Pathology informatics has evolved from early pioneers applying data analytics and computers to medicine. It involves applying information science principles to pathology practice and laboratory data. At UCDHS, pathology informatics manages laboratory information systems, implements digital pathology, performs data mining and analytics, and oversees clinical registries. Future trends include personalized medicine using "big data", wearable devices, learning healthcare systems, and tethered meta-registries that integrate multiple data sources to improve quality and lower costs.

1. Pathology Informatics:
Past, Present, and Future
Mike Hogarth, MD, FACP
UCDHS Medical Dir. of Clinical Registries
Professor and Vice Chair, Pathology and Lab Medicine
Professor, Internal Medicine
mahogarth@ucdavis.edu

2. Overview
• What is “informatics”?
• What is “medical informatics”?
• A history of medical informatics
• History of UCDHS informatics (in pathology)
• What is “pathology informatics”?
• UCDHS pathology informatics – what do we do?
• Thoughts on pathology informatics and the future of
healthcare -- ?what does the future hold?

3. What is “Informatics”
It is the science of “information”....

4. What is “medical informatics”?
"The study, invention and implementation of
structures and algorithms to improve
communication, understanding and management of
medical information."
--- Homer Warmer
"Medical information science is the science of
using system-analytic tools . . . to develop
procedures (algorithms) for management,
process control, decision making and scientific
analysis of medical knowledge.”
--- Ted Shortliffe

5. Informatics does not always require computers –
Nightingale was a pioneer in medical data analytics
Notes on matters affecting the health, efficiency and hospital administration of the British army – Florence
Nightingale (1858)-- demonstrated that sanitation was a significant cause of the 42.7% hospital mortality rate in
Barrack Hospital, Scutari, Istanbul
Crimean War
1853-1856
Florence
Nightingale
1858

6. Nightingale pioneered the use of data
and statistics to improve health
• Developed a Model Hospital Statistical Form
• 1858 – Became Fellow of the Royal Statistical Society
• 1874 – Honorary Member, American Statistical
Association
• 1860 – Sent letter to Intl. Statistical Congress president
advocating for uniform collection of hospital statistics so
outcomes could be compared – the first model for the
systematic collection of hospital data using a uniform
classification of diseases (ICD)

7. Really, what is medical informatics...?
• A multi-disciplinary field that is focused on the science
of information
• Examples of what you might see in the field
• Medical decision making models
• Clinical decision support
• Information organization and flow
• Algorithms
• User interface design and usability (error causing?)
• Medical image processing
• Modeling of medical observations and data
• Ontology and terminology systems
• Methods for evaluating healthcare information systems
• Development and design of clinical information systems

8. Informatics draws from many fields

9. What medical informatics is NOT...
• It is not “information technology”
• It uses information technology as a tool... much like a pathologist
might use a microscope... A pathologist is not a “microscopist”
but a diagnostician!
• It is not “computers in medicine”
• It studies various aspects of information in healthcare, but it is
not simply the implementation of computerization of the process
• Some excellent informatics has been done *without* computers!
• It is not “healthcare programming”
• We often build systems to implement models of information
management but informatics is not about the building of these
systems..
• Informatics uses software design/development to achieve its goals
(and study its benefits/detrimental effects of such systems)

10. Medical Informatics is not a new field...

11. Robert Ledley
– a pioneer in using computers in medicine
Robert Ledley
-Physicist and DDS
-Pioneered the use of digital computers
in biology and medicine
-Developed system to automate
analysis of chromosomes (FIDAC)
-Led the development of the Automatic
Computerized Transverse Axial
(ACTA) scanner...the CT scan!
-National Medal of Technology

12. The direct application of computing to
medical practice is also not new...
• Dr. Morris Collen hired by Dr. Sidney Garfield (Kaiser
Permanente)
• 1952 – Became Medical Director, Kaiser, Oakland
• 1961 – Heard presentation on automating clinical data
capture and processing
• mid 1960’s - Implemented computerized “multi-phasic”
testing (health screening)
• Kaiser was one of the first to computerize medical data

13. Medical informatics is not just for young
healthcare professionals...

14. Computerized medical records are also not new...
• 1965 – El Camino Hospital
(Mt. View, CA) and
Lockheed collaborate on
the “Technicon Systems”
electronic medical record
system
• 1972 – Technicon Medical
Information System goes
“live” in El Camino hospital
• Physician order entry
• Clinical documentation
directly from health provider
• Results reporting
Bill Creelman of Technicon performing training on
System with nursing staff.

15. UCDHS and Medical Informatics
• 1973 – Sacramento
Medical Center is bought
from Sac county by UC
Davis Medical School
• 1976 - Dick Walters, PhD –
Faculty in Computer
Science Dept. also joins
faculty in Family Practice
• 1985 - Dr. Walters elected
to ACMI
• co-developer of MUMPS, a
programming language in
clinical systems
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1130476/
1976

16. UC Davis Informatics Milestones
• 1985 - Dr. Cardiff (Chair,
DOPLM) and Dr. Walters
create the “Center for
Medical Informatics”
• 1999 – Health Informatics
master’s program
• 1987 – 1st
“web-cast”
informatics symposium
featuring Dr. Don Lindberg
• 2000 – UCD DOPLM
develops hybrid tele-
pathology system

