Looking Back, Looking Forward

On June 22, 2007 I wrote my first post on this blog. Over 3,100 posts later, a lot has changed. That post contained an image of pneumocystis carinii pneumonia (PCP) highlighted by a special stain (GMS) and my idea was to have a pathology image per post with a clinical vignette along with it. It was an idea that proved more difficult than I thought but other venues became available to do so with continued interest by friends and followers.

At the time, I didn’t follow a lot of other blogs. I was familiar with “Why I hate DC” which might now have its own hashtag #whyihatedc. It was popular in DC when I lived and practiced there before 2005.

Tweeting was less than a year old. By 2009 Wall Street wasn’t sure if Twitter had a successful business model. Twitter today has thousands of pathology cases posted, updates from meetings and even journal clubs in pathology.

In October of 2007 Facebook had 50 million monthly users, which grew to over 1 billion in just 5 years. LinkedIn was still considered for “professional use only.” Instagram was still a couple of years away with over 100,000 users in its first week and over 1,000,000 within a few months.

And a lot has changed in pathology and healthcare since 2007. A lot. Forget about POTUS tweeting or Facebook having more than 1 billion daily users.

In 2007, we would still do 1, 3 and 5-year plans.  I haven’t heard a “5-year plan” mentioned in more than 5 years. I don’t hear that many 1 and 3-year plans discussed either. Now I hear about making it to the next budget cycle. Many of us were signing out perhaps 50-60% of what we do today. Today most pathologists will tell you they are “doing more for less” and trying to “do more with less.”

Reference labs, outsourcing clinical pathology tests, in-office labs, changes in healthcare payment models, diminishing reimbursements, increasing costs, regulatory issues and much more have contributed to our inability to think ahead, or to plan 5 or even 3 years out on a consistent basis.  In 2014, the technical component, what laboratories were paid to produce a biopsy slide (CPT code 88305), was cut by more than 50%. There are an estimated 100 million biopsies performed in this country every year, so this was not pocket change. According to the Clinical Laboratory Fee Schedule (CLFS), more cuts, particularly to flow cytometry and prostate biopsies, lay ahead with the predictions of a downward trend for both technical and professional components for biopsy procedures and reads.

US-based companies producing whole slide scanners in 2007 largely consisted of two companies, one located in Northern and the other in Southern California. Both were acquired many years ago and the number of scanner and software companies in the space has grown. At that point, most thought FDA approval for clinical use was 5 years away. In fact, it was nearly a decade away.

Terms such as “machine learning,” “deep learning” and “artificial intelligence” (AI) were not likely topics of discussion in either academic pathology departments or pathology group boardrooms. Certainly @DeepMindAI and #AlphaGo were not among those we followed on our smartphones in 2007. Google and AI mentioned in the same sentence likely was not water cooler talk around the laboratory.

Technologies such as next generation sequencing (high throughput DNA sequencing) became commercially available in large scale by 2007, and those companies continue to dominate the market. While the technology was available in the late 70’s, more than two decades after Watson and Crick (with Franklin’s assistance) described the structure of DNA in 1953, clinical applications were still not in wide use in 2007. Today this has changed has well.

Fortunately, here at tissuepathology.com we can look back over the last decade, as we look forward to another 10 years – contributing to the first drafts of history, educating and informing the pathology community.

And as we look ahead to the next 10 years, I feel it has become imperative that we broaden our horizons. In addition to digital imaging and image analysis, terms popularized over 10 years ago, we look forward to covering news relevant to a broader readership and stakeholders – personalized medicine, liquid biopsy, artificial intelligence, next generation sequencing, immuno-oncology and what the effects of healthcare “payment” reform (encompassing 1/6^th of our economy) mean to pathology, laboratory medicine and ultimately, to our customers – our patients. To paraphrase the old saying: The only constant in life is change.

In the coming months, you will see many exciting changes in how we present information to you, including a more mobile-friendly experience and expansion in the depth and breadth of information, as we continue to educate, learn and grow as a community. This will translate into not only what it means for those of us in pathology and the laboratory medicine business, but also to what it means for our healthcare system and patients as well.

Here’s to another 10 years before I should write something like this again!

Cheers,

Keith