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Pathology Informatics in the USA Automating Anatomic Pathology
J. Mark Tuthill, MDDivision of Pathology Informatics,
Henry Ford HospitalDetroit, MI [email protected]
International Academy of Pathology and thePathological Society of Great Britain & Ireland
Belfast Pathology, June, 2017
Disclosures
• I have no financial disclosures• I am:
– A non paid member of the Sunquest Information Systems Strategic Advisory Board
• Current President of the Sunquest User Group– Member of the MSMS Board of Directors– Past Program Chair of the API– Conference Co-Director of the PI Summit
• Any vendors or productus mentioned during this presentation DO NOT represent an endorsement and are shared as examples– Your mileage may vary~
Objectives
• Understand Pathology Informatics as a medical subspecialty and it evolution in the USA
• Describe the structure of the Division of Pathology Informatics at Henry Ford Health System
• Innumerate areas of anatomic pathology that might be automated
• Enumerate some of the pre-requisites for anatomic pathology automation and LIS interfaces
• Present examples of evolving automation, their impact, and associated AP-LIS Requirements
Henry Ford Health System
Detroit, Michigan, USA
J. Mark Tuthill, MD, Henry Ford Health
About Pathology and Laboratory MedicineHenry Ford Health System
• HFH established 1915, by Henry Ford, who organized a closed staff of physicians and surgeons, many of whom came from Johns Hopkins– http://www.henryford.com/body_nologin.cfm?id=39484
• Laboratory grouped into divisions– Anatomic Pathology divisions
• Cytology, Surgical Pathology, Autopsy– Clinical Pathology divisions
• Blood bank, chemistry, microbiology, hematology etc– Molecular pathology– Pathology Informatics– Affiliated specialty labs: cytogenetics, bone and mineral Mohs Service etc
• 12+ million billable clinical laboratory tests and 200, 000 Anatomic Pathology Reports– 12th largest hospital based laboratory in the U.S.
• Operates as a single service line across– 5 hospitals– 36 medical centers– Single Integrated AP and CP LIS: Sunquest Clinical Lab and CoPathPlus
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Pathology Informatics
Patient Care One (Giga) Byte at a Time
Pathology InformaticsA Brave New World
• “The computer will be as important to future pathologists as the microscope has been to those of the past”
• Jeffery Ross, MD– Chair, Department of Pathology, Albany
Medical Center– Past commissioner for continuing education,
American Society of Clinical Pathologists» Circa 1993
Pathology InformaticsWhat Is It?
• The study of information technology and its application to the problems of pathology and laboratory medicine – What are information needs of pathology and
laboratory medicine?– What are the information needs of pathology and
laboratory medicine customers?– How can these needs be met?– Implementation of solutions (systems)– What new opportunities exist?– Keeping the lights on!
LIS Operations
Education Support
Strategic Planning
InternetTechnologySystems
Integration
Regulatory Compliance
Research andDevelopment
Imaging
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Board Exam for Clinical InformaticsIncludes Pathology Informaticists
• American Board of Preventive Health has created an board exam and credentialing program– This is jointly sponsored by American Board of
Pathology and includes pathology informatics• First exam was offered in 2013
– Four administration over 1500 certifications• Formalization of Clinical Pathology Informatics
fellowships by the ACGME has been achieved– CDC recently created a fellowship in public health
informatics
Where did we start at Henry Ford?
• Single operational system– Primary focus of LIS/LIT/System teams
• LIS on lab supported network– Housed in laboratory– Terminals and PC’s supported by laboratory
• Fragmented Internet services• Little standardization• Separate teams: LIS, LIT, System
Where are we now?(We’re getting there!)
• Integrated, system team approach– Pathology Informatics
• Suite of operational systems– AP LIS, CP-LIS, Imaging, Web Portal– LIS only part of focus, albeit, most significant!
