The Effects of Time Delays on a Telepathology User Interface

Telepathology enables a pathologist to examine physically distant tissue samples by microscope operation over a communication link. Communication links can impose time delays which cause difficulties in controlling the remote device. Such difficulties were found in a microscope teleoperation system. Since the user interface is critical to pathologist's acceptance of telepathology, we redesigned the user interface for this system, built two different versions (a keypad whose movement commands operated by specifying a start command followed by a stop command and a trackball interface whose movement commands were incremental and directly proportional to the rotation of the trackball). We then conducted a pilot study to determine the effect of time delays on the new user interfaces. In our experiment, the keypad was the faster interface when the time delay is short. There was no evidence to favor either the keypad or trackball when the time delay was longer. Moving long distances over the microscope slide by dragging the field-of-view indicator on the touchscreen control panel improved inexperienced user performance. Also, the experiment suggests that changes could be made to improve the trackball interface. (Also cross-referenced as CAR-TR-616) (Also cross-referenced as SRC-TR-92-49

The Transformative Role of Telemedicine on Coordination: A Practice Approach

Delivering coordinated care at a distance challenges work practices and interprofessional collaboration. Using a case study methodology, we analyzed how three occupational groups, pathologists, technologists, and surgeons, coordinate work during the deployment of a major telepathology network in Eastern Canada. The aim of this study is to determine the extent to which and how telemedicine modifies coordination practices. \ \ Transformations emerged from our in-depth case analysis around three aspects of coordination: predictability, common understanding and accountability. First, predictability relied on routines in traditional settings, but shifted to a reliance on plans and rules in a telemedicine setting. Second, common understanding of the task shifted from relying on familiarity between stakeholders to an emphasis on standards. Third, accountability became less collective and more individual and contractual in a telemedicine setting, resulting in more marked boundaries between professional groups. Finally, proximity remained a determinant of accountability in telemedicine contexts, regardless of organizational arrangements. Implications for research and practice are discussed

Remote direct manipulation:A case study of a telemedicine workstation

This paper describes our experience with the design of a remote pathologists workstation. We illustrate how our effort to apply direct manipulation principles led us to explore remote direct manipulation designs. The use of computer and communication systems to operate devices remotely introduces new challenges for users and designers. In addition to the usual concerns, the activation delays, reduced feedback, and increased potential for breakdowns mean that designers must be especially careful and creative. The user interface design is closely linked to the total system design. (Also cross-referenced as CAR-TR-551

The future of laboratory medicine - A 2014 perspective.

Predicting the future is a difficult task. Not surprisingly, there are many examples and assumptions that have proved to be wrong. This review surveys the many predictions, beginning in 1887, about the future of laboratory medicine and its sub-specialties such as clinical chemistry and molecular pathology. It provides a commentary on the accuracy of the predictions and offers opinions on emerging technologies, economic factors and social developments that may play a role in shaping the future of laboratory medicine

Telemedicine for improving access to health care in resource-constrained areas : from individual diagnosis to strengthening health systems

