American PathologistsFoundation Conference IVPathology Practice in a World ofChanging TechnologyJanuary 16-18, 1987 - Hawaii

First use of the word“telepathology” in a

scientific paper.

Page 9: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

No.

Site

s/N

o. C

ases

Years

S-Curve of InnovationTelepathology/Digital Pathology

2007

Page 10: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

S-Curves of Innovation

Robotic Microscopy Virtual Microscopy

Telepathology/Digital Pathology

Page 11: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Site #3Internet

Virtual Slide Processor

ClientSite #2

Site #1

Virtual slide network1999

Whole slide digital imaging

Page 12: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Virtual Slide Image Acquisition

Raster scanning

Single optical axis light microscope

Page 13: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Virtual Slide Telepathology

TelepathologyReport

Fully Digitized Slide Server

workstation

Page 14: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Aperio virtual slide scanner

Page 15: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Aperio virtual slide scanner

Lab Services Education

Page 16: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

What’s next?

• 1987 to 2007• 2007 to 2027

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2001

Page 18: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Arizona College of Optical SciencesUltra-Rapid Virtual Slide Processor Program

Working Group: Michael R. Descour, Ph.D, Peter Bartels, Ph.D. Chen Liang, René Slack, Ph.D., Ronald S. Weinstein, M.D.

Aim: Increase the field-of-view of the light microscopeDeliverable: Miniaturized microscope array digital imaging engine

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Miniaturized microscope

• Miniaturization• Array microscope• Parallel processing

ArizonaProgram

Page 20: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Conventional Optics vs. Array Microscope OpticsConventional Optics vs. Array Microscope Optics

ArizonaProgram

Page 21: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

9 mm

Weinstein et al, Human Pathology, 2001

Miniaturized Microscope ArrayConcept rendering

Page 22: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

field-of-view

Page 23: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

FOV 1 to 25 FOV 1 to 7

Page 24: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,
Page 25: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,
Page 26: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

tissue

glass slide

Page 27: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,
Page 28: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

MiniaturizedOptical Bench

Page 29: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Lenslet Array U.S. Quarter Coin

Invention of the lenslet array ensemble

ArizonaProgram

Page 30: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

3 stacked lenslet arrays = 1 lenslet array ensemble

Page 31: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,
Page 32: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Patient Name

S-14926-06

University Physicians HospitalTucson, Arizona

Page 33: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Virtual Slide Breast core biopsy

Scan time - ~ 1 minute

Page 34: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Virtual Slide

Page 35: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

S-Curves of Innovation

Single axis LM Array microscopy

Virtual Microscopy

Page 36: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

College of MedicineUniversity of Arizona

Tucson, Arizona

University of Arizona Virtual Slide Applications

Page 37: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,
Page 38: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Virtual Slides in Diagnostic Pathologyat the University of Arizona

DMetrix Virtual Slides

Page 39: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

U of A Pathology Quality Assurance Program

DMetrix Virtual Slides

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®

SameSame--day Breast Care Servicesday Breast Care Services

•• ““One stop shoppingOne stop shopping””

•• TelemedicineTelemedicine--enabledenabled

•• UltraUltra--rapid labs and radiology servicesrapid labs and radiology services

•• OnOn--line second opinions line second opinions

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IBM SYSTEMS JOURNAL 46: 69-84, 2007

®

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NBC Tucson, AZ UltraClinics®

Page 43: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Susan G. Komen Race for the Cure - Tucson, Arizona – April 15, 2007

Page 44: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Tucson CitizenApril 16, 2007

Page 45: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Susan G. Komen Race for the Cure - Tucson, Arizona – April 15, 2007

“Patients Vote With Their Feet”

Page 46: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Perf

orm

ance

Effort

Robotic Telepathology Virtual Microscopy

Digital Pathology Laboratories

Discontinuity

? Retail Clinics

Page 47: Patients are clamoring for convenience and the Arizona ...webapps.cap.org/apps/docs/cap_foundation/C_Weinstein_0609_900.pdfPredicting the Future in Anatomic Pathology Ronald S. Weinstein,

Thank you!

Ronald S. Weinstein, M.D.

[email protected]

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