Informatics

PRESENTED BY:
DR. AAMIR
1ST YEAR RESIDENT
PATHOLOGY

 It describes the combination of applied and basic
sciences to the processing of data and information.
 The study and practice of data acquisition, storage,
processing, retrieval, analysis, and presentation to
facilitate workflow and increase the accuracy and value
of the information contained within the data.
2
INTRODUCTION

 When applied to medically related information term
‘MEDICAL INFORMATICS’ is used. Its scope
includes clinical and pathological sciences, computer
sciences, decision sciences, and information science.
3

41. PATHOLOGY INFORMATICS
2. PATHOLOGIST AS AN INFORMATION OFFICER.
3. COMMON INFORMATION SYSTEMS.
4.LABORATORY INFORMATION SYSTEM.
5. FEATURES OF LIS.
6. HARDWARE USED IN LIS.
7. NETWORK COMMUNCATIONS.

58. SOFTWARE USED IN LIS.
9. SPECIALIZED FUNCTIONS OF THE SOFTWARE.
10. INTERFACES BETWEEN ISs.
11. COMMUNICATION STANDARDS.
12. SELECTION OF IS.
13. LEGAL REQUIREMENTS.
14. THE FUTURE OF INFORMATICS.

1.PATHOLOGY INFORMATICS
 The practice of pathology produces vast amount of
data, which are communicated to physicians and
others.
 When this data is processed it becomes information
which guides clinical decisions. So to make this data
processing more efficient and useful the use of latest
technology is put to use.
6

7 The data produced by an Pathologist is not simply
attaching names to pieces of tissue or report numbers
measured by a machine; we provide an assessment
which directs the clinical care of the patient .
 The “final interpretation” is based not solely upon the
tissue and/or the results of analysis, but rather is
tempered by the clinical setting.
 We choose the wording of our interpretive reports to
trigger the appropriate clinical response.

8 Tools to Produce the Data.
 The histologic image is one of the richest data
streams in medicine, and the ability of the
pathologist to synthesize and interpret this
information is unlikely to be duplicated
electronically for some time.
 Other techniques: immunohistochemistry, flow
cytometry, gene rearrangement studies, molecular
tests

9
2.PATHOLOGIST
AS AN INFORMATION OFFICER.
 Pathologist would evaluate information and technology
and install and us softwares that would add value to the
current data stream passed to the clinician or a
laboratory customer .
 In this regard models have been proposed to include
informatics rotations in pathology residency.

10
 A universal theme for this is the development of
computer proficiency and skills during this period.
 Skills include;
 Understanding of Hardware and Network connections,
Ability to use Email and Internet access,
Word processing, Software use, Spreadsheets,
Use Statistical and graphical tools.

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 In future informatics will be recognized as a distinct
discipline.
 The pathologist is in unique position to capitalize on
the current opportunities because of the long
experience of laboratory computerization.
 For the purpose of being an information officer
various laboratory information systems are being
used.

123.Common Health Care Enterprise Information Systems.
SYSTEM FUNCTIONALITY
Admission–discharge–transfer
(ADT)
Runs the entire patient care workflow,
from registration of patient
information to bed tracking and
discharge
Health information system
(HIS)
Stores patient information generated
by different departments during one
or more visits.
Laboratory Information System (LIS) Electronic data processing and
information management functions
necessary for laboratory operations
Electronic medical record
(EMR)
A chronologically ordered paperless
chart that summarizes the clinical
history with diagnostic test results
Billing Receives information on charges
and/or tests performed to calculate
charges to patient insurance

13
 An information system (IS) refers empirically to the
hardware, software, and network connectivity
designed to perform data management functions.
Different types of ISs are listed in the previous Table.
 The LIS was classically a standalone insulated
system that generated results from manual reporting
by pathologist for viewing by the clinician.

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4. LABORATORY INFORMATION SYSTEM
(LIS)
 LIS is an information system/software that
processes, stores and manages data from all stages
of medical processes and tests.
 Pathologists, physicians and lab technicians use LIS
to coordinate varieties of IP and OP medical testing,
including hematology, biochemistry, immunology
and microbiology.

15
 Basic LIS commonly has features that manage
1. Patient check in
2. Order entry.
3. Specimen processing.
4. Result entry.
5. Patient demographics.
 The LIS is used to communicate with analyzers and
external systems such as the larger health information
system (HIS) and/or billing systems.

16 Today, it is frequently a major part of a health care
system network for communication with the patient
registration and billing systems and the (EMR).
 The LIS exchanges information with all these systems,
and the effectiveness of this exchange is dependent on
successful hardware and software implementation.
 Most LIS constructs have an interface, which is a
combination of software and connections that translate
electronic messages, so that data can be exchanged
with different systems.

