This document discusses pathology informatics and describes several key concepts:
- Pathology informatics involves using information technology to facilitate pathology practices like patient care, disease understanding, and education. It requires integrating diverse data sources and presenting data to support decisions.
- Key components of a pathology information system include managing specimens, acquiring and processing data, and generating integrated reports that can be accessed across hospital systems.
- Standards like SNOMED, ICD-10, and LOINC are important for representing and communicating information between different medical systems.
- A laboratory information system is a comprehensive software that manages the pathology laboratory workflow and reporting.
Internal quality control (IQC) in coagulation labAnkit Raiyani
In the haematology laboratory it is essential to ensure that the right test is carried out on the right specimen and that the correct results are delivered to the appropriate recipient without delay.
Quality control (QC) is defined as measures that must be included during each assay run to verify that the test is working properly.
Internal quality control (IQC) is monitoring the haematology test procedures to ensure continual evaluation of the reliability of the daily work of the laboratory with validation of tests before reports are released
Internal quality control (IQC) in coagulation labAnkit Raiyani
In the haematology laboratory it is essential to ensure that the right test is carried out on the right specimen and that the correct results are delivered to the appropriate recipient without delay.
Quality control (QC) is defined as measures that must be included during each assay run to verify that the test is working properly.
Internal quality control (IQC) is monitoring the haematology test procedures to ensure continual evaluation of the reliability of the daily work of the laboratory with validation of tests before reports are released
Here in these slides we are going to discuss about the Digital pathology in which we have discuss about the working, role, benefits and requirements of Digital pathology.
Here in these slides we are going to discuss about the Digital pathology in which we have discuss about the working, role, benefits and requirements of Digital pathology.
Professor Jon Patrick
Health Information Technology Research Laboratory (HITRL - www.it.usyd.edu.au/~hitru)
School of Information Technologies
University of Sydney
(P38, 16/10/08, Coding stream, 3.30pm)
Health research, clinical registries, electronic health records – how do they...Koray Atalag
This is a talk I gave at my own organisation - National Institute for Health Innovation (NIHI) of the University of Auckland on 6 Aug 2014. Abstract as follows:
In this talk I’ll first cover the topic of clinical registry – an invaluable tool for supporting clinical practice but also gaining momentum in research and quality improvement. NIHI has been very active in this space: we have delivered the prestigious and highly successful National Cardiac Registry (ANZACS-QI) together with VIEW research team and also very recently launched the Gestational Diabetes Registry with Counties Manukau DHB & Diabetes Projects Trust. A few others are in likely to come down the line. This is a huge opportunity for health data driven research and NIHI to position itself as ‘the health data steward’ in the country given our independent status and existing IT infrastructure and “good culture” of working with health data . NIHI’s ‘health informatics’ twist in delivering these projects is how we go about defining ‘information’ – using a scientifically credible and robust methodology: openEHR. This is an international (and now national too) standard to non-ambiguously define health information so that they are easy to understand and also are computable. We build software (even automatically in some cases!) using models created by this formalism. I’ll give basics of openEHR approach and then walk you through how to make sense out of all these. Hopefully you may have an idea about its ‘value proposition’ (as business people call) or Science merit as I like to call it ;)
Systematic review of quality standards for medical devices and practice measu...Pubrica
A systematic literature search performed in databases (Medline, Cochrane Library, Scopus, Embase, CRD York), selected journals and websites identified articles describing either a general MDR structure or the development process of specific registries.
Learn More : https://pubrica.com/services/research-services/systematic-review/
Reference: https://bit.ly/3MCXLOK
Why Pubrica:
When you order our services, we promise you the following – Plagiarism free | always on Time | 24*7 customer support | Written to international Standard | Unlimited Revisions support | Medical writing Expert | Publication Support | Bio statistical experts | High-quality Subject Matter Experts.
Contact us:
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
United Kingdom: +44-1618186353
An AI-based Decision Platform built using unified data model, incorporating systems biology topics for unit analysis using semi-supervised learning models
As part of 'Are you seeing 2020', the event held by SFSP-York and the ISA to showcase the IBM Skills truck stopping at York University, Angus Campbell will show us how healthcare is going to change in the next ten years.
