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78 Pages·2014·13.8 MB·English

by  J. Mark Tuthill

Automating Anatomic Pathology

J. Mark Tuthill, MD
Division of Pathology Informatics,
Henry Ford Hospital
Detroit, MI 48202

ASCP 2014, Tampa, FL
Disclosures
• No financial or relationship conflicts of interest to
disclose
• Customer relationships with Sunquest Information
Systems, Dako, Ventana, Milestone, and General Data
Objectives
• Describe how automation and the future of the Anatomic
Pathology LIS (AP-LIS) are inextricably related
• List the areas of anatomic pathology that are capable of
being automating
• Enumerate some of the pre-requisites for anatomic
pathology automation and LIS interfaces
• Present examples of evolving automation and
associated AP-LIS Requirements
What Can We Envision Automating?
The Big Picture
• Pre analytic
– Prior to receiving or analyzing the sample
– Preparing samples for analysis
• Analytic
– The process of analyzing the tissue
• Post analytic
– The reporting of diagnostic information
– Preparing for additional analytic studies
What Can We Envision Automating?
The Big Picture
• Electronic order to AP-LIS
• Biopsy/Label (sample procurement) Imagine
• Transport including tracking and routing
automating and
• Accession
• Tissue Gross Exam
integrating these
• Processing, including fixation
• Embedding
process using
• Cutting/ Slide Labeling
• Routine Staining/Cover slipping computerization
• Case Collation
and advanced
• Delivery
• Microscopic Exam
robotics!
• Special Stains/Re-cut Orders/materials retrieval
• Diagnosis

• Dictation
• Transcription
The Future of the
• Report Sign out
• Materials filing and storage AP-LIS
Interfacing Anatomic Pathology
Prerequisites
Why has AP Automation Lagged Behind the
Clinical Pathology Laboratory?
• The variability of specimens
– Versus CP specimens which come in tubes, AP
sample vary with each surgery
• The extent of manual processes
– Manual dissection, embedding, sectioning
• A lack of interest?
– Do anatomic pathologists lack exposure to the ideas
of automation used in the clinical laboratory?
– Why change what works?
• The harsh environment
– Chemicals, paraffin, bloody tissue etc
Prerequisites for Anatomic Pathology
Automation
• Sophisticated electronic medical records system
• Electronic orders interface Anatomic Pathology orders
• Bar code labeled assets with the laboratory
– Assets with unique identifiers
• Development of robotic technologies
Prerequisites for Anatomic Pathology
Automation
• Sophisticated electronic medical records systems
– Such systems will enable clinical orders to be sent to
the anatomic pathology information system as well as
supporting:
• Decision support
• Gathering of accurate and required information
• Positive patient identification
• Generation of laboratory ready labels to the point
of service
• Tracking of samples to the laboratory including
monitoring of conditions
Prerequisites for Anatomic Pathology
Automation
• Electronic orders interface to the Anatomic Pathology
Laboratory Information System (AP-LIS)
– Similar to the clinical laboratory, a flow of orders to the
LIS will enable:
• Sample receipt
• Tracking
• Routing
• Processing
• Automation of several elements of case accessing
– Decrease errors
– Increased throughput