• Increasing central support– Network, microcomputers, other services
• Integrated Laboratory information portal– Education, operation, research, administration,
communications• Application of data standards
– LOINC, SNOMED-CT, UML
System Teams
LIS LIT
Pathology InformaticsCP TeamAP Team
GK
RB BK*
LD*
Analytics
JMT
JWRZ
MC TC*RD
DA
HLDM
TBD
Academic Programs
Fellow Resident Med Tech
JR
Pathology Informatics Organization Structure
MA
EC
Cross DivisionalCross DepartmentalCross Institutional
Local Support•HFMH-Warren•HFMH: DM•WYH: BB•Cottage•WBH: LM•HFAH: MH
Central IT
MW
THSM
SD
Outreach Team
KCTBD
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Vision
The division of pathology informatics will continuously improve the efficiency and quality of patient care by applying information technology to the service, educational, and research missions of Pathology and Laboratory Medicine and its customers.
Mission
The division of pathology informatics will expand the use of laboratory information technology from a single systemthat primarily supports the operational aspects of the diagnostic laboratory to a suite of integrated applications and databases that generate information from analytic data, ensure quality and regulatory compliance, and provide pathology and laboratory information to those who need it, whenever, and wherever they are.
What is our Laboratory Information System (LIS)?
• Sunquest (formerly Misys Healthcare) Laboratory Information Systems– Clinical Pathology (blood and fluid testing) version 6.4
• Send it to “The Lab”• Sunquest Clinical Laboratory
– Single clinical pathology LIS for all medical centers and hospitals
– Anatomic Pathology (tissues; microscope based diagnosis
• Sunquest CoPath version 6.3– Single anatomic pathology LIS
Lab Information
System
TECHNICAL & SUPPORT STAFF
PATHOLOGISTS
Information Technology
Sunquest :
Lab and CoPath Histotrak HLAMAS POC
Aqueduct HematologyLane Faxing
LAB PORTAL Atlas
APOLLO Pathpacs
Scantron
LAB USER’S GUIDE
pathology.hfhs.org/lug
Digital PathologyRoche
MikroScanDigital Cameras
− Store AP Req Scans− Store Clin Path Req Scans− Integrate External AP Results− Telepath Integration− Associate Imaging to Reports− Interface to acquisition devices
Cameras (1-2 M records/yr)- Gels-Microbiology
− Surg Path Reqs− Cytopath Reqs− Clin Path Reqs− Outreach Documents
PathInformatics 032309
SCANNING
TISSUE BIOREPOSITORY
DOCUMENT CONTROL
Master Control
HEALTHSTREAMTraining (HFHS U)
Competency
Wired
Molecular Pathology and NGS
Epic
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Pathology Information Systems: Hardware
Each AIX computer contains: 8 CPUs, 16 gb memory Lab: PROD Lab: PROD
TEST TEST
Lab allocated: TESTUPG TESTUPG
6 CPUs, 12 gb memory
Integration Manager: SAM
CoPath allocated: CoPath PROD CoPath PROD 2 CPUs, 4 gb memory TEST TEST
Each VM server: 32 gb memory
Sunquest Lab Sunquest CoPath Other LIS / Application future state of standalone applications
Standalone Servers: RHDC & HFH K5
Virtual servers are defined by dynamic load balancing across all four servers dependant on
system resources
All servers running Windows2003 except, SIMs
running Linux
[ Histotrak HLA ]
Scantron
Lab Users Guide
PI-Tracks Change Control
Virtual Machine Server Cluster
Aqueduct Hematology Middleware
Lane Faxing
CoPath Inquiry
Macro-Scheduler
BTM : Tissue Biorepository
SMART (test)
Interfaces (prod)Report Writer
Histotrak HLA
Document Control
MAS RALS Point-of-Care
Integration
ePath (AP reports to
JFCC)
Sunquest AIX CPUs
Sunquest Lab Sunquest CoPath
SMART (prod) specimen labeling
sybase v12.5 sybase v12.5
Distribution1 / SNOMED
SIM (primary) Instruments Manager
Distribution3 SMART (upgrade)
[ PI-Tracks Change Control ]
[ Lab Users Guide ]
[Tissue Biorepository ]
ADMIN (SMART failover)
Atlas Gateway
Distribution2
[ ePath ]
Apollo PathPACS
[ Document Control ]
Interfaces (test)
SIM (failover) Instruments Manager
[ Scantron ]
[ CoPath Inquiry ]
VMserver #3 VMserver #4
AIX v5.3 AIX v5.3
VMserver #1 VMserver #2
cache v5.0 cache v5.0
SAM1SAM2
Clinical Pathology SystemsFunctional Areas Applications
• Chemistry• Hematology• Coagulation• Urinalysis• Blood Bank• Microbiology• Serology• Virology• HLA• Molecular• Genomic Pathology• Point of Care
– Glucometers >650– Coagulation clinics
• SunquestLab• SMART – barcoded specimen tracking,
management. and archiving
• >140 Instrument Interfaces via Sunquest Instrument Manager (SIM)
• Autovalidation• Macroscheduler automated jobs• Histotrac: HLA laboratory system
• MSQL Report Writer w/ Crystal• Results transmitted to EPIC