Systematic review of quality standards for medical devices and practice measu...Pubrica
A systematic literature search performed in databases (Medline, Cochrane Library, Scopus, Embase, CRD York), selected journals and websites identified articles describing either a general MDR structure or the development process of specific registries.
Learn More : https://pubrica.com/services/research-services/systematic-review/
Reference: https://bit.ly/3MCXLOK
Why Pubrica:
When you order our services, we promise you the following – Plagiarism free | always on Time | 24*7 customer support | Written to international Standard | Unlimited Revisions support | Medical writing Expert | Publication Support | Bio statistical experts | High-quality Subject Matter Experts.
Contact us:
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
United Kingdom: +44-1618186353
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
2. Introduction
Definitions
Pathology Information System
Basic design criteria
Additional features
Laboratory Information System
Role of Informatics
3. Introduction
20th
century - histologic evaluation of tissue by
pathologist - single most information rich and
decisive, diagnostic assessment tool available
4. Introduction
21st
century
Information & communication technologies - changes in
health services
Parallel methodologies - gene analysis, molecular basis
of disorder & drug susceptibilities
Provide information rich data streams to aid diagnoses
& treatment
5. Challenge to historic role of pathologist
To meet these challenges - need to merge these
methods & other data stream with traditional approaches
of tissue assessment
Requires development of a pathology information system
Data integration from diverse modalities , data
presentation & decision support
These activities fall under the emerging field of
Pathology Informatics
6. Definition
Informatics:
Study of application of
Information Technology
Acquiring, storing,
processing & retrieving
analysed data
Convert data into
information
Medical Informatics: Study
of application of information
technology to medical
science & health care
delivery
7. 7
Components of Medical Informatics
Information Technology
Health care
Research
Education
Fundamentals
Clinical Information
Management
Knowledge Management
Decision support
Communication
9. Current vs. Integrated Approach
Current Method: Integrated Approach:
Medical records written on
paper forms by doctors,
some information stored in
private database
Data typed into electronic
forms which are
connected to a central
database or network of
databases
Pt’s original records stored at
care facility where treatment
took place
Records must be manually
faxed if needed by a different
care facility.
Data stored in a protected
database which can be
accessed remotely with
correct authorization
10. Pathology Informatics
Discipline & practice of
using electronic
information systems
To facilitate, promote &
advance practice of
pathology
patient care
understanding of
disease
education
11. Pathology Informatics
Laboratories & Anatomic pathology - digitized /
automated
Information derived from various sources
Standardized & coded "machine consumable" data
Integrated reports communicate with multiple hospital
systems
12. Pathology Informatics
Data need to be exchanged between multiple,
heterogeneous systems
For representing & communicating information – well
defined standards needed
Standards needed for :
Transferring patient data across different systems
Representing medical knowledge that can be reused
14. SNOMED
Systematized Nomenclature of Medicine
Coded medical nomenclature, which allows recording of
all disease entities regardless of prevalence
Developed & supported by College of American
Pathologists
Comprehensive clinical terminology that is used to:
Code
Retrieve &
Analyze clinical data
15. ICD-10
International standard classification for all
general epidemiological, many health
management purposes and clinical use
3-digit codes
Used in ~110 countries for cause of death
reporting & statistics
17. Logical Observations, Identifiers,
Names and Codes (LOINC)
Database & universal standard for identifying medical
laboratory observations
Created in response to demand for an electronic
database for clinical care & management
Database has expanded to include medical & laboratory
code names
Purpose - assist in electronic exchange & gathering of
clinical results (such as laboratory tests, clinical
observations, outcomes management and research)
18. Information systems in pathology
Rapid pace of workflow - efficient methods to collect,
store, display & distribute data generated
At one end of information system - specimen received
& accessioned & at other end analyzed into
‘pathology report’
Report must be accessible to all those who need it,
ensuring confidentiality
Pathology Information System – Foundation for critical
information handling
19. Information systems in pathology
Pathology laboratory information system –
Comprehensive software that manages laboratory
workflow & reporting
Properly implemented enhance
Ability to store, organize & retrieve prodigious
amounts of information
Efficiency of surgical pathology laboratory
Improve quality of services
Monitor quality assurance parameters
Aid in research
20. Information systems in pathology
First such software
developed at
Tufts University
(SURGPATH)
Massachusetts’s
General Hospital
(CAPER)
Yale University
(CoPATH)
21.
