At Tucson Breast Center, women get their biopsy results within hours and meet with an oncologist the same day. We examine the repercussions for the healthcare industry.

There are a lot of problems with our current healthcare system, but from the patient’s perspective, perhaps none is more glaring than having to wait days or weeks for the results of a cancer biopsy. Dr. Ronald Weinstein and his team at the University of Arizona College of Medicine have come up with a solution to this problem that will likely have repercussions throughout the healthcare industry.

Dr. Ronald Weinstein

“We have a million women a year who get breast biopsies. Eighty percent are benign, yet everyone thinks they have cancer until they get their report. It has to stop,” said Weinstein, professor and chair of the dept of pathology at the University of Arizona College of Medicine and director of the Arizona Telemedicine Program.

Weinstein is not satisfied to simply reduce the length of time it takes to get mammogram reads or biopsy results, however. He says expedited services are going to become the standard in pathology care and that telemedicine has the potential to significantly change the role of mini clinics such as MinuteClinic.

Planting the seed
The program at the university started with a digital mammography trailer created jointly by the Department of Defense and Johns Hopkins/GE Imaging (an effort to better serve the breast health needs of women in the Army). The mobile lab prototype was placed on the Tuba City Navajo reservation to facilitate healthcare for women on the reservation, who often had difficulty getting test results due to lack of transportation or telephone.

The experiment was a stunning success, Weinstein said. More than 6,000 cases have been handled so far, 75% of the women get their written report within 45 minutes, and two more sites have been set up on the reservation. “That was what planted the seed that we could do a lot of women’s healthcare in a single day,” he said. “It’s changed the standard of care for women’s breast care on the Navajo reservation.”

The next logical step was to see if rapid tissue processing and telepathology could be used to decrease the time patients waited for biopsy results, said Weinstein. The step after that was to see if women diagnosed with cancer could see an oncologist the same day, either within the facility or via teleconference. Today, this is being done successfully at The Tucson Breast Cancer, which Weinstein said handles about 30 cases a month and plans to increase volume.

Taking shape
Since faculty at the university are encouraged to spin out companies as part of technology transfer, Weinstein founded UltraClinics, based in Phoenix. The fledgling for-profit company holds the intellectual property for the technology (called virtual slide telepathology) that allows for rapid diagnostic services for breast and prostate biopsies.

Right now, Weinstein and his partners at UltraClinics are unsure of the new company’s exact role. One possibility is to open and run more clinics like the Tucson Breast Center; another is to act as a consultants for healthcare organizations that want to open their own clinics.

One thing Weinstein is sure of is the affect this technology can have on breast and prostate treatment, as well as the potential telemedicine has for mini clinics. “We’ve shown how you can greatly expand the menu of a mini clinic,” he said. “With telemedicine, you can bring physician services into a mini clinic. That’s a paradigm shift.”

Similarly, telehealth has the potential to change the patient treatment model. “Just as we can bring a pathologist into where the lab is, we can bring an oncologist to where the patient is,” Weinstein said. Rather than having the patient travel to various offices, with the labor associated with each registration, in the not-too-distant future, we may see virtual group practices where the patient stays in one place, and physicians are brought in via a telehealth system.

Hurtling barriers
Weinstein said the largest barrier to adoption of these types of systems is IT. “Many times, healthcare systems can’t leverage themselves into these types of activities because they don’t have the skill sets. They frequently don’t have the IT people, and firewalls are always the overriding issue,” he said.

The Arizona Telemedicine Program uses an application service provider model to connect with 55 healthcare organizations all over the Arizona region, including 11 prisons and many smaller providers. “We can provide turnkey clinics to a lot of small hospitals that don’t have IT people,” said Weinstein.

Another major challenge is insurance. “So much of insurance, particularly in pathology, is carve outs,” Weinstein said. “For example, for medical care in Arizona, even within our university practice, outpatient Medicare patients’ samples would be sent to Phoenix to a commercial lab.” He noted that consumer-driven health plans are one solution to this problem. “That’s the only way you’re going to be able to let people make choices.”

Despite the challenges facing this new model, Weinstein is passionate about advancing it. “The majority of phone calls I get are from women who want to know where their breast biopsy report is. The terror in their voice is really moving.”