In many developing countries there is an acute shortage of trained medical specialists. This does not only hamper individual patients’ access to medical diagnostics but furthermore limits the development of health systems because a major role of the specialists is the provision of continuous medical education of health care personnel. The rapid development of information and communication technologies has enabled radically new forms of virtual collaboration at a distance. So-called telemedicine enables us today to transmit knowledge to the patient rather than to only transport patients to the centres where the knowledge is available; this has promising implications in particular for remote and under-served areas. Initiated by a request from a Swiss surgeon from Solomon Islands, a project for supporting the hospital in Honiara, capital of Solomon Islands, with pathology diagnoses was started between Honiara and the Department of Pathology in Basel in 2001. After a successful start this pilot project found broad interest, and the Internet platform that had been developed was soon utilised by projects from other countries and medical disciplines. Thus, questions arose about the diagnostic accuracy of such remote diagnoses as well as about their acceptance and impact on the local health care system. The work presented here was initiated on this background. It analyses the applicability of telemedicine in the context of resource-constrained areas and in particular the possibilities to extend its impact from improving individual diagnosis towards strengthening health care systems. A central part of this project was the development of iPath, an Internet- and email-based telemedicine platform, which facilitates medical consultations, knowledge exchange and continuous education on a global scale. A particular emphasis was put on the applicability and accessibility for users from developing countries with limited infrastructure and network connectivity. The complete software was released under an open-source licence in order to allow unrestricted reuse for other institutions. The diagnostic accuracy of this form of telemedicine was studied in two projects from the field of pathology. A retrospective review of over 200 glass slides from each project revealed complete diagnostic concordance between the telemedical diagnosis and review diagnosis in 69% and 85% respectively. Clinically relevant discrepancies were found in 8% and 3.3% of all examinations. Selection of images by the non-expert and communication were found to have the greatest impact on diagnostic accuracy. Both factors can be addressed by training and organisation of workflow. In comparison to submitting material for pathological examination by courier, the turn-around time could be reduced from weeks to days or hours. Besides the more rapid availability of diagnosis, telemedicine enabled a direct dialogue between the surgeon and the pathologist and thus facilitated an implicit permanent medical education. The educational aspects of telemedicine were studied within the scope of a tele-dermatology project in South Africa. Distance collaboration with a dermatologist empowered a general practitioner based in a rural area to diagnose and treat a majority of patients with dermatological problems. Besides the direct benefit of saving the patients the cost of transportation to visit the dermatologist, the general practitioner could strengthen his own diagnostic skills under direct guidance and quality control of a specialist. As a consequence he will be able to treat more patients locally, close to their homes and families. The whole project was implemented within the local health system in order to facilitate a future inclusion of other primary care facilities. Regional telemedicine networks play a major role to ensure relevance and acceptability of consultative and educational telemedicine. Within the scope of the Ukrainian Swiss Perinatal Health Program a telemedicine component was included, and it was found that the use of regional language as well as inclusion of the regional specialists are important for the acceptance of telemedicine and should not be neglected in a era of globalisation. The presented results demonstrate that save and reliable telemedicine can be implemented with limited resources. Telemedicine is suitable in particular to strengthen existing international collaborations and to support professionally isolated medical specialists. Regional collaboration and inclusion of regional specialists are desirable if telemedicine shall help to strengthen health care systems. The application of telemedicine should not only focus on providing care to individual patients, but should explicitly incorporate skills development and capacity building of primary care staff. Organisation of work flow and communication have been found to be the most challenging task for the implementation of telemedicine networks. Resources must be invested not only in technology but more importantly in training and organisation. Utilisation of existing technological infrastructure is advisable wherever possible and greatly reduces the complexity of providing support and maintenance. The presented telemedicine platform provides an efficient tool for the organisation of interdisciplinary, regional and international telemedicine networks. We hope that the unrestricted availability of the software developed during this project will enable other institutions to utilise it for their own purpose and that they will thus be able to allocate resources on the organisation of workflow rather than technology

Digital Pathology: The Time Is Now to Bridge the Gap between Medicine and Technological Singularity

Digitalization of the imaging in radiology is a reality in several healthcare institutions worldwide. The challenges of filing, confidentiality, and manipulation have been brilliantly solved in radiology. However, digitalization of hematoxylin- and eosin-stained routine histological slides has shown slow movement. Although the application for external quality assurance is a reality for a pathologist with most of the continuing medical education programs utilizing virtual microscopy, the abandonment of traditional glass slides for routine diagnostics is far from the perspectives of many departments of laboratory medicine and pathology. Digital pathology images are captured as images by scanning and whole slide imaging/virtual microscopy can be obtained by microscopy (robotic) on an entire histological (microscopic) glass slide. Since 1986, services using telepathology for the transfer of images of anatomic pathology between detached locations have benefited countless patients globally, including the University of Alberta. The purpose of specialist recertification or re-validation for the Royal College of Pathologists of Canada belonging to the Royal College of Physicians and Surgeons of Canada and College of American Pathologists is a milestone in virtual reality. Challenges, such as high bandwidth requirement, electronic platforms, the stability of the operating systems, have been targeted and are improving enormously. The encryption of digital images may be a requirement for the accreditation of laboratory services—quantum computing results in quantum-mechanical phenomena, such as superposition and entanglement. Different from binary digital electronic computers based on transistors where data are encoded into binary digits (bits) with two different states (0 and 1), quantum computing uses quantum bits (qubits), which can be in superpositions of states. The use of quantum computing protocols on encrypted data is crucial for the permanent implementation of virtual pathology in hospitals and universities. Quantum computing may well represent the technological singularity to create new classifications and taxonomic rules in medicine

