Was it something I said? Anybody out there?
A little dated but worthy of reading none-the-less. The article from the Chicago Tribune reveals a few insightful facts about AccuMed and their system.
9/26/97 - Computer offers help in search for cervical cancer
CHICAGO _ Using machines to do the routine, tedious jobs that wear
people down is the premise behind automation, and it works wonderfully
for things like picking corn or filling soda cans. But for tasks requiring more thought and experience, creating a computer to replace human labor can prove maddeningly difficult, as researchers discovered when they tried to make machines to sort through samples of vaginal tissue for cancer.
As attractive as it might be for computers to scrutinize billions of
sample tissue cells daily to determine which ones might be abnormal so
that human pathologists could view only those worthy of attention, it
just hasn"t worked, despite almost three decades of research.
Indeed, efforts to automate Pap smear screening not only have failed to ease human drudgery, but have tended to raise costs, annoy lab
technicians and cause patient anxiety.
Now a Chicago-based company, AccuMed International Inc., is about to
launch a product it hopes will reverse the trend. AccuMed"s product
doesn"t replace the lab technicians who scan specimens for signs of
cancer, but helps them be more accurate and productive by reducing the
tedium of their work.
The philosophical difference between designing a machine to replace a
human being or one to help a human work better surely predates the
legendary John Henry and his steel-driving nemesis, but today it is a
drama being played out more often in silicon chips that steam engines.
More than 50 years ago Dr. George N. Papanicollaou first described how
cell smears taken from a patient"s vagina could be studied under a
microscope to find abnormalities suggesting cervical cancer in its
earliest and treatable stages.
Although the Pap smear proved itself a lifesaver, it also spawned
tedious work for laboratory technicians who must be trained to spot just a handful of abnormal cells out of 300,000 or so cells from each
patient"s smear.
The American Cancer Society estimates that nearly 100 million Pap smears are performed annually in the United States, but useful as it is, the procedure has been under fire in recent years. News reports have charged that in their quest to cut costs, large labs worked technicians too hard, causing them to miss seeing some abnormal cells.
Even though efforts to develop computers to read Pap smears failed to
produce machines capable of replacing humans, some companies promote
their systems to second-guess human technicians by rereading slides
after the humans are done with them. A marketing campaign is urging
women to demand that their Pap smears go only to labs using this
technology.
This is nonsense, according to the September issue of the Harvard
Medical School"s Women"s Health Watch, which notes that most of the
human slip-ups caught by machines are low-grade abnormalities that often go away on their own, not the high-risk ones. Woman are advised to ignore scare tactics and get Pap smears every year.
Peter Gombrich, founder and chief executive of AccuMed, said his
company"s philosophy of making machines that help people do their jobs
better instead of trying to replace them is relatively new to the field.
""We acquired some companies doing medical automation that we had to
change the direction of their thinking,"" he said. ""Our philosophy is
to keep the human in the center of things and build the system around
him.""
The key element in making automation work in Pap smear reading is to
realize just where in the process errors are being made.
Studies of cases where women had cancer, but whose Pap smear readings
don"t issue a warning, suggest that one-third of the time the problem is administrative error rather than a mistake reading a slide under a
microscope. The records were lost, paired with the wrong specimen or
garbled in some other way.
To correct this, AccuMed"s system begins by replacing the sample"s paper trail with an electronic record.
A non-linear bar code is written for each specimen on a 1-by-3-inch
strip of paper and is affixed to each sample sent in for lab analysis.
Each bar code _ like a supermarket price tag but much more complex _
contains up to two pages of information, and a swipe of the code brings up the information about the patient and the specimen on a personal computer screen, assuring that records stay attached to the proper sample.
Then, the computer scans the specimen, creating an electronic map of the specimen and displaying it on a computer screen next to the microscope where the technician looks at the smear.
Instead of marking suspicious cells on the slide with a pen and writing a report by hand, as they now typically do, in the AccuMed system technicians use the computer to mark slides and select descriptive terms from a menu so the report is produced immediately on the computer rather than being sent as notes to be typed up later.
The computerized system also can guide the technician"s view of the
slide to avoid looking at places where no cells are in view.
""It"s like riding through a neighborhood with a chauffeur driving as
you look out the window instead of having to look and drive yourself,"" said Dr. Donnica Moore, a gynecologist who is president-elect of the American Women"s Medical Association.
When the examination is done, the computer updates the information and
prints a new code strip to be affixed to the sample.
Several other AccuMed features are intended to reduce stress and
fatigue, such as using a computer mouse to control the microscope rather than having to twist manual knobs. Taken together, Gombrich said, the system should improve accuracy and productivity and reduce costs.
Because insurance companies typically don"t pay for the full cost of Pap smear analysis, cost reduction should be a strong selling point to
laboratories that offer Pap smear analysis as a loss leader to attract
other, more lucrative, business, he said.
Indeed, laboratories are generally so unhappy with past efforts to sell them Pap smear automation, it may be a necessity to offer cost reduction guarantees to win sales.
""Labs can get independent experts to appraise their operation and
estimate how much our system could cut their costs,"" Gombrich said.
""If the estimate is a 20 percent productivity increase, for instance,
we"ll install the equipment and they don"t pay until we"ve proven they
have achieved that improvement.""
Pathologists familiar with AccuMed"s system said its goals are
admirable, and that it surely will reduce administrative error. But some are skeptical about cost reduction.
""The concept of what they"re doing is very good,"" said Dr. Larry
Kluskens, a pathologist at Rush-Presbyterian-St. Luke"s Medical Center
in Chicago. ""It"s excellent for quality control in the lab. Whether it will speed up the process, I don"t know.""
David Carpenter, laboratory chief for the Illinois Department of Public Health, said his department"s employees have used AccuMed"s system and advised the company on changes to improve it.
He said the state ""absolutely will go with something like this. The
concept is on the right path,"" although Carpenter"s office plans to
evaluate other systems before deciding which to select.
(c) 1997, Chicago Tribune.
-0- |
