Is Telepathology the Right Solution for Your Practice?

Though the term telepathology may conjure images of psychic abilities, the reality is much more simple. Initially conceptualized in 1986 by Dr. Ronald S. Weinstein, the field has grown substantially, though widespread use has not yet been fully realized, both here in the United States and abroad.

Curious if telepathology is the right solution for your practice? We’ll examine just what telepathology is—including the different methodologies it can encompass—and how it can improve patient care, research, and diagnoses, to help you decide for yourself.

What is Telepathology?

Simply put, telepathology is the practice of pathology done remotely. This is primarily achieved through the sharing of digital slides with pathologists over the internet, though we’ll examine other methods later on. Using a digital slide system, samples are digitized at a high resolution, making them easier to examine at various magnification levels. This makes them ideal for telepathology, as pathologists are able to manipulate and study samples in ways that cannot be achieved through other methods.

Though the use of telepathology was increased due to the COVID-19 pandemic, a 2020 report found that prior to that in the United States, fewer than 20 percent of laboratories were utilizing the benefits of telepathology for secondary diagnosis, and fewer than one percent were using it for a primary diagnosis. The reasons for this could range from a cost-prohibitive standpoint to difficulties with EMR integration and more. PathologyWatch has addressed these concerns, providing infrastructure implementation with complete EMR integration along with improved read quality, resulting in reductions in associated overhead costs.

Additional Types of Telepathology

Along with the aforementioned digital slide method, there are two other common methods of telepathology. One is a real-time system, which falls under the umbrella of telemedicine. Through this approach, pathologists are able to remotely control a microscope, which allows them the ability to adjust and view results from their location. A live video feed of the microscopy is fed back to the pathologists over a secure network, and a communication system allows them to speak with the individual placing the slides on the microscope at the lab or medical office. This approach does allow for pathologists to examine samples in real time, but unlike the digital slide method, they are unable to access slides 24/7.

The second is an image-based system, which is similar to the digital slide method, though much less advanced. In effect, an image of a slide is captured and shared remotely with a pathologist, who is able to then access the file and make a determination based on what they see. Unlike the digital slide approach, these images are not saved at the same high-resolution quality, meaning they cannot be magnified or manipulated in a similar way.

Benefits of Using Telepathology

The biggest benefit of telepathology is the response time. When samples are able to be instantly shared with pathologists anywhere in the world—especially through a streamlined system—it allows for an expedited response, typically resulting in a faster diagnosis. This is especially true when fully interpreted pathology reports can be uploaded directly into a patient’s EMR.

In the same vein, telepathology allows for better collaboration among medical professionals. By partnering with a digital dermpath lab like PathologyWatch, clinics can experience improved clinical correlation by including more than one pathologist to examine a sample to compare interpretations or sending a sample to a specialist if the slide indicates something indicative of a systemic illness. 

Additionally, evaluations made using telepathology tend to have a higher quality. When using the digital slide method, pathologists can examine a whole-slide image more easily and compare it to other slides for confirmation. Because of the design of the digital slide software, the margin for error is also greatly reduced.

So is telepathology the right solution for your practice? Advancements in technology have led to more widespread use, and according to Industry Research, the global telepathology market size was more than $500 million in 2019 and is expected to reach $985 million by 2026. If you are interested in telepathology—or more specifically, digital dermatopathology—contact PathologyWatch to learn more about how our approach has revolutionized the industry for our dermatology clients.

TDS Hosts 2021 Annual Fall Meeting Virtually, and We Can’t Wait

The Texas Dermatological Society (TDS) is getting ready to roll out the red carpet—Texas-style—for their 2021 Annual Fall Meeting

In preparation for this event, we sat down with Laura Madole, executive director at the TDS, to talk about the upcoming 2021 Annual Fall Meeting to be held virtually on September 24–25, 2021. In the past, the in-person TDS event welcomed almost 400 attendees to their annual spring and fall meetings. This time, TDS looks forward to hosting hundreds in a virtual setting. 

Despite the changes prompted by COVID-19, which forced TDS to cancel their spring 2020 event, Laura is confident that attendees, sponsors, and exhibitors will enjoy the unique features of this virtual meeting. 