185. FEATURES OF LABORATORY INFORMATION
SYSTEM.
 ADVANTAGES
a. ACCESS TO INFORMATION:
 Repetitive access to diagnostic information is required
in most departments and areas of hospital/clinics. LIS
gives instant access through computer network and
improves patient care

19b. TURNAROUND TIME:
 It’s the time elapsed in specimen collection to
reporting of result. An LIS shortens turnaround time
by improving processing of specimen, transcription,
distribution of results, and billing.
c. PRODUCTIVITYAND FINANCIAL
MANAGEMENT:
 LIS can improve productivity by use as management
tool to collect data regarding the work load,
turnaround time and potentially, cost accounting.

20
c. REGULATORY COMPLIANCE:
 Compliance with rules and regulations created by
accreditation Agencies requires data to be either
manually accounted for or to utilize an information
system to extract the information. e.g. correlation of
biopsy and cytological diagnosis of Sq. cell ca of Cx.
 LIS allows rapid collection of such data and helps a lab
to perform quality assurance.

21
 Ability to access large volumes of data, using and
providing the data at several organizational levels is a
important function.
d. RESEARCH SUPPORT:
 The ability to analyze large quantities of data,
collected over prolonged period of time is of great
value. Databases can be used to perform statistical
analysis comparing various parameters. Hence very
essential in conducting medical research.

22 6. HARDWARE
 The components of LIS are:
a. Central Processing Unit(CPU).
 It performs the logical commands within the software.
CPUs differ in design, functionality, and speed of
executing these commands. Speed is designated as
MHz or MIPS.
 Processor is the key to LIS.

23
b. Storage device:
 Electronic storage is a key feature of LIS because it
provides a permanent easily accessible record.
c. Terminals:
 “dumb” terminals (cathode ray tubes ,CRTs)
and “smart” terminals (PCs/workstations).

24
7. NETWORK COMMUNICATIONS
 Definition of Network as per IEEE
“A data communication system allowing a number of
independent devices to communicate directly with each
other, within a moderately sized geographic area or over
a physical communication channel of moderate data
rates.”
 Network uses dedicated or non dedicated
communication lines. Dedicated are high speed lines
as T1(1.5Mbps), T3(45Mbps) or Asynchronous
transfer mode(ATM 100Mbps).

25 Networks are termed as per there geographic
separations of its users.
 “Wide area network” or WAN
 “Local area network” or LAN
 Networks provide a bridge to integrate the laboratory
system into an existing information system
environment.
 Primary reason to install a LAN is to improve
productivity through automation of routine job
functions and improve manageability of information
and improved accessibility.

28
 8. SOFTWARE:
The basic functionality of software used is to automate
data and information handling in pathology, it includes
1. Registration
2. Demographics(admissions-discharge-transfer[ADT])
3. Order Entry
4. Entry of results,
5. Printing of reports.

299. SPECIALIZED FUNCTIONS
 Specialized functions of information system serve
anatomic pathology and clinical lab functions.
a. Anatomic Pathology functions:
 It contains modules or subsections for surgical
pathology, cytology and autopsy pathology.
 Reports are usually composed of narrative
descriptions of clinical, gross, and microscopic
diagnosis.

30 Coding mechanisms such as SNOMED(Standardized
nomenclature of medicine)(College of American
Pathologists, Skokie, Illinois) are used to sub classify
cases based on key words in their narrative
descriptions.
 M (Morphology) – Changes found in cells, tissues
and organs
 (M-40000) Inflammation
 (M-44000) Granuloma
 (M-54700) Infarcted
 (M-54701) Microscopic infarct.

31 F (Function) – Signs and symptoms
 (F-03003) Fever.
 T (Topography) – Anatomic terms
 (T-28000) Lung
 (T-32000) Heart
 Databases in which the diagnoses have been recorded
may be searched by standardized codes by SNOMED
 These coding systems are less time consuming then
natural language searching.

32
b. Clinical Laboratory functions:
 Clinical Laboratory produces high volume of discrete
data results that fit into numerical reference ranges or
are Positive or Negative.
 E.g. in Blood Bank a bar code identification system has
been implemented for disbursing of blood products.

3710.INTERFACES
 Interface is an electronic or mechanical mechanism
for data transfer between information systems. e.g.
billing interface and an admission-discharge-
transfer(ADT) between hospital admitting and LIS
 Transfer of ADT data to the LIS by means of a
network saves lot of time.
 Its preferable to buy all components from same
vendor so that data transfer is more efficient and
relaible.

38
RESULT REPORTING
 Reporting is done by either Printing reports or by
electronic transmission of results to another LIS.
 Printing of reports may occur based upon the type of
patient, either IP ( results are printed in rows and
columns format like spreadsheets) or OP( results are
printed singly with defined reference range values.
 Remote printing may also be accomplished by
transmission to modem connected printer or through
fax.

39
 An emerging and popular feature of the LIS is its
ability to perform auto-verification, which refers to
release of results from automated analyzers directly to
LIS without prior human review.
 The auto-verification criteria are defined and detailed
in LIS tables and specify things such as allowable
numeric result range and delta checks (in comparison
with previous results).