Anatomic Pathology SystemsFunctional Areas Applications
• Histology• Molecular Pathology• Cytology• Frozen Room• Autopsy• CP Integration
– Special Hematology– Flow Cytometry– Immunohistochemistry
• Sunquest CoPath• Telepathology: Mikroscan• Biomaterial tracking system (BTM)• Scantron: requisition scanning
• mTuitive: synoptic checklists
• JFCC reporting via ePath• Apollo Digital photography• Barcoded LEAN production• WSI: Ventana connect and Virtuoso• Dako Connect• Ventana Connect• Illumna NGS
Other LIS Applications and Operations Functions• Atlas Portal: Outreach EMR; order entry and result reporting
• Scantron: Document scanning for regulatory retention
• LUG: Laboratory Users Guide
• Lane Faxing: supports all Health system laboratory faxing
• BTM: Tissue Biorepository
• IT Service Now: Helpdesk; PI Change Control database for compliance
• Apollo PathPACS: image storage integrated with both Sunquest systems (Lab & CoPath)
Automating Anatomic Pathology
What Can We Envision Automating?The Big Picture
• Electronic order to AP-LIS• Biopsy/Label (sample procurement)• Transport including tracking and routing• Accession • Tissue Gross Exam • Processing, including fixation • Embedding • Cutting/ Slide Labeling • Routine Staining/Cover slipping• Case Collation • Delivery • Microscopic Exam • Special Stains/Re-cut Orders/materials retrieval • Diagnosis• Dictation • Transcription • Report Sign out • Materials filing and storage, tracking, routing
Imagine automating and integrating these process using computerization and advanced robotics!
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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
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• Required manual processes (so far)
– 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 for Anatomic Pathology
• Bar code labeled assets with the laboratory– Assets with unique identifiers
• Development of robotic technologies– Grossing– Sectioning– Tissue transport– Storage systems: cassettes and slides– Sampling
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
accessioning– Decrease errors– Increased throughput
Prerequisites for Anatomic Pathology Automation
• Bar code labeled assets within the laboratory– This is most essential early prerequisite to achieve
automation within the laboratory– Bar coding of assets allows for:
• Bar code driven workflow• Identification error reduction due to mislabeling• Improved efficiency by reducing manual labeling• Automation of subsequent activities
– Integration whole slide imaging, interface devices
– This is the key requirement for all many automation requirement, and thus the AP-LIS
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Prerequisites for Anatomic Pathology Automation
• Bar code labeled assets within the laboratory– In addition to simple bar coding of assets with a accession
number or medical record number it will be critical for each asset to have an unique ID embedded in the bar code
– This will allow each block and each slide to be managed uniquely supporting
• Sophisticated routing• Tracking of assets • Digital Pathology (unique ID on slides will be essential!)• Systems interfaces
• Without uniquely identified assets the clinical laboratory could not have achieved the level of automation currently experienced
Examples of Anatomic Pathology Automation
Real World Examples and Status Updates
Examples of AP Automation
• Automation of histology orders (stain protocols)• Auto stainers and auto cover slippers• Interfaced immunostain orders to automated
immunostain platform• Bar code labeling automation
– Automated production of cassettes at accessioning– Cassette driven generation of labeled slides
• Tracking, routing and storage• Automated tissue embedding• Automated microtome's
Examples of AP Automation
• Automated block sampling• Automated slide sampling
– Laser capture micro dissection• Conveyor belt systems, tubes, roving robots• Slide collation robotics• Automatic diagnostics
– Whole slide imaging algorithms for immunostains quantification
– Automated pap smear readers for thin layer cytology
Examples of AP AutomationHistology Protocols
• Automated ordering histology protocols for different sample types at case accession– When a particular part is accession the appropriate blocks and
initial stain orders are generated– Initial billing fee codes are applied– Histology logs are electronic sent and printed providing early
notification of work• This has increases efficiency and allows for LEAN processes
