ASSOCIATION FOR PATHOLOGY INFORMATICS (API) ADVANCED COURSE
Automating AP Lab Workflow and the Enhancement of Reporting

Sunday, September20, 2009

PowerPoint Files To Be Posted by 01/15/2010

The 2009 Course focused on the workflow and automation in Anatomic Pathology including, but not limited to, order entry, specimen receiving, accessioning, back bench, histology, special studies, sign-out, block, slide and image management, archiving and post diagnostic support for translational research. It is of particular relevance to those interested in improving the efficiency, quality and patient safety in surgical pathology.

Lab Tracking Systems Overview
Walter Van Tilburg - General Data
This presentation discusses industry development of technology for Anatomic Pathology Automation including identification devices and media that allow laboratories to identify and track specimens (and use this identification to drive processes and improve quality) throughout the surgical pathology workflow (accessioning, grossing, processing, embedding, slide cutting, staining, checkout, sign-out, etc.).

Quality and Efficiency in Anatomic Pathology
Rodney A. Schmidt, MD, PhD - University of Washington
This presentation details workflow changes, efficiency benefits, and error reduction benefits of the barcode-driven AP system developed and implemented at University of Washington Medical Center, and how these can be generalized for other systems and environments. Finally, we will discuss extended specimen tracking – before specimens are received in pathology and after cases are signed out (including applications such as tissue banking, tissue microarrays, nucleic acid extracts, cultured cells, etc.)

The University of Michigan Experience to Date with Advanced Asset Tracking and Workflow Process Automation for Anatomic Pathology
Ulysses J. Balis, MD - University of Michgian Medical Center
Based on the fundamental workflow optimizations and automation technologies initially developed at Massachusetts General Hospital, and now in partnership with Suncoast Pathology Associates, the University of Michigan is well under way in its comprehensive project to fully automate its Anatomic Pathology Laboratories (including surgical pathology, histology, immunohistochemistry, cytopathology, electron microscopy, autopsy and forensic pathology services). This presentation covers the fundamental enabling technologies and workflow/automation aspects of the project, with an emphasis of universally-applicable operational realities that would be expected to be germane at most, if not all, similar initiatives. Specific topics discussed include: automation technologies themselves, barcode symbologies, label adhesive technologies, database schemata considerations, workflow design and lean/six sigma considerations, managing the culture of change, integration with legacy and contemporary LIS systems, electronic order entry, bedside accessioning, realtime asset tracking and management, and management report approaches that concurrently support patient safety and process efficiency.

Bar-code Driven AP Workflow: Step by Step
Mark Routbort, MD, PhD - M.D. Anderson
AP workflow can be viewed simplistically as a series of cascading transitions: from patient to specimens to cassettes to slides. Each of these steps represents a critical transition where errors can occur and result in devastating consequences. This presentation reviews challenges encountered and solutions developed in implementing asset-driven bar-coded workflow for the patient-to-specimen and specimen-to-cassette transitions at MD Anderson Cancer Center.

Our solution for specimen labeling leverages existing patient wristbands and software developed to work alongside our AP-LIS to create real-time printed bar-coded specimen labels which do not have to be replaced in the lab, and which automate critical portions of the process of accessioning the specimens into our AP-LIS system. For the specimen-to-cassette transition, we review the approach we have developed, and contrast the real-time printing model with a bar-code driven specimen-cassette reconciliation approach.

Taken step by step, the complex and challenging process of implementing automated AP workflow can be broken down into incremental chunks, with demonstrable benefits to efficiency and patient safety at each successfully implemented transition.

Re-engineering Surgical Pathology workflow: Leveraging your AP-LIS to Make Surgical Pathology Lean
J. Mark Tuthill, MD - Henry Ford Health Care System
This presentation focuses on the advantages of utilizing bar code technology within the surgical pathology workflow with focus on design, implementation, pitfalls, outcomes, and future opportunities. Inherent in the talk is a discussion of electronic histology orders, utilizing default protocols, text templates and LEAN as accomplished using the Sunquest CoPathPlus AP-LIS.

Re-engineering the Grossing Room
John R. Gilbertson, MD - Massachusetts General Hospital
This presentation discusses the analysis and re-design of the small grossing workflow at the Massachusetts General Hospital, including the incorporation of bar coding, voice recognition, structured data entry and default protocols driven by specimen types. We also discuss the way analysis of grossing workflow drove the redesign of other parts of the surgical pathology workflow, including accessioning, transcription, histology and communications with the operating room. A major part of the discussion involves the use of the Toyota Production System in Anatomic Pathology, including the representation of the surgical pathology lab as a production line, the creation of operational groups that own design projects, re-design as a continuous set of experiments, and how this has resulted continuous process improvement and a stronger relationship between operations and informatics.

Computerized Order Entry and Orders Interfaces for Anatomic Pathology in Upstream Electronic Medical Record Systems - Another Aspect of Automating the Front End in AP
Walter H. Henricks, MD - Cleveland Clinic
Order entry interfaces are well established for electronic communication of clinical laboratory test orders from clinical order entry systems (e.g. electronic medical record (EMR), computerized physician/provider order entry (CPOE)) to the LIS. CPOE and order entry interfaces for anatomic pathology, however, are less common and present unique issues. This presentation examines considerations in implementing computerized order entry and orders interfaces between CPOE/EMR systems and AP LISs

Automating Image File Management in Anatomic Pathology
John H. Sinard, MD, PhD, Yale University
This presentation discusses management of digital image files of all types (including gross, microscopic and EM), with integration into LIS and creating an image archive. It also discusses the extension of the system to automate the filing of scans of surgical pathology requisitions using bar-coded labels within the images to rename and file the image scans, eliminating the need for sorting or microfilming paper requisitions.