Pathology informatics

Editor's Notes

• #5: Major challenge facing pathologists - how to best optimize pathology workstation Ensure efficient & accurate processing of information
• #8: Informatics is more than information technology, it is the development and application of IT systems to problems in health care, research, and education. (Masys et al., 2000) The fundamentals of informatics include: communication, knowledge management, decision support and the management of clinical information (Scherger, personal communication), without which clinicians cannot be truly effective. As practitioners attempt to keep abreast of the burgeoning information base – there are nearly 10,000 randomized controlled trials annually – it has become clear, as David Eddy has said, that the complexity of health care “exceeds the inherent limitations of the unaided human mind.” (Millenson, 1997)
• #9: Here is a diagram that shows these four areas of Medical Informatics. I will revisit this from time to time to illustrate a point. Currently there are largely stand alone products that fall in one of these areas.
• #11: Increase in volume of data - led to development of new processes & tools for information mgmt Non electronic storage of that information is impractical, hence computer becomes indispensable tool for informatics
• #28: 1. Few pathologists would welcome a system that asked them to alter their way of phrasing a report, however some would resist a system that forces them to change their way of reporting Therefore the first and foremost desgn requirement of any system must be to allow the pathologists to work independently of the computer without sacrificing the advantages of system With increasing familiarity to computers this criteria is becoming less important 2. Second desirable feature for effective automation is avoidance of redundant data entry. Each data item relating to case (pt name, No of blocks, special stains) should ideally involve a single human intervention All derivative information should be autmatically assigned by computer eg diagnoses codes This principla should apply even to enquiry of patient data to make it possible to retrieve information by just identifying only a portion of name or diagnoses 3. Eg specimen of a patient may be simultaneously received cytology, surgoical pathology, flow cytometry etc. The sytem should automatically bring to attention of each user on all previous & current specimens details Must be able to simultaneously correlate input from multiple users whether they are working on different aspects of same case or different specimens of same patient Also it should automatically inform each user pertinent information regardless of when it was entered
• #29: 4. Must be able to permantly store ‘on-line’ all information about case (gross & microscopic) On-line storage cost effective & practical, Eliminates the need to store hard copies of patients record if adequate precaution taken to safe guard the data Safeguard- all entries must be simulataneously stored on 2 separate devices, copies of all data must be backed up daily Complete machine readable copies of data must be stored off-site & archival copies of data on magnetic tapes must be stored permanently at regular intervals 5 An acceptable automated computer system must provide rapid response times for all routine tasks. Any system that takes >than a second for routine patient related enquiries or > tha few seconds for simple diagnosis based searches on patients files is frustating in daily use
• #32:  picture archiving and communication systems (PACS) have been developed in an attempt to provide economical storage, rapid retrieval of images, access to images acquired with multiple modalities, and simultaneous access at multiple sites".[1] Electronic images and reports are transmitted digitally via PACS; this eliminates the need to manually file, retrieve, or transport film jackets. The universal format for PACS image storage and transfer is DICOM (Digital Imaging and Communications in Medicine)
• #55: So, what does all of that “regulatory language” mean? Here is a graphic of each of the components in WSI systems. As you can see the optical microscope is only one component of the system. We consider other components such as, image acquisition, processing and the display new technology for this intended use. In addition the use of WSI for primary diagnosis of surgical pathology specimens encompasses not only neoplastic disease but the entire spectrum of human pathologic diagnoses and carries the risk of serious public health consequences if erroneous results are rendered using these systems. Therefore, WSI can not be considered exempt from premarket submission requirements.
• #60: and that they can focus their attention on the slide contents itself instead of fiddling around with glass slides and old microscopes interpretation and quantification of disease state by examining a tissue section depends on the knowledge and skill of an individual pathologist and is therefore inherently affected by a certain level of subjectivity.
• #61: In the medical field, efficiency and sharing of information are proportional. To illustrate this, think about rare case diagnoses. Some diseases are so rare and come with very variable morphology that even highly skilled experts will submit opinions that show variation. This indicates that really a collection of experts is needed to reliably diagnose such cases. This is one aspect where virtual microscopy may become indispensable to improve diagnoses, both in quality and time, under the circumstance that availability of experts is scarce. In fact, where several days or weeks would be needed to send the physical slides to each expert, every expert of the network can access simultaneously and remotely a virtual slide simply over the Internet, making diagnoses possible much quicker. In addition, there's no risk of losing or damaging a valuable physical slide during transport.
• #63: The physical bulk of large physical slide collections have created massive storage and accessibility problems.
• #71: immediate access to off-site pathologists for rapid frozen section diagnoses. Another benefit can be gaining direct access to subspecialty pathologists such as a kidney pathologist (renal pathologist), nervous system pathologist ([neuropathologist]), and skin pathologist ([dermatopathologist]), for immediate consultations.
• #80: so that a technologist can easily identify what needs to be repeated or further evaluated
• #84: present role: The “Steady as she Goes” model.The proliferation of alternative information- rich data streams provided by reference labs, electronic medical records, pharmaceutical companies, biotechnology companies, etc., compete with the diagnostic evaluation provided by pathologists.Pathology information systems manage the flow of this information to the clinician decision-maker, who depends increasingly on computer-aided, decision- support systems (inner dark circle) to accurately and most effectively interpret this information for the benefit of the patient
• #85: .(C) Alternate Future of AP Informatics: The “Pathologist as Diagnostic Specialist.” The proliferation of alternative information-rich data streams are used effectively by the pathologist to improve patient management decisions.Pathology information systems are critical to this task, because they manage the flow of this information to the pathologist and provide computeraided, decision support (inner dark circle) to assist the pathologist in the interpretation of this information for the benefit of the patient.