Telepathology as a
Networking Tool in VISN 12
Bruce E. Dunn, M.D.
Milwaukee VA Medical Center
E-mail: Bruce.Dunn@med.va.gov
VISN 12 Hospitals
Milwaukee (M,R,S)
Iron Mt. (S)
Tomah
Madison (M,R,S)
N. Chicago(M) Hines, (M,R,S)
Westside(M,R,S)
Lakesi...
VISN 12 Distance
Schematic
Madison
Iron Mountain
Tomah
North Chicago
Milwaukee
Hines
LakesideWestside
92 mi
220 mi
60 mi
3...
VISN 12 Telepathology Network
Hines
Lakeside
Madison
Tomah
North
Chicago
Westside
Milw
Iron
Mtn
VHA WAN
Internet
VHA WAN
I...
Applications of Telepathology
• Surgical pathology
– Primary diagnosis or consultation
– Documentation of gross pathology
...
Clinical Need for Telepathology at
Iron Mountain VAMC
• Retirement of pathologist
– Surgical pathology (~1,000 cases per y...
Dynamic Robotic Telepathology
1 Tissue examined/
hub site pathologist
2
3
54
6
7
8
9
H & E Sections made
Slides examined u...
Surgical Pathology TAT for Iron Mountain
VA Medical Center
0
1
2
3
4
5
6
7
May-95
Jun-95
Jul-95
Aug-95
Sep-95
Oct-95
Nov-9...
Technical Summary (first 2,200
cases)
Deferral rate: ~2%
Concordance on non-deferred cases: 99.7%
Time per case: 11.6 min ...
Telepathology and the Autopsy
• Send key images electronically to attending along
with PAD
• Submit tissue sections from a...
Consolidation of Microbiology
Functions
• Plate, incubate and send (portable incubators)
• Telepathology to view gram stai...
Conclusions
• Telepathology can be extended to all areas of
anatomic and clinical pathology
• Multiple capabilities availa...
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Telepathology Networking in VA Great Lakes

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Telepathology Networking in VA Great Lakes

  1. 1. Telepathology as a Networking Tool in VISN 12 Bruce E. Dunn, M.D. Milwaukee VA Medical Center E-mail: Bruce.Dunn@med.va.gov
  2. 2. VISN 12 Hospitals Milwaukee (M,R,S) Iron Mt. (S) Tomah Madison (M,R,S) N. Chicago(M) Hines, (M,R,S) Westside(M,R,S) Lakeside (M,R,S) Chicago Chicago Metro VAs M = Affiliated with medical school R = Pathology residence training program S = Surgery program Legend
  3. 3. VISN 12 Distance Schematic Madison Iron Mountain Tomah North Chicago Milwaukee Hines LakesideWestside 92 mi 220 mi 60 mi 35 mi 3 mi9 mi 78 mi
  4. 4. VISN 12 Telepathology Network Hines Lakeside Madison Tomah North Chicago Westside Milw Iron Mtn VHA WAN Internet VHA WAN Internet DR DR DR GS RM NRM DR GS NRM NRM NRM NRM GS GS NRM NRM KEY GS - gross station DR - document reader RM - robotic microscope NRM - non-robotic microscope * New function WAN Printer POP POP POP POP POP POP POP POP Multi-site Conferencing* DR Scanner Scanner DR DR Printer ST Micro (Hines) NRM DR POP Interface to VistA* Voice-Activated Dictation
  5. 5. Applications of Telepathology • Surgical pathology – Primary diagnosis or consultation – Documentation of gross pathology – Consultation with clinicians • Autopsy pathology • Clinical pathology – Microbiology – Protein electrophoresis and immunofixation • Continuing education
  6. 6. Clinical Need for Telepathology at Iron Mountain VAMC • Retirement of pathologist – Surgical pathology (~1,000 cases per year) – Frozen sections – Autopsies (~10 per year) – Diagnostic Nuclear Medicine studies – (Service chief, clinical pathology) • Component of comprehensive telemedicine program
  7. 7. Dynamic Robotic Telepathology 1 Tissue examined/ hub site pathologist 2 3 54 6 7 8 9 H & E Sections made Slides examined using robotically-controlled microscope WAN Pathologist views images in real time Slides read in Milwaukee Pathologist dictates report to PA PA enters report into Iron Mt.. DHCP Report printed locally and signed IRM Router IRM Router
  8. 8. Surgical Pathology TAT for Iron Mountain VA Medical Center 0 1 2 3 4 5 6 7 May-95 Jun-95 Jul-95 Aug-95 Sep-95 Oct-95 Nov-95 Dec-95 Jan-96 Feb-96 Mar-96 Apr-96 May-96 Jun-96 Jul-96 Aug-96 Sep-96 Oct-96 Nov-96 Dec-96 Jan-97 Feb-97 Mar-97 Apr-97 May-97 Jun-97 Jul-97 Aug-97 Sep-97 Oct-97 Nov-97 Dec-97 Jan-98 Feb-98 Month - Year Time(Days) TP used onlyTP used only to cover on-siteto cover on-site pathologistpathologist absenceabsence TP implementedTP implemented completely;completely; dictationsdictations streamlinedstreamlined Histotech/PAHistotech/PA both involvedboth involved in TPin TP PA begins on-linePA begins on-line transcription andtranscription and correctioncorrection PA onlyPA only involvedinvolved in TPin TP Iron Mtn.Iron Mtn. TranscriptionistTranscriptionist retiresretires
  9. 9. Technical Summary (first 2,200 cases) Deferral rate: ~2% Concordance on non-deferred cases: 99.7% Time per case: 11.6 min (cases 1-200), reduced to 3.58 min (cases 2001-2200) Time per slide: 4.25 min (cases 1-200), reduced to 1.13 min (cases 2001-2200) Case turn-around-time: < 1.5 days
  10. 10. Telepathology and the Autopsy • Send key images electronically to attending along with PAD • Submit tissue sections from a distance • Documentation of sections • Autopsy conference presentations • VistA Imaging as permanent record
  11. 11. Consolidation of Microbiology Functions • Plate, incubate and send (portable incubators) • Telepathology to view gram stains and early culture growth - primary lab • Telepathology to view gram stains and show cultures to clinicians - core lab
  12. 12. Conclusions • Telepathology can be extended to all areas of anatomic and clinical pathology • Multiple capabilities available • Must balance access, diagnostic accuracy and cost • Users must be flexible, but do not have to be computer experts • Strong support of telecommunications network is essential

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