22.
23. Basic design criteria
To allow pathologist
to work independently
of the computer
Elimination of
redundant data entry
Real time integration
of data from all
aspects of diagnostic
pathology
24. Basic design criteria
On-line permanent and
safe storage of all
primary data
Rapid response time
Flexible & easily
modified design
25. Automated Anatomical Pathology System
Operates on computer dedicated to anatomic pathology
Terminals linked to system installed at foll places:
Staff offices
Sign out areas
Secretarial areas & Administration
Cytology
Histology
Surgical pathology gross room
Autopsy room
Similar terminals placed throughout hospital
29. Surgical pathology
Accomplishes all tasks performed in surgical pathology
laboratory
On accessioning a new specimen
– information on the patient, specimen, submitting
physician etc. collected
Information on ‘type of specimen’ captured - allows
computer to obtain preliminary information
30. Surgical pathology
Specimen of breast resection
Entering ‘BRE’ – computer responds by asking the user
to select from:
1. Breast: Biopsy
2. Breast: Resection for Cancer
3. Breast: Reduction Mammoplasty( Not Cancer)
To anticipate
proper procedure for grossing specimen
Generate customized data labels
Provide specific instructions to technicians & pathologist
31. Surgical pathology
All information & protocols generated by selection of
‘specimen type’
- derived from user defined ‘dictionaries’
All text entries ( e.g gross description, final diagnosis)
- made directly in appropriate data field
- simple text editor/word processor
All aspects of the case - edited simultaneously by
different users
32. Surgical pathology
All text fields allow
free text entry or
choices of user defined ‘canned’ text
forms & check lists for standardized reporting
diagnoses for major tumor types
Diagnoses entered may be
‘Preliminary’ report – cases requiring special studies;
reads as – ‘poorly differentiated carcinoma, specific
type pending IHC’
‘Final’ report
33. Surgical pathology
Many standard reports generated by system – 2 most
common being:
Working Draft
Printed on completion of gross dictation
- contains synopsis of all previous/current related clinical
history
- cytology & other data
- full text of gross description
Pathologist may record diagnosis on this sheet or
enter it directly into terminal
Finished format report
Signed electronically & made immediately
available
34. Surgical pathology
Standard Inquiry –displays full text of
Gross description
Diagnosis, amendments to diagnosis
Information on special procedures
Date each task completed
Other data - gross photograph taken
- tissue saved
- special fixatives used
- status of slides preparation
35. Surgical pathology
For use outside department - separate inquiry options
simplified presentation of diagnostic information
other options provide detailed information on status of
microscopic slides & special stains for each case
36. Cytology
Similar to functioning of surgical pathology section
Major difference
makes extensive use of case/type- specific
questionnaires
only relevant questions asked at time of accessioning
On accessioning slides - labels automatically generated
contg:
Patient name
Slide designation
Cytology number
37. Cytology
Reporting cytology specimens facilitated by using
‘checklist’
Cytotechnologist selects predefined features recognized
in smear
From these checklists computer automatically SNOMED
codes specimen
Decides which specimens reqd to be reviewed by
pathologist( based on predefined criteria)
Generate a completed full text report
Quality control review - captures a percentage of cases
38.