Development and evaluation of the virtual pathology slide: a new tool for understanding inter-observer variability in diagnostic microscopy

The VPS (Virtual Pathology Slide) is a microscope emulator enabling the examination of pathology slides via the Internet or CD-Rom. A novel feature of the VPS is the ability to record the migratory traces (image viewed and magnification) of pathologists examinations on a remote relational database located in Dublin City University. In order to evaluate the VPS, Ten breast needle core biopsies were randomly selected and presented to 17 pathologists or trainee pathologists with at least 2 years experience in pathology practice. Participants were required to examine each case online and provide a diagnostic classification using online feedback forms, based on the Core Biopsy Reporting Guidelines for Non-operative Diagnostic Procedures and Reporting in Breast Cancer screening as used by the British National Co-ordinating Committee for Breast Screening Pathology. The recorded data permitted examination of interobserver variability and user satisfaction. The study demonstrated that Pathologists can make a correct diagnosis using the VPS. Consensus glass diagnosis agreed with consensus VPS diagnosis in 9 out of 10 cases. Consensus diagnosis for Slide 8 differed from glass slide diagnosis by one classification grade. Several Participants using the VPS achieved strong individual performance, with 10 of the 17 participants displaying “good” to “exce//e«i” (>0.6) agreement with VPS consensus, based on a weighted Kappa rating. Modification of diagnostic classification based on a review of text diagnosis resulted in VPS consensus diagnosis for Slide 8 concurring with glass slide diagnosis and demonstrated a lack o f familiarity and understanding amongst participants in the application of the applied diagnostic guidelines, particularly in the diagnosis of Intraductal Pappilloma. Modification of diagnostic classification based on text diagnosis increased average overall slide consensus from 66.5% to 69.4% but decreased individual Kappa performance by 0.76 to 0.72. Participants diagnostic performance was found to be unrelated to their confidence in making a diagnostic decision using the VPS. Perception of image quality was demonstrated to be clearly dependent on participants screen resolution and colour depth, but was shown not to influence diagnostic performance. Perception of download speed was found to be unrelated to individual diagnostic performance. However, it was demonstrated that there is an increase in the number of fields of view examined by participants as their perception of download speed improves. The number of fields of view examined per slide was found to be representative of the histological difficulty in interpreting a case. In general, as slide consensus decreases, the number of fields view examined for that slide increases. The number of fields of view examined at a particular magnification was found to be unique for each slide and dependent on the histological complexity of each slide. To elucidate reasons for diagnostic inconsistency, a software application called ‘Bitmapper’ was developed. This generates a graphical representation of a diagnostic trace using data stored on the VPS database. This takes the form of 128x128 pixel bitmap image, where each pixel is representative of an individual field of view on a VPS slide at the highest magnification available. The colour value of each pixel is determined by whether the field of view it represents has been viewed, and if so, at what magnification. This diagnostic trace was used to locate hotspot regions of potential diagnostic importance within a slide. For each of the slides a pathologist, specialist in breast disorders, examined images from these hotspots and successfully deduced a reason for diagnostic inconsistencies. This demonstrated that Bitmapper is an extremely useful tool for determining reasons for observer variation. The development of the VPS and ancillary software tools was successful in that pathologists were willing to use the system. Pathologists could make a correct diagnostic decision using the system. The degree of observer variation could be quantified and using Bitmapper, reasons for observer variation could be determined. This technology has applications in determining the cause of observer variability and will prove a useful tool in external quality assurance studies (EQA) in pathology

Comparison of Navigation Techniques for Large Digital Images

Medical images are examined on computer screens in a variety of contexts. Frequently, these images are larger than computer screens, and computer applications support different paradigms for user navigation of large images. The paper reports on a systematic investigation of what interaction techniques are the most effective for navigating images larger than the screen size for the purpose of detecting small image features. An experiment compares five different types of geometrically zoomable interaction techniques, each at two speeds (fast and slow update rates) for the task of finding a known feature in the image. There were statistically significant performance differences between several groupings of the techniques. The fast versions of the ArrowKey, Pointer, and ScrollBar performed the best. In general, techniques that enable both intuitive and systematic searching performed the best at the fast speed, while techniques that minimize the number of interactions with the image were more effective at the slow speed. Additionally, based on a postexperiment questionnaire and qualitative comparison, users expressed a clear preference for the Pointer technique, which allowed them to more freely and naturally interact with the image