Philips’ Ultrasound Hack Suit | Tomoelastography Advances | Philly Residency Auction

“The approval of this $55 million sale sets a dangerous precedent and sends a signal to Wall Street that there is money to be made off the downfall of community hospitals.”

U.S. Representatives Frank Pallone Jr. and Richard Neal on the PE-owned Hahnemann University Hospital’s efforts to auction off its 550 residency positions after closing earlier this year.

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The Imaging Wire

Philips’ Ultrasound Hack Suit

Philips’ recent lawsuit against Summit Imaging accuses the Seattle-area imaging parts/repair company of illegally hacking into its ultrasound systems to change how they can be used. This story hasn’t received much coverage, but it could have big implications on how imaging devices can be modified once in the field. Here are some details:

About Summit Imaging – In addition to ultrasound and mammography parts, probes, and repairs, Summit provides its Adepto Software to healthcare facilities to allow their internal clinical engineering teams to upgrade and service their own ultrasound equipment. This may seem like a good way for Summit to differentiate itself versus other ultrasound parts / probes / repairs companies (it is pretty shrewd), but Philips alleges that it’s also illegal.

The Issue with Adepto Software – Calling it the “Adepto hacking tool” in its lawsuit, Philips alleges that Adepto alters software on Philips’ ultrasound systems through a process that involves removing the devices’ hard drive. These alterations give customers access to options and add-on features that they otherwise would’ve had to purchase from Philips (e.g. allowing specific systems and transducers to work together) or lets them create configurations Philips never even offered, while giving Summit a unique complement to its parts and repairs business.

The Case Against Summit – Philips accuses Summit of misappropriating trade secrets, false advertising, and modifying copyrighted materials, demanding that Summit return its trade secrets, pay damages, and stop using any tools used to circumvent its hardware controls.

With 37 employees on LinkedIn and a solid list of customers, Summit seems to have created a nice business for itself, but Summit may be in for its biggest fight yet with this case. Adepto also works with GE ultrasound systems, by the way.

Tomoelastography Advances

German researchers found that tomoelastography, a novel imaging technique that combines MR imaging and elastography, might improve liver cancer detection. Here are some details to back that up:

Tomoelastography – The new imaging method is highlighted by its ability to measure solid and fluid tissues in tumors, going beyond liver tumor diagnosis’ traditional focus on measuring stiffness. The team’s tomoelastography research has already revealed that hepatic malignancies have both stiff and fluid tissues (they were previously thought to be solid), which could be used to improve liver cancer detection and progression monitoring.

The Study – In their latest tomoelastography study, the researchers scanned 77 patients with 141 focal liver lesions, finding that malignant tumors’ combination of high tissue stiffness and fluidity characteristics can be used to distinguish them from non-tumorous liver tissue with a 0.88 AUC.

This same Berlin-based team has been the driving force behind tomoelastography research on a range of cancers, and although the imaging method appears promising, it’s still in its very early stages.

Philadelphia Residency Auction

A Slate.com exposé provided new insights into how Philadelphia’s now-closed Hahnemann University Hospital is trying to auction-off its 550 unused residency positions, calling the auction illegal and using it as yet another example of the negative influence that private equity is having on healthcare.

Ethics aside, one can see why a PE firm would view residency spots as an asset that could/should be sold. Hospitals receive $100k/yr from CMS for each resident (a 20% margin after their salaries and educational / malpractice costs) and then save $168k-$218k in annual operating cost for the medical services each resident provides, making each spot attractive to other hospitals at the right transfer price.

The even better evidence that residency spots could be viewed as an asset is the fact that the auction generated bids as high as $55 and $60 million from hospital groups across the country. However, the auction is now on hold after an appeal from CMS and is facing stiff opposition from some in Congress, who are concerned that it would send a “signal to Wall Street that there is money to be made off the downfall of community hospitals.”