“We were a little nervous,” admits Laura, concerning their switch to virtual meetings. “So while we hope we can open doors in the spring of 2022, the virtual event has been the next-best option.” In fact, the fall 2020 and spring 2021 TDS events attracted almost 500 attendees. 

The unexpected benefits of hosting a virtual event focus mainly on the accessibility of the event. “It opened up opportunities for us to connect with members living in rural areas or other members who are residents at Texas Tech, for example, who can’t easily get to these events,” she says.

Experience a Unique, Interactive Virtual Event

TDS is using a company called vFairs, which invites attendees to visit customizable virtual exhibit halls, rooms, and vendor booths. Attendees can reach out directly to exhibitors and sponsors via video chat or direct text messaging. Plus, all of the attendees are listed, so face-to-face chat is easy. 

Laura says that many of these attendees have known each other for years; it’s a fun and fantastic way to earn CME credits. But if this is a member’s first time attending the event, she has some tips for a successful virtual experience. 

“I recommend just going in and looking around within the platform: click around and get familiar with the layout. There’s an auditorium, a virtual lobby, a lounge, and several other rooms. I’d definitely utilize the chat feature at a meeting, so it feels like you’re surrounded by your friends and colleagues. It’s more fun when people can interact on the platform.”

The virtual element definitely encourages participation among residents who often have difficulty attending in-person events. Laura says that TDS usually hosts around seven podium presenters for the resident competition. But with virtual, they are delighted to offer 19 podium presenters this fall. 

Take Exhibitor Information with You

This is not a typical Zoom meeting. The vFairs platform provides a hotel lobby feel that engulfs attendees in a rich, virtual world filled with uniquely designed exhibits and booths. Guests can virtually stroll amid custom-designed booths, or they can move directly to a booth of their choice from a directory.

“While we enjoy meeting people face to face at events like this, virtually connecting with people who are genuinely interested in learning more about our technology is a fantastic opportunity,” says Rachel Reeg, senior sales director at PathologyWatch. “At in-person events, you compete with high-volume activity that can be distracting, and people often limit the time they spend at your booth. With the virtual briefcase, we can provide valuable information through video, downloadable case studies, ebooks, product information, and other resources that guests can look through when it’s convenient for them and reach out if they want to know more.”

After the conference, attendees will receive all of the information they saved in their virtual briefcase via email. This is a great feature for attendees to keep track of exhibitor information without the risk of losing papers or accidentally leaving them behind. Since the materials are digital, exhibitors can promote products and services through expanded forms of media; a feature that isn’t possible at in-person events. 

Host a Social Scene, Just on a Screen

For Laura, the conference is an ideal opportunity to interact with members. “There are many components of my job with the TDS. There are meetings, but there are also membership duties. There’s a financial side and boardwork, and grants, and grant-writing,” she says. “With all of those duties, it’s always a good refresher to be surrounded by our members and make personal connections. That interaction reminds me why I do the job that I do. I love it. I do it for my members, and I hope these meetings are a benefit to them.”

The event offers attendees required CME credits as well as the one-hour ethics credit required for those practicing in Texas. But the platform also hosts a background gamification. A visit to the leaderboard shows attendees how to accumulate points from participating in sessions, visiting exhibit booths, and more. 

“For those who are present, and based on the leaderboard points, I will be doing raffles throughout the conference,” says Laura, who promises some amazing prizes for the winners. 

Although hosting virtual events may be a temporary condition for TDS, Laura is partial to the idea of maintaining a virtual component to future events. “I would love to offer a virtual component to our events because it’s a member benefit,” she says. “Members being able to attend from anywhere in Texas if they can’t attend a physical event is huge.” 

She believes that incorporating virtual sessions or activities in conjunction with in-person events is a great offering for members. But the upcoming fall event is the main focus, and it’s shaping up to be “virtually” one of the most engaging, must-attend dermatology events of the season. 

For registration and event information, click here.

Are Your Billing and CPT Codes Up to Date?

The AMA released a list of CPT code updates and changes, notably for patient encounters, ordering tests, and discussions, among others. They reported 329 code changes in the most current CPT code edition, some of which impact dermatologists, pathologists, and dermatopathologists.