– Work is standardized– Revenues were enhanced through better charge capture
• This is not easy and required iterative re-work and constant attention to defects to get the most satisfactory end result
Examples of AP AutomationBar Code Labeling
• Essential first step to widespread AP automation– Note the impact of re-labeling in the automated
staining platform• As previously stated the implications of bar code labeled
cassettes drives all other processes• By themselves, the impact of automation of cassette
labeling following by label generation are profound
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Examples of AP AutomationReal Time Labeling
• Bar code specified surgical pathology– 2D bar codes were not available so we created a
solution and integrated it using middleware• Interfaced to CoPath eliminating dual entry
– Cassettes are etched at the time of accession– Uses predefined protocols
• Provides nicely formatted cassettes with 2D bar codes• Bar coded cassettes are used to create slides labels
“just in time” at the cutting bench– “Stainer shield”
Historical Workflow
• After processing, sections were cut and mounted onto slides then hand labeled with the case accession number and part designation
• Stains were performed based on requests that were available at the histology department through the LIS– Or phone calls…– Or emails…– Or notes on scrap paper
Historical Workflow• After staining, paper labels were batch printed from the LIS and
affixed onto the corresponding slides
46
CoPath terminalBarcode label printer-Lab tag-Specimen containers
Lab tag scanner, bar code readerCassette etcher- 2D barcode
Accession Station U-shaped Cell
CoPath terminal2D Barcode reader-Individual cassettes
Slide label printer-Chemical resistant slide labels-Print 1 cassette not batch
Microtome Station U-shaped Cell
47
Microtomy Station
48
This case is submitted in 3 specimen containers consisting of:part A - sigmoid colon biopsy, part B - transverse colon biopsy and part C - stomach biopsy with standing preorder
for Helicobacter pylori immunostain.
Protocol driven information is reflected in the slide labels dictating 2 levels cut for each part.
The stomach biopsy protocol, part C, calls for an additional 2 blanks slides to be cut, one for the immunostain & a 4th left unstained.
1
4
3
2
Barcode SpecifiedWork Processes
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Outcome• With 'real-time labeling' the batch printing process has
now been entirely eliminated
• Specimen misidentification rates have been reduced
• Workflow efficacy in the histology lab has increased as cassette reading defects have been eliminated– Barcode reading defects required the histotechnologist to
manually type in cases numbers, leading to increased risk of patient misidentification
Results: Misidentification Rates
Baseline Linear BarCodes(Jan.2007)
2D BarCodes(June2012)
45
18
10
5
10
15
20
25
30
35
40
45
Number Mis-IDDefectsPercent of Cases
1.67%
0.62%
0.02%
Interfacing Automated Immunostaining
• Perhaps the most commonly automated process in the current AP lab– Included automated cover slipping
• This saves hundreds of man hours per year• Has more consistent results versus manual staining and
cover slipping• Interfaces with AP LIS will further enhance productivity
and decrease errors
Examples of AP AutomationAutomated Staining Platforms
Automated ImmunostainingInterface Design
• An HL7 interface was created between CoPath and the Dako autostainer Link 48 platforms– Allowed IHC orders placed in CoPath to be directly
transmitted and received by the DakoLink instrument control software; used Dako labels
• Our CoPath LIS was upgraded to version 6.0 which provided the capability to uniquely identify and track each case assets – Assign unique identifiers to each and every case asset (i.e.
parts, blocks, and slides)– With this in place, unique slide IDs (linked to IHC orders in
the AP-LIS) were transmitted to Dako autostainer control software
– Dako autostainer instruments could then read and utilize native CoPath labels
CoPath – Dako New Workflow1. Stains are ordered in CoPathPlus.2. Stain orders are released to the interface on demand
or scheduled.3. Interface creates an HL7 message and delivers to
Dako 4. Message is routed to instrument. Slide labels print
from CoPath. 5. Slides are cut in the laboratory and Slide labels print
from CoPath and labels are applied to slides.6. Slides are placed into the instrument. Label is
scanned by instrument which indicates the reagent stain workup.