4011.COMMUNICATION STANDARDS
The use of conventions and definitions to standardize
information exchange between different systems is a
less complex and time-consuming strategy than the
traditional creation of custom interfaces between such
applications.
For this purpose, coding of laboratory procedures
using Current Procedural Terminology (CPT) and
coding of medical conditions using the International
Classification of Diseases have been the norm.

41
 The CPT code set (copyright protected by the AMA)
describes medical, surgical, and diagnostic services
and is designed to communicate uniform information
about medical services and procedures among
physicians, coders, patients, accreditation
organizations, and payers for administrative, financial,
and analytical purposes.
 There are three types of CPT code: Category I,
Category II, and Category III.

42 Codes for evaluation and management: 99201–99499.
(99201–99216) Office/other outpatient services.
(99217–99220)Hospital observation services.
(99221–99239) Hospital inpatient services.
(99241–99255) Consultations.
 Codes for pathology and laboratory: 80000–89398.
(80000–80076) organ or disease-oriented panels.
(88104–88199) cytopathology.
(88230–88299) cytogenetic studies.
(88300–88399) surgical pathology.

43
One example of a newer, and currently the most
prevalent, standard developed by the health care
industry is Health Level 7 (HL7) which is a
protocol for electronic data exchange that specifies
syntax and rules for messaging.
Another standard is Logical Observation Identifier
Names and Codes, which is a set of universal
identifiers for laboratory test code data fields
within HL7 messages and in databases.

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12.SELECTION OF AN INFORMATION SYSTEM.
Evaluation of current needs and operations
 Understanding current needs and operations of
laboratory is essential for proper selection of an LIS.
 Financial considerations , cost analysis and cost
justification studies need to be considered .

46Tangible Benefits
Time saved in performing specific tasks which include
1. Specimen processing.
2. Results reporting.
3. Administration and management.
Intangible Benefits
Decreased turnaround time.
Improved report formats.
Increased access to results.

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Reduced transcription errors.
Reduction in duplicate resting.
Printing of pending lists & overdue lists.
Access to data for research.
Computer proficiency etc.

48
13. EVALUATION AND SELECTION OF
AVAILABLE SYSTEMS
 New vendors are entering the market constantly and
there are few established vendors. So selection
becomes an arduous task.
 Few publications provide annual lists and updates on
LIS vendors including, CAP today, Healthcare
Informatics, and Medical Laboratory Observer(MLO).

4917. LEGAL REQUIREMENTS
 A number of regulatory/accrediting bodies are pertinent
to LIS constructs
 The legal requirements for LISs involve issues such as
unique specimen and patient identification, date of
specimen collection, date and time of specimen receipt
in the lab, records and dates of all specimen testing,
personnel who performed the test(s), and the name and
address of the laboratory where testing was performed.

50
 Security is of paramount concern when it comes to
transferring patient data many times over a network.
 To comply with HIPAA (Health insurance portability
and accountability act), all laboratories should have
safeguards in place to ensure that patient data are
accessed only by appropriate individuals in appropriate
circumstances.
 This is essential not just with transfer of data between
information systems, but also with electronic
correspondence (e.g., e-mail), which laboratory
personnel frequently use.

5114.THE FUTURE OF INFORMATICS
 With the emergence of new technologies, especially in
the realm of bioinformatics, the roles of pathologists
and of the laboratory will undoubtedly be redefined
over time.
 Microfluidic instrumentation is being applied to
common laboratory techniques, essentially providing a
“lab-on-a-chip” solution that allows a patient-centric
approach to testing, and may eventually perform at
levels comparable to centralized analyzers.

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EMERGING TECHNOLOGIES.
 SPEECH RECOGNITION;
Computerized speech recognition allows computers to
transform spoken words into text or to recognize spoken
words to execute commands with a computer program.
 IMAGE MANAGEMENT;
Digital images can be captured by various techniques.
Insight into this technology can be drawn from
experience in the radiology department.

53CONCLUSION
 With all these developments taking place, the
traditional role of the pathologist as one who provides
data and interpretation to the clinician from which a
therapeutic decision will be made will be expanded to
include informatics design and management.
 The pathologist will have to use informatics tools that
span different diagnostic methods to integrate all
available data and produce an outcomes-based
treatment recommendation for optimal patient care.

55REFERENCES
1. Richard A. McPherson, MD, Matthew R. Pincus, MD, PhD, HENRY’S
Clinical Diagnosis and Management by Laboratory Methods, Twenty
Second Edition.
2. Ivan Damjanov, James Linder, ANDERSON’S Pathology, Tenth
Edition.
3. Julie-Gai B. Harris1 RN, GradCertHlthSci (CDM), Clinical Data
Manager.
4. Claire F. Snyder, PhD,* Albert W. Wu, MD, MPH, Robert S. Miller,
MD, Roxanne E. Jensen, PhD, Elissa T. Bantug, MHS, and Antonio C.
Wolff, MD. The Role of Informatics in Promoting Patient-Centered
Care.
5. Internet Sources.

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