Electronic Pathology System May Improve Accuracy and Efficiency

Barbara Boughton

November 15, 2010

November 15, 2010 (San Francisco, California) — Two pathologists from Emory University and the Atlanta Veterans Administration (VA) Medical Center, in Georgia, have developed a unique electronic anatomic pathology system that can be run as a Microsoft Office tool, without the need for new software or hardware, and therefore at no extra cost.

A study on their system, which uses Microsoft InfoPath forms linked to a Microsoft Access database, was unveiled here at the American Society for Clinical Pathology 2010 Annual Meeting by is inventors, Vijay Varma, MD, and Stephen Lau, MD.

With the advent of molecular diagnostics, anatomic oncology pathology reports have become increasingly complex, In addition, workloads for pathologists have increased over the past few years. To ensure accuracy and efficiency in this environment, commercial electronic anatomic pathology systems have been developed, but they are expensive — running between $50,000 and $100,000 or more. Because these systems require new software and hardware, integrating them into a hospital's existing information system can be a challenge.

In the study funded by the US Centers for Disease Control and Prevention, Dr. Lau and Dr. Varma designed a system that they say is easy to use, can be easily customized to the informatics system of any medical practice or hospital, and — best of all — is free, according to Dr. Varma, chief of laboratory pathology medicine at the Atlanta VA Medical Center and an associate professor at Emory University. Dr. Varma and Dr. Lau hope to eventually put the system in the public domain, and will be announcing the system's availability on several pathology Web sites.

Dr. Varma noted that as the diagnosis and treatment of cancer has become more complicated, it has become increasingly important that pathology reports be complete, clear, and error-free. Currently, however, pathologists fill out reports by hand, or dictate them, and a transcriptionist types them out. "It's inefficient and error-prone. For a pathologist doing 20 to 60 cases a day, it becomes very easy to miss a transcriptionist error," Dr. Varma said.

"Because there are many more options for cancer therapies than there used to be, establishing the stage of the tumor has become very important, and many ancillary studies need to be done. With an electronic system that provides more organized reports, you can have a pathology system that actually makes a difference in treatment. If someone has lung cancer, their clinician needs to get a lot of information from the pathologist in order to tailor treatment," said Dr. Lau, chief of anatomic pathology at the Atlanta VA Medical Center and assistant professor at Emory University.

In the electronic pathology system that Dr. Varma and Dr. Lau designed, data such as patient-identifying information, specimen site, procedure type, and diagnosis are entered using drop-down lists in InfoPath forms. Synoptic text reports are generated for tumor specimens from these forms, using a cancer-staging system. Pathologists can search and "query" the reports and find answers to questions concerning patient data. "The tool gives you prompts and limits. Using it is like filling out a form to buy an airline ticket online. You can rapidly enter information in a standardized way," Dr. Varma said.

In the new electronic pathology system, data from InfoPath forms are mapped to a searchable Access database and are XML-ready, so it can easily be integrated into existing healthcare information databases, such as those used by government agencies to track disease incidence rates or for population-based studies. The system can be run on any personal computer with Microsoft Office installed.

For their system's trial run, Dr. Varma and Dr. Lau introduced it to the clinicians at the Atlanta VA Medical Center, who have been using it for a year. The feedback the researchers have received from these 40 clinicians and pathologists has been positive — most have found it easy to incorporate into their daily work flow. "When we show the system to our residents, they usually can start using it the same day," Dr. Varma said. Dr. Varma and Dr. Lau plan a second study in which they will collect objective data from users of their system at the Atlanta VA Medical Center, allowing them to assess clinician satisfaction with it, Dr. Varma said.

The electronic anatomic pathology system can be used for the Centers for Medicaid & Medicare Services current procedural terminology coding and coding from the organizational system for pathology reports (Systemized Nomenclature of Medicine). Dr. Varma and Dr. Lau are currently adding a cytology module. "Since the system is flexible and easy to improve, we are constantly tweaking it," Dr. Varma said.

"We've also included quality management into the system, enabling pathologists to assess the quality of slides and collected data as part of our work flow. By doing it automatically, quality management becomes less labor intensive, and more efficient and complete," Dr. Lau said.

"There are many informatics tools for pathologists, but there really aren't any that can be used without an impossibly hefty investment and that can be tweaked to the needs and individualities of an individual practice," said Monica de Baca, MD, director of hematopathology at Pathology Associates of Kitsap County in Bremerton, Washington. Dr. de Baca is cochair of the pathology electronics reporting task force for the Diagnostic Intelligence Health Information Technology Committee for the College of American Pathologists.

"Standardizing reporting and using electronics tools for pathology not only increases the number of reports that go out complete, it also eliminates error. It also allows for downstream utilization of pathology data in databases such as tumor registries and in epidemiologic studies," Dr. de Baca said.

Although Dr. de Baca has not used the system designed by Dr. Varma and Dr. Lau, she noted that certain characteristics of the system — its usability, ease of installation, and the fact that it will be in the public domain — make it a welcome addition to pathology practice. "I've already asked Dr. Varma when I can get this," she said.

For many pathologists, it has been difficult to move into the electronic era because individual pathologists often distinguish themselves by the quality of their narrative reports, Dr. de Baca said. "But if you start with systems that only ask pertinent questions, some of those obstacles can be overcome. It's through the implementation of electronic reporting systems designed by pathologists for pathologists that we will be able to increase the quality of our reporting, minimize patient risk, and improve quality of care," Dr. de Baca said.

The study was supported by the Centers for Disease Control and Prevention. Dr. Varma, Dr. Lau, and Dr. de Baca have disclosed no relevant financial relationships.

American Society for Clinical Pathology (ASCP) 2010 Annual Meeting: Abstract 48. Presented October 28, 2010.

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