Build a better mousetrap and they’ll beat a path to your door—or will they?
UltraClinics, Inc, is a company prepared to offer same-day interpretation of breast-biopsy tissue and, if needed, teleoncology consultation for women undergoing breast-cancer screening. Its processes and technologies have been patented and trademarked; they can be applied to other procedures, such as prostrate-cancer screening. UltraClinics has allied itself with large corporations like IBM and has even purchased its own pathology recruiting service to find staff for its proposed clinics.
For all this, more than a year after its unveiling, its actual operation is confined to two clinics affiliated with the University of Arizona. The patients that it serves number a handful per day. UltraClinics, for now, is an example of the inertia that can strike medical advances—not because the core ideas don’t work, but because the health care delivery apparatus isn’t designed or prepared to support them.
The irony is that while UltraClinics sits more or less motionless, its founder is almost certainly correct when he says that what the company offers is a model for how medicine will be practiced, perhaps in the near future.
Ronald S. Weinstein, MD, founder and chair of UltraClinics, is a cancer pathologist trained at Tufts University who did his residency at Massachusetts General Hospital. Weinstein says that he coined the term telepathology, along with inventing the first robotic telepathology system in the mid-1980s. He says, “The first patent on telepathology was issued to me. The very first patent is my patent. It is a solo-authored patent.” Weinstein successfully demonstrated his system in a 1986 feed between El Paso, Tex, and Washington, DC, proving, he says, that pathology could be done working from a video monitor.
In 1990, Weinstein moved to the University of Arizona College of Medicine in Tucson, where he oversaw the development of the Arizona Telemedicine Program (ATP), of which he is still the director. He is also a professor and chair of the school’s pathology department.
By 1998, ATP had evolved into a model telemedicine program that now links 65 specialty physicians with 171 sites and 71 communities in or adjacent to Arizona. More than 250,000 patients have been served through the network, including patients on the state’s Native American reservations and in its prisons. About 65,000 telemammograms have been done. “We’re number one in the country,” Weinstein says. He notes that grants to ATP exceed $25 million. One of those grants was to develop a mobile trailer that could house a digital mammography unit.
It was the mammography unit that got Weinstein pointed toward what would become UltraClinics. Over and over, he says, the chief complaint that he heard from women who had to undergo a breast biopsy after a positive mammogram was the waiting that they had to endure before they knew, a month or more later, whether they had cancer. For most of them, the biopsy results would indicate benign growths, but they still had to endure the long wait; a month is a long time to wait if you think that the outcome may be life changing.
Weinstein set himself the goal of cutting down that waiting time. He already had the telemedicine network in place to complete the mammography and get a quick interpretation from a radiologist anywhere on the network. If a breast biopsy was called for, an interventional radiologist or a surgeon could do that the same day that the woman got her mammogram. For most patients, the time bottleneck was the pathology report: How could the tissue be prepared and analyzed while the woman was still at the clinic? With his background in telepathology, Weinstein was well prepared to look for an answer. He only had to look across campus.
Inventing a Virtual Slide Scanner
By happenstance, the University of Arizona is a world leader in the study of optics. Because the air is clear around Tucson, according to Weinstein, 25% of the research done at the university is in optics. The place has even been dubbed Optics Valley. “There are three Nobels in optics over there,” Weinstein says. “They came up with the idea of an optical chip. That ended up as the DMetrix.”
The DMetrix was the final piece that allowed the UltraClinics concept of same-day cancer diagnosis to become a reality. The Dmetrix, for which Weinstein says that he played the role of initiating inventor, is a virtual slide scanner that uses an array microscope to turn