Although few dermatologists would take pride in their CPT coding skills, being proficient in billing practices can ensure the business side of your practice runs smoothly and gets reimbursed quickly. But as AMA announces major updates to their CPT coding sets, now is the time to check your CPT codes for accuracy and compliance.

There are a few factors that have impacted the need for changes: First, the shift toward value-based care; second, the Patients over Paperwork initiative launched by the US Department of Health and Human Services in 2017; and third, the onset of COVID-19, which required additional codes.

As healthcare systems transition to a VBC model, here’s why it’s important for your CPT codes to be current.  

Why Update CPT Codes?

In response to the growing concern among healthcare providers that the documentation requirements for billing weren’t benefiting patient care, the AMA set out to streamline the CPT coding process. 

According to the AMA, “The CPT code set continues to be modified to respond to the fast pace innovation among digital medicine services that can improve access to health care and improved health outcomes for patients across the country.”

By streamlining the standard for communicating healthcare procedures and services across healthcare teams and health systems, better CPT coding and billing procedures will reduce the cost of care while increasing the quality of care and expand access to it. In addition to preventing fraudulent claims and reducing the risk of monetary or legal penalties, other results may include more accurate billing and a reduction in claim denials, which can frustrate patients and impact a provider’s reputation.

“The AMA is attacking dysfunction in health care by removing obstacles and burdens that interfere with patient care,” the AMA says. “Our focus is on making technology an asset in the delivery of health care, not a burden.”

What CPT Code Changes Can We Expect for Pathology and Dermatopathology?

To focus on codes that impact the pathology, dermatology, and dermatopathology fields, APS Medical Billing released a CPT code change summary highlighting the most common CPT codes. You can access it here

For instance, although coding for inpatient encounters and consultations are not affected by these changes, doctors should note changes in codes 99201 through 99215 that pertain to outpatient office visits. “With these landmark changes, as approved by the CPT Editorial Panel, documentation for E/M office visits will now be centered around how physician think and take care of patients and not on mandatory standards that encouraged copy/paste and checking boxes,” says the AMA, adding that the goal of these coding changes is to decrease the overload of documentation and coding, cut down on unnecessary documentation, reduce audits, and make sure reimbursement for E/M is resource-based.

How Does EMR Technology Make It Easy to Update CPT Codes?

Fortunately, using EMR for your patients’ information makes it easy to update CPT code changes. EMR technology houses patient data in a secure location that is easy to organize and share with other healthcare providers, insurance companies, pharmacies, labs, other clinics, billing services, and more. Compared to traditional handwriting, an EMR facilitates the code assignment for billing, increases legibility to reduce errors, curtails paperwork, and eliminates duplicate tests.  

According to the Centers for Medicare and Medicaid Services, “Documenting a patient’s record with all relevant and important facts, and having that information readily available, allows providers to furnish correct and appropriate services that can improve quality, safety, and efficiency.” 

If your clinic is considering updating to digital patient records, we’ve weighed some pros and cons of using an EMR system. Check it out! 

Digital Dermatopathology Digest: Identifying Hair Follicle Tumors

Images shown are not intended to be used for the diagnosis or treatment of a disease or condition.

There are a number of different hair follicle tumors, each with its own distinguishing features. In the Digital Dermatopathology Digest series, Rajni Mandal, MD, clinical research associate in dermatopathology for PathologyWatch, discusses these different variants in greater detail.

Trichilemmal cells come from the outer root sheath of the hair follicle. The cells show abrupt keratinization and pink to clear cytoplasm with a lack of keratohyalin granules.

Trichilemmoma cells have a lobular proliferation of cells that can push into the dermis. They can also present as pink to clear due to glycogen, and there can be peripheral palisading at the periphery of the islands as well as a thick pink basement membrane deposition. Multiple trichilemmomas are associated with Cowden syndrome.

Trichoadenoma cells can have multiple epithelial islands of keratin-filled cysts in the dermis. These cysts can frequently rupture, shoring a foreign body giant cell reaction to keratin fibers. Cyst islands are lined by epithelium, and the majority of the squamous epithelium lacks keratohyalin granules.