17. Medical Informatics evolves in the US
AMIA Definition of Biomedical Informatics and related fields

18. Medical Informatics evolves in the US
AMIA Definition of Biomedical Informatics and related fields

19. Pathology Informatics
-- Association of Pathology Informatics (API)
• 2000 – founded with the goal of defining pathology
informatics as a clinical subspecialty within pathology
• Develops standards for managing pathology-related
information
• Promotes education in pathology informatics
• “Pathology informatics involves collecting, examining,
reporting, and storing large complex sets of data
derived from tests performed in clinical laboratories,
anatomic pathology laboratories, or research
laboratories in order to improve patient care and
enhance our understanding of disease-related
processes”

20. UCDHS Pathology Informatics
• 2009 – Pathology
Informatics formally
established in DOPLM
• Mission – to apply
information science to
solve challenges in the
discipline of pathology

21. So what is “pathology informatics” here?
• The application of information science to support the scope of
pathology practice (or research)
• What does it entail?
• Laboratory Information Systems
• Managing clinical information systems supporting anatomic pathology, clinical
pathology, transfusion medicine, and molecular diagnostics
• Laboratory automation
• Digital Pathology Imaging Systems
• Image capture methods, diagnostic fidelity
• Whole-slide scanning systems, tele-pathology systems, Image archives/path-
PACS
• Data mining (of pathology information)
• Natural language processing of surgical pathology reports
• Decision support
• Provide CDSS for diagnostic testing by health providers
• Analytics and Registries
• to support performance/quality improvement

22. UCDHS Pathology Informatics: 2014-
2015
• Information Management
• Implement, operate/manage systems that support UCDHS anatomic pathology,
clinical pathology, transfusion medicine
• Integration of LIS data with EHR
• Integration of LIS data with external referral labs (ie, ARUP)
• Whole slide scanning systems (in collab with health IT)
• Education
• PGY Pathology informatics rotation
• Health informatics certificate for pathology fellows
• Health informatics master’s program (leadership, teaching courses)
• Master’s of Public Health (public health informatics)
• Grants/Contracts -- ~$25M in grants/contracts since 2005
• California Electronic Death Registration System (2005)
• Maryland EDRS (2014)
• MediCal “Big Data” analytics and EHRs (2014)
• TRANSCEND Clinical Trial Information System (supporting I-SPY2 since 2009)
• pSCANNER – PCORI Clinical Data Research Network (2014)
• UC-ReX (founding member, 2009)
• Athena Breast Health Network (2008)
• Oversight of UCDHS clinical registries (2011)
• UC Health Quality Improvement analytics (2014)

23. UCDHS Pathology Informatics
http://www.ucdmc.ucdavis.edu/pathinformatics

24. Pathology Informatics Staff

25. What does the future hold?
• Trends in healthcare
1. The pursuit of the Triple Aim
 Increasing focus on
quality/cost (value)
• DSRIP (Delivery System
Reform Incentive
Payments) program
• Accountable Care
Organizations (ACOs)
1. Tailored diagnostics and
therapeutics
2. Wearable devices
3. “Big Data” and “Data
Science”
4. “Open Data” movement
(health.data.gov)
“The Triple Aim”

26. 21st
Century US Healthcare

27. The Learning Healthcare System
Sarah M. Greene, Robert J. Reid, Eric B. Larson; Implementing the Learning Health System: From Concept to Action. Annals of Internal Medicine. 2012 Aug;157(3):207-210.

28. TMR Transfusion Registry
Transfusion registry
leverages data from the
Laboratory Information
System (LIS), clinical
data from UC Davis
Health System EHR, and
administrative (coded)
data

29. Registries a new way
A Tethered Meta-
Registry
-“Meta-Registry” – All
data for all registries is in
one repository
-“Tethered” – routine,
automated data
extraction from source
systems
-One data set –
algorithms “tag” patients
as being in one or more
registries
-Automated dashboards
and reports
A Tethered Meta-
Registry
-“Meta-Registry” – All
data for all registries is in
one repository
-“Tethered” – routine,
automated data
extraction from source
systems
-One data set –
algorithms “tag” patients
as being in one or more
registries
-Automated dashboards
and reports
Did you know?
“80% of data elements in institutional registries are common across
all of them”
Did you know?
“80% of data elements in institutional registries are common across
all of them”

30. Tethered Meta Registry Data Flow
Sepsis
Registry
Mobility
(ICU)
Registry
Diabetes
Registry
Source Data
“Tether”
EMR
Reporting
Database
Administrativ
e Data
Laboratory
Information
System
TMR Patient
TMR Encounters
TMR Flowsheets
TMR Procedures/Labs
TMR Medications
2.2 Million
25 Million
100 Million
57 Million
Cancer
Registry
Database
TMR Cancer Diagnosis
Transfusion
Registry
Cancer
Registry

31. A glimpse into the possible future...
http://www.businessweek.com/articles/2014-07-03/hospitals-are-mining-patients-credit-card-data-to-predict-who-will-get-sick#r%3Dread

32. Pathology Informatics and future trends
• “Team Medicine” / Integrated care
• Will require tight data integration between EHR and LIS functions
• Consolidation of LIS as a core EHR component
• Computerized clinical decision support
• Will require structured data from pathologists
• Structured reporting (synoptic reporting) using XML CAP “electronic checklists”
(eCC XML)
• We are currently collaborating with ASCO and CAP on improving structured data
capture in cancer care
• Population health management
• Will require clinical data analytics and registries
• Combining data from multiple sources for predictive analytics.
• Creation/management of data sets (registries) to support performance
improvement within pathology, as well as externally
• Analytics platform to characterize care
• Patient-centered care
• Will require new ways of “reporting” information
• Patient-directed reports?
• Mobile/mhealth

33. Questions...
Slide deck download – http://www.hogarth.org