Future

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Future of Pathology
Jared N. Schwartz, MD, PhD FCAP President,
College of American Pathologists
PATHOLOGY VISIONS
Digital Pathology Solutions Conference October
2007 San Diego, CA
2007
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The struggle of today, is not altogether for
todayit is for a vast future also.
Abraham Lincoln
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Technology is transforming the delivery of
patient care
Clinical transformation is occurring
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Why now?
Dramatic technology advancements provide new
insight and the ability to answer the vital
questions that drive diagnosis, and prognosis and
therapy
Tumor Cell Chromosome Proteins Genes DNA

• What disease/condition do I have?
• Which drug should I use
• How much drug do I need?
• Is the drug working?
• Is my disease gone?

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And this transformation has implications for
pathology
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Digital imaging has already progressed on the
technology adoption curve
Becoming standard of care patient guidelines
established and applied. Reimbursement
established with major players
Devices available FDA approved reimbursement
not wide spread. Trials focused on patient mgmt
Beta and early production models available not
FDA approved
Accepted Standard
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CAD for Pathology
HR HPV PAP adjunct
Technology Curve
Genetic risk assessment
Companion Dx
Waived CBC test
Sample to answer PCR
HPV vaccine
Gene expression assays
Microwave tissue processors
Continuous monitoring
Screening virtual colonscopy
Pharmacogenetics for DMEs
Lab automation
Imaging for tissue characterization
POCT PLT fn testing
Robotic telepathology
Digital imaging for path
Probability of Adoption into Clinical Use
Proteomics for cancer screening
Comparative genomic hybridization
InVivo Histology
Circulating tumor cell assay
Color Key
Intraoperative PCR
Positive Impact
Laser capture microdissection
Magnitude of Impact--UNSURE
Tech Curve Position-- UNSURE
Pyrosequencing
2 Early Adopters
0 Pre-Clinical
3 Consensus Adopters
1 Innovators
5 Late Adopters
4 Cautious Adopters
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Its impact on pathology will increase

• Accelerators
• Decreased cost with ongoing product enhancement
• Clinical demand for pathologist
  sub-specialization
• Patient demand for reduced TAT for rapid,
  advanced diagnostics
• Demand for complete EMR, including multimedia Dx
  data
• Hospital demand for rapid TAT and value
  enhancement for differentiation

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It is just a matter of time

• Barriers
• High equipment costs and work flow change
• Parallel technology developments
• Automation
• Image acquisition
• Standards agreements
• Data storage
• Communication and clinical applications

Source Sg2 T3 Virtual Slide Imaging
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Each pathologist and organization has a place on
the Tech Curve
Where is the specialty of pathology?
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Never, ever, think outside the box.
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If pathologists dont step up, others will battle
over the turf
Clinical care has a history of conflict A
reluctance to train in new technologies opens the
door to others to seize the opportunity.
Pathology is no exception
The Battle of the Barbers and Surgeons, 18th c.
caricature
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Reluctance to train in new technologies opens the
door to others to seize the opportunity
Main Topic at ACRs 2007 Forum Leadership in
Radiology Forum attendees worked to pinpoint
ways in which the ACR and its partners can better
identify, cultivate, and empower a new generation
of radiology leaders in these increasingly
turbulent times
Could it happen?
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Myths and rumors about the future may be
inhibiting action

• Pathology is merging with radiology
• There is too much to learn I dont have time
• Emerging technologies wont impact my practice
• Besides nobody will pay for it
• We are turning into dinosaurs
• Etc., etc. etc

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Opportunity exists for pathologists that are ready
Opportunity paged me, beeped me, linked me,
emailed me, faxed me, and spammed me. But I was
expecting it to knock!
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Prognosis Treatment
The value of traditional pathology has not
diminished. It is simply no longer sufficient.
Predisposition, Signs, Symptoms
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• Pathologists can generate test results
• OR

provide answers that guide the treatment team
with diagnosis and therapy
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Pathologists are physicians

• 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.

Pathologists are not defined by the tools they
use, but the knowledge they share
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so, what can you do?

• Acknowledge market forces driving changes in
  practice of pathology
• Re-assess your tool kitall diagnostic tools are
  available to you
• Engage the changeintegrate new concepts and
  technologies
• Be life long learners dont use the
  certification exam as the guidepost
• Expand beyond the tissue on the slide

Ill be happy to give you innovative thinking.
What are the guidelines?
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So, whats it going to take?

• Get back to being a physician!

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It is not the strongest of the species that
survives, nor the most intelligent, but the one
most responsive to change. Charles Darwin