Trichoblastoma cells typically have multiple blue islands with fibrotic stroma and are associated with nevus sebaceous.

Cells on the trichofolliculoma, fibrofolliculoma, and trichodiscoma spectrum are all different stages of the same tumor. They can present with branches of anastomosing epithelium originating out of the hair follicle and often occur in small antigen hair follicles.

  • In a fibrofolliculoma, there can be a proliferation of fibrous cells or fibrous stroma, which can have a concentric pattern around the tumor.
  • Fibrous proliferations are most prominent in a trichodiscoma.
  • Cells can show peripheral palisading, but there is no retraction artifact or myxoid stroma surrounding them, which would be seen in basal cell carcinoma.
  • Multiple fibrofolliculomas and trichodiscomas are commonly associated with Birt-Hogg-Dubé syndrome.

The Digital Dermatopathology Digest series provides educational information for both students and professionals on a number of topics. To view the complete series, click here.

Digital Dermatopathology Digest: Identifying Sebaceous Neoplasms 

Images shown are not intended to be used for the diagnosis or treatment of a disease or condition.

Sebaceous neoplasms are abnormal growths of cells originating in the oil glands of the skin. As part of the ongoing Digital Dermatopathology Digest series, Rajni Mandal, MD, a clinical research associate in dermatopathology for PathologyWatch, discusses the characteristics of sebaceous differentiation, up to and including sebaceous carcinoma.

Sebaceous glands found in the dermis are formed by mature sebocytes and immature sebaceous cells. Mature sebocytes show evacuated cytoplasm, which can indent the nucleus in contrast to the immature cells that show increased nuclear-cytoplasmic ratio, sometimes with foamy cytoplasm.

“Neva sebaceous has an increased risk of basal cell carcinoma, trichoblastoma, and syringocystadenoma papilliferum,” says Rajni.

Sebaceous adenoma is defined as having greater than 50 percent mature sebaceous cells as compared to basaloid cells, in contrast to a sebaceoma. It can present as multiple nests in the dermis, with a predominance of the immature basaloid cells, as compared to the mature sebocytes.

The malignant counterpart of a sebaceous neoplasm is sebaceous carcinoma. It is most common in the eyelid, originating from the Meibomian gland. It can include the dermis as a proliferation of predominantly immature cells. In the epidermis, sebaceous cells—which are predominantly immature—can infiltrate in a pagetoid manner, which can mimic squamous cell carcinoma.

To learn more about sebaceous neoplasms, check the Digital Dermatopathology Digest video series, which provides detailed information and examples on a number of skin conditions, click here.

Digital Dermatology Digest: Identifying Syringomas

Images shown are not intended to be used for the diagnosis or treatment of a disease or condition.

If you happen across a small cluster of brown, yellow, or pink bumps (or papules), around the eyes or on the neck, it may be a case of syringomas. In this episode of Digital Dermatopathology Digest, Rajni Mandal, MD, clinical research associate in dermatopathology for PathologyWatch, briefly discusses the distinct characteristics of this benign growth of the sweat gland. 

According to Rajni, syringomas are common in the periorbital and genital regions. Growths can be associated with Down’s syndrome, and disseminated, solitary, or eruptive types sometimes indicate Nicolau-Balus syndrome. 

“Note that the eccrine ducts have an eccentric lumen and can have a tadpole shape,” says Rajni, referring to a common variant of syringomas. “And a clear cell syringoma is often associated with diabetes.” 

Another type of syringomas, a mixed tumor called chondroid syringoma, is common in elderly males and appears on the head and neck. It’s characterized by a circumscribed dermal tumor, and it also appears as an apocrine/eccrine proliferation in fibrous, myxoid, or chondroid stroma. 

“Women, especially of Japanese heritage, are affected more than men,” explains the American Osteopathic College of Dermatology. “Syringomas tend to first erupt in adolescence, but could start at any age.” The AOCD adds that young people may be predisposed to “eruptive syringomas,” wherein the growths occur suddenly.  

Whether you’re in residency, studying for board exams, or a practicing dermatologist looking to stay sharp, the Digital Dermatopathology Digest video series is your informational and convenient source for dermatopathology review. Find the full series here.