7. Slides are processed.
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New workflow after deployment of the automated stainer interface
Stains Ordered
Slide are cut & labeled
Creates HL7 message
Slides placed onto
instruments
Slide labels scanned
Slides processed
CoPath Interface
IHC
Special stains
From CoPath Printer to Slides to DakoBypassing Dako Relabeling
ResultsActivity Number of
Slides Time
Pick up and sort slides from histology 12.0 mins.
Look up patient name in CoPath and record on sheet 7.0 mins.
Daily QC sheet 11.0 mins
Program Stainer: Enter name, acc#, path. initials, stain orders
IHC Autostainer #1 44 slides 11.5 mins.
- Label slides and place in rack 7.0 mins.
IHC Autostainer #2 32 sildes 10.5 mins.
- Label slides and place on rack 5.5 mins.
IHC Autostainer #3 36 slides 10.0 mins.
- Label Slides and place on rack 5.5 mins.
Approximate time saved per run: 56.5 mins.
Assuming 2.0 runs per day X 56.5 minutes = 1.88 hours
Assuming 1.9 hours X 303 days worked per year = 575.7 Hrs/YR
Results
• With elimination of relabeling the slides and dual order entry through automation markedly decreases assay run time – This saves upward of ~700 hours of manual effort per
year while eliminating errors, improving patient safety and improving laboratory throughput
• Increases order accuracy by reducing keystroke errors.• Enhances operational efficiency by automating processes.• Enforces safe, consistent, efficient handling of specimen.
Electronic EMR Orders Interface
AP Orders Interface
• Project initiated to transmit AP orders from our EMR to CoPath
• This will solve several problems:– Elimination of unsolicited results as orders will be
fulfilled in the EMR– Proper encounter selection– Routing to provider inboxes– Better tracking or AP tissue– More efficient accessioning
• ADT, MD, Part Type, ICD, Clinical History and ask at order entry questions will be transmitted from EMR to CoPath
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AP Orders Interface
• Project initiated to transmit AP orders from our EMR to CoPath recently completed
• Impact based on time studies– 1.5 minute average decrease in case accession– 100,000 cases as a baseline for our math
• Savings of 2500 hours• Minimum of $50,000, direct cost savings
• Time savings doesn’t include elimination of the complexities of mis-accessioned cases and required resolution– Elimination of defect in encounter selection alone will
have huge impact
Deploying and Integrating Whole Slide Imaging
Evolution of WSI strategies at HFHS
WSI Drivers for HFHS Pathology2013-2016
• Maturity of the WSI technology platforms – Improved performance– Decreasing costs
• Increasing likelihood of FDA approval/acceptance for primary diagnosis
• The need for a distributed digital pathology workflow to support diagnostic studies– Move images not glass!