39. Autopsy
Complete morgue registration system
Handles all aspects of autopsy report preparation
Unlike surgical/cytology section - unlimited text &
‘canned’ text entries
‘Specimen type’ concept also used in autopsy section
- To generate case specific autopsy worksheets
Provide a measure of increased quality control in
autopsy room
40. Department - wide options
General search capabilities of system in this section
Two search options provided –
Disease Search option
Report Generator
41. Department - wide options
Disease Search option
Involves finding of cases with certain diagnoses or
combination of diagnoses
Done using SNOMED search option
42. Department - wide options
Report generator
Software package - arbitrary search over any of data
items captured in system
Output format – user defined
Any type of report can be compiled with this option
43. Systems manager
Allows editing of all dictionaries used in system
Provides a number of other maintenance &
administrative features
All transactions in systems manager leave an audit trail
Access to this section strictly limited to staff members
44. Histology & IHC laboratory
Handles all functions related to preparation of slides from
handling of specimens
Begins in grossing room
Pathologist enters directly into the terminal
Information on - number of blocks & tissue
pieces submitted
- any special request for
stains, recuts etc
For routine specimens – information needed is already
anticipated by computer based on ‘specimen type’, only
needed to be verified
45. Histology & IHC laboratory
All worksheets in histology lab
Generated automatically from entries in grossing
room
Contain all information necessary for slide preparation
All requests for special stain, recuts etc - entered directly
into system & appear on ‘SPECIAL STAIN’ log
All slide labels printed automatically
For special stains - labels contain type of stain & date of
procedure
46. Molecular genetic laboratory
Provides a separate registration system
Fully integrated with surgical pathology & cytology
sections
Miscellaneous
Contains items such as grading & staging manual for
major tumor types
48. Digital Pathology
Whole slide imaging
(WSI), digital imaging,
virtual slides, virtual
microscopy
Use of computer
technology to convert
microscopic images
into digital images
50. Digital Pathology
Scan - Digital slides
created using scanning
device
View - Digital slides
viewed via viewing
software on computer
monitor
51. Digital Pathology
Manage - Digital slides
maintained in information
management system that
allows for archival &
retrieval
Analyze - Image analysis
tools for objective
quantification measures
52. Digital Pathology
Integrate – Workflow
integrated into institution's
operational environment
Sharing - internet
information sharing for
education, diagnostics,
publication & research
53. Utility of Digital Pathology
View images even over large distances via the Internet
Share exactly same image with colleagues at same time
Clinico-pathological conferences without glass slides
Automate & optimize pathology workflow
54. Digital Pathology Applications
1. Education and Training
- allows viewing of
virtual slides by large
numbers of students
simultaneously
- advantage- all
students view exactly
the same slide at the
same time
55. Digital Pathology Applications
2. Diagnosis
- easy consultation
(without any need to
physically transport the
slides)
- rare diseases
- Instant frozen section
diagnosis over the
Internet
56. Digital Pathology Applications
3. Tissue Micro Array (TMA)
- scanner & TMA software
- segment TMA slides into
cores
- Assist in manual, semi-
automatic / automatic
scoring
- Link individual scores with
patient ID in database
- Perform data mining and
statistics in huge databases
57. Digital Pathology Applications
4. Image Analysis
- Quantify nuclear, cellular or membrane markers
- Count cells, nuclei or more complex structures
- Use powerful morphometry tools
5. Archiving
- Virtual slides - stored locally on computer systems
- Allows easy retrieval for retrospective studies
58. Virtual Microscopy ideal method for
following applications
Remote diagnostic viewing
Clinical remote consultation
Group presentations and discussion
Student education
Case libraries and tissue databanks
Large-volume software-aided image analysis
59. Telepathology
Practice of pathology at a
distance
Uses telecommunications
technology
To facilitate transfer of
image-rich pathology data
b/w distant locations
For the purposes of
diagnosis, education &
research
60. Telepathology
Divided into three major
types:
Static image-based
systems
- benefit - most
reasonably priced &
usable systems
- drawback - capture a
only a selected subset
of microscopic fields
for off-site evaluation
61. Telepathology
Real-time systems
- robotic microscopy systems & virtual slides
- allow consultant pathologist to evaluate HPE slides in
entirety, from a distance
- consultant actively operates robotically controlled
motorized microscope
- located at a distant site—changing focus, illumination,
magnification, & field of view—at will
- perform best on local area networks (LANs)
63. Telepathology
Virtual slide system
- utilize automated digital slide scanners to create digital
image
- stored on computer server & can be navigated at a
distance, over the Internet using a browser
- emerging as the technology of choice for telepathology
services
65. Uses & Benefits of Telepathology
Wide spectrum clinical applications
diagnosing of frozen section specimens
primary histopathology diagnoses
second opinion diagnoses
subspecialty pathology expert diagnoses
education, compentency assessment & research