The Wire

  • A study published in the British Journal of General Practice argued against the use of chest X-ray as a first line step for lung cancer diagnosis, finding that CXR fails to identify lung cancer in 23% of cases. The researchers reviewed 21 previous studies on using CXR for lung cancer detection, finding that the three studies that had a satisfactory bias risk achieved sensitivities of just 76.8%, 79.3%, and 79.7%. The researchers criticized the UK’s reliance on lower-cost X-rays for lung cancer detection (vs. CTs), blaming the practice for the country’s later cancer diagnosis and warning patients that they shouldn’t feel reassured by negative non-contrast CXR lung cancer results.
  • Partners HealthCare announced the launch of its $30 million Artificial Intelligence & Digital Translation Fund (providing AI and digital health companies with funding and co-development support) and its $50 million Translational Innovation Fund (supporting pre-clinical life science companies developing therapeutics at Partners facilities). The two new funds join the 11-year-old Partners Innovation Fund ($171 million) and help to build the massive system’s role as a major Boston area healthcare venture player.
  • A Reaction Data healthcare leader survey (n=48) revealed that they place a high value on patient engagement, but most providers have significant room to improve/standardize how they actually engage with patients. The vast majority of respondents ranked the importance of patient feedback as a 5 or 6 on a 0-6 scale (26%=5, 39%=6) and a leading 24% of respondents listed patient feedback as the top influencer of organizational decision making (followed by staff and clinician feedback, both 23%). However, providers seemed to be unclear on the best way to engage patients, with 31% listing HCAHPS surveys as their primary method, followed by phone calls (27%) and patient portals (24%).
  • Rice University researchers found that the regional expansion of freestanding emergency departments (FrEDs) is driving up regional healthcare costs. Looking at 2013-2017 data from 495 different local markets in Arizona, Florida, North Carolina, and Texas, the researchers found that when a FrED entered a new local market in Florida, North Carolina, and Texas reimbursements per beneficially went up 3.6 percentage points (AZ was flat). Meanwhile, the openings of new FrEDs drove a 3.6 point increase in patients’ out‐of‐pocket ED payments in Texas, Florida, and Arizona (NC fell 15.3 points).
  • HeartVista announced the FDA clearance of its One Click Cardiac MRI Package software, using AI-guided image acquisition to prescribe standard cardiac views with just “one click,” notify operators if artifacts or low image quality is detected, and streamline a range of cardiac imaging procedures (myocardial delayed-enhancement acquisition, volumetric parallel imaging, preliminary left ventricular measurements). The company claims that One Click lowers cardiac MRI adoption barriers (fewer breath holds, less discomfort, less tech training) and can lead to 20% fewer catheterizations compared to invasive FFR.
  • New research in the American Journal of Roentgenology finds that contrast-enhanced ultrasound can be used to predict hepatocellular carcinoma. The study looked at 39 patients with 44 pathologically confirmed cirrhotic nodules who underwent CEUS every 3-4 months following detection, finding in the 14 nodules that became malignant that the CEUS contrast arrival time difference between the cirrhotic nodule and liver could be used to estimate risk of future malignancy.
  • Dr. Luke Oakden-Rayner set his sights on AI-based PET/MRI “denoising” tech in his latest blog, following the FDA’s approval of Subtle Medical’s SubtleMR imaging processing software. Dr. Luke is never short on details (and the original is a very worthwhile read), but his general premise is that medical super-resolution could be very beneficial (shorter exams, more MRI productivity, lower healthcare costs), but using AI to improve noisy images is essentially high-tech “guessing” and AI might not always make the right guesses in rare and variable cases. Dr. Oakden-Rayner encourages readers to evaluate these solutions on whether the images they create are actually diagnostic (rather than just looking real) and whether the diseases that reconstructions miss are too dangerous to be ok with missing.

The Resource Wire

  • Yale University research reveals that the average patient drives past SIX lower-cost providers on the way to an imaging procedure, due in large part to patients’ and physicians’ limited cost consciousness. Medmo helps address this issue by letting patients enter what they can afford for their scan, then booking them at a nearby imaging center willing to accept that rate.
  • In this interview, Nuance Chief Medical Officer, Woojin Kim, MD, discusses the evolving role of blockchain in healthcare.

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