• Loss of support for our robotic telepathology platforms• The desire to adopt cISH and image analysis for
diagnostic panels
Prerequisites for Interfacing WSI
• Requisite hardware and software for WSI capable of using HL7 messaging– Network attached storage solution– Network bandwidth
• We had WSI in place since January 2016• An LIS capable of communicating with WSI systems via
HL7• Electronic histology orders used for all histology
processes• Bar code labeled assets with unique ID’s
Value of Interfacing WSI
• Immediate case annotation through interface– Elimination of labeling errors
• Significantly more data is populated – Part, Block, stain– Patients details: age, sex, DOB; – Assigned pathologist
• Leveraging bar code technology– Current 2D bar codes are read directly by the scanners
and match with the order information• Case available to pathologist immediately upon successful
scan– No need to annotate and release
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TECHNOLOGYFile mover services leveraged
Autopsy suite
Apollo EPMM
Specimen X-rays
Grossing stations
DocumentScanners
Autopsy suite
Whole Slide Imaging
LIS Integration
Decisions and Goals
• Select WSI partner for cISH analysis and distributed diagnostic imaging– Selected Ventana Roche as a partner
• Implement iScan Coreo and Coreo HT platforms• Interface these platforms with Sunquest CoPath• Validate the Ventana Ultra cISH platform• Harmonize bar code labeling symbologies so that
CoPath generate bar codes labels would be used• Integrate this technology into our CoPath and
Apollo workflow
Ventana Roche2015-2016
• Stand up iScan Coreo and iScan HT systems including servers, scanners, networking, and storage– Train pathologist and histology– Complete validation studies for images analysis on
iScan Coreo• Develop interfaces between iScan systems and
Sunquest CoPath– Ventana Connect– Virtuoso
• Harmonize labeling of slides so that copath labels could be used on all systems– Implement USID technology recently made available
• 11/1/2016 Roche Ventana iScan Coreo
Roche Ventana HT
Roche Ventana Virtuoso
CoPath
Dako
Apollo Imager
SAM
Stain orders
Stain status updates
Image ordersImage orders
Image results Image results
Past HL7 Setup
SAMSunquest Application Manager
CoPath
Dako
Apollo Imager
Dako stain ordersStain status updates
Image orders
Image orders
Image resultsImage results
Ventana Connect
Dako stain orders
Dako Stain status updates
Dako & Ventana stain orders
Ventana Stain status updatesVentana Image Results
Ventana stain orders
Current HL7 Setup
SAM
SAMSunquest Application Manager
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Benchmark Ultra
Virtuoso
Ventana Stain status updatesVentana Connect
Dako & Ventana stain orders Ventana images
Ventana stain orders from CoPath
Current HL7 Setup
Coreo PC
Ventana imagesHT PC
Ventana image results
Dako & Ventana stain orders
iScan HT Workflow
• Cases are created in CoPath at accession• HL7 message is sent to Ventana Connect and onto
Virtuoso• Slides cut, stained and placed on HT for scanning• Scanned images automatically associated with patient,
CoPath accession and pathologist• Scanned images available to be viewed through CoPath
interface• Select fields can be exported and integrated into the
CoPath report using Apollo EPMM
Conclusions
Conclusions
• More aspects of anatomic pathology can be automated than are typically envisioned
• Automation of AP process have significant cost savings• Automation of manual process eliminates defects,
improves efficiency, and frees up time for value added tasks
• Elimination of defects results in improved patient safety• Electronic orders interfaces to CoPath markedly impact
the accession process as well as clinical customer satisfaction and patient safety
• New “instruments” are coming for tissue pathology imaging; think of WSI as a tissue analyzer
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• Najmabadi P, Goldenberg AA, Emili A. Hardware flexibility of laboratory automation systems: analysis and new flexible automation architectures. Clin Lab Med. 2007;27:1-28.
• Pantanowitz L, Hornish M, Goulart RA. The impact of digital imaging in the field of cytopathology.Cytojournal. 2009;6:6.
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• Zarbo RJ, Tuthill JM, D'Angelo R, Varney R, Mahar B, Neuman C, Ormsby A. The Henry Ford Production System: reduction of surgical pathology in-process misidentification defects by bar code-specified work process standardization. Am J Clin Pathol. 2009;131:468-77.
• College of American Pathologists system review series: Laboratory automation systems & workcells. CAP Today [www.CAP.org].
• Tissue-Tek® AutoTEC® Automated Embedder– http://www.sakura.eu/products/showitem.asp?cat=7&subcat=83
• Laser Capture Microdissection– http://www.appliedbiosystems.com/absite/us/en/home/applications-technologies/laser-
capture-microdissection/overview-of-arcturus-laser-capture-microdissection-process.html
Pathology Informatics in the USA Automating Anatomic Pathology
J. Mark Tuthill, MDDivision of Pathology Informatics,
Henry Ford HospitalDetroit, MI [email protected]
International Academy of Pathology and thePathological Society of Great Britain & Ireland
Belfast Pathology, June, 2017
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Pathology Informatics 2018Monday, May 21–Thursday, May 24, 2018, Pittsburgh, PA
Pathology Informatics 2019Monday, May 6-Thursday,May 9, 2019, Pittsburgh, PA