66. Digital speech recognition
Converts spoken words
to text
“Voice recognition" -
recognition systems
trained to a particular
speaker’ voice
Front-end or back-end of
medical documentation
process
67. Digital speech recognition
Front-End SR
- provider dictates into
speech-recognition
engine
- recognized words
displayed right after they
are spoken
- dictator responsible for
editing & signing off on
document
68. Digital speech recognition
Back-End SR / Deferred SR
- provider dictates into digital dictation system
- voice routed through speech-recognition machine
- recognized draft document routed to the MT/editor
- MT edits draft & finalizes report
69. Digital speech recognition
Electronic Medical Records (EMR) - more effective &
performed easily when in conjunction with speech-
recognition engine
Searches, queries, & form filling - all may be faster to
perform by voice than by using a keyboard
71. Lab Information System - Key Steps
Register patient - Patient record created in LIS
LIS automatically receives data from hospital registration
system (when pt admitted)
Order tests - Physician orders tests to be drawn as part
of laboratory's morning bld collection
Order entered into the HIS & electronically sent to the
LIS
72. Lab Information System - Key Steps
Collect sample - Before collection, LIS prints list of all
pts & appropriate number of sample bar code labels for
each patient printed
Each bar code has - patient ID, sample container type
and laboratory workstation
Another approach - patient caregivers/nurses to collect
sample
Prior to collection, bar code labels printed (on demand)
at nursing station on LIS printer
73. Lab Information System - Key Steps
Receive sample - on arrival in laboratory, status to be
updated in LIS from ‘collected’ to ‘received’
Can be done by scanning each sample container's
bar code ID into LIS
Once sample ‘received’ - LIS transmits test order to
analyzer
Run sample - sample loaded onto analyzer & bar code
is read
analyzer knows which tests to perform on patient – as
test order from LIS already been received
No worklist needed
74. Lab Information System - Key Steps
For manually performed tests - technologist prints
worklist from LIS - contains list of patients & tests
ordered on each
Next to each test is a space to record result
Review results - analyzer produces results & send to
LIS
Results viewable only to technologists as they have not
been released for general viewing
LIS can be programmed to flag critical values
75. Lab Information System - Key Steps
Release results - technologist releases results
Unflagged results usually reviewed & released at
same time
LIS can be programmed to automatically review &
release normal results or results that fall within a certain
range
Latter approach reduces number of tests that
technologist has to review
On release
- Results automatically transmitted to HIS
- Physician can view results on HIS screen
76. Pathology Informatics - Specific tasks
1. Modification of existing information systems –
Integrating data with clinical laboratory , radiology,
pharmacy, medical records & all systems collecting
information of medical relevance
Pathology systems - properly formatted, organized &
highest stds of security
77. Pathology Informatics - Specific tasks
2. Adoption of methodologies & techniques –
Quantitative & rationalized indexing of primary data
Data collection, organization, interpretation,
presentation, & decision-making algorithms
3. Expanded recognition & support for Path Informatics as
legitimate subdiscipline of pathology
80. Conclusion
Pathology Informatics – moving rapidly to keep
up with advances in pathology diagnostics
Facilitate in quality assurance, internal
workflow, clinical services & academic
endeavors
Rapid advances occurring in the fields of digital
imaging & telepathology
An integrated pathology workstation with
capability of photographing, scanning &
sharing images is the future of pathology
81. References
Rosai and Ackerman’s Surgical pathology 9th
volume. Chapter 1-
Introduction:14-22
Modern Surgical Pathology 2nd
edition. Chapter 4- Anatomic
Pathology Information Systems:36-47
Henry's Clinical Diagnosis and Management by Laboratory
Methods, 21st
edition.Chapter11:214-230
Sinard JH, Morrow Jon S.Informatics and Anatomic
Pathology:Meeting Challenges and Charting the Future. Hum
Pathology 2001,32:143-148
Reinhold Haux. Health information systems- past, present, future.
International Journal of Medical Informatics 2006,75: 268—281
Elizabeth A. Krupinsnki. Optimising the pathology workstation
“cockpit”:Challenges and solutions International Journal of Medical
Informatics 2010,1: 14 -19
Editor's Notes
Major challenge facing pathologists - how to best optimize pathology workstation
Ensure efficient & accurate processing of information
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)
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.
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
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
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
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)
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.
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.
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.
The physical bulk of large physical slide collections have created massive storage and accessibility problems.
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.
so that a technologist can easily identify what needs to be repeated or further evaluated
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
.(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.