Histopathology Workflow Enhancements


Vol. 16 •Issue 7 • Page 54
Histopathology Workflow Enhancements

Advanced middleware solutions can eliminate existing histology bottlenecks.

Despite the use of advanced tissue processing and staining equipment, histology workflows are almost medieval compared to automated chemistry and hematology. Histology workflows are characterized by:

  • disparate systems/equipment that require redundant data entry;
  • multiple handoffs across the processing cycle;
  • manually intensive workflow;
  • potential for error (patient safety due to multiple manual inputs); and
  • difficulty in obtaining operational statistics.

    The use of advanced middleware solutions that create a histology work area manager (H-WAM), however, can help eliminate the existing issues and bottlenecks. The H-WAM could work independently or in conjunction with an anatomic pathology laboratory information system (APLIS) and/or an LIS.

    Histology Processes

    Most histology laboratory processes are manual with “islands of automation” provided by advanced tissue processing, staining, coverslipping and image analysis equipment. Although these instruments are technologically advanced and well designed, they are not well integrated with laboratory and/or APLISs. Linkages to original specimens and patient identification are typically encoded as barcode labels affixed to blocks and slides. Nevertheless, the use of bar codes involves multiple discrete entries of the bar code at each instrument. This consumes personnel time and opens the possibility of mislabeled slides being entered or processes being inadvertently skipped.

    An alternative approach could utilize a dedicated computer-based H-WAM to serve as an active intermediary between a laboratory’s LIS or APLIS and networked histology processing equipment.

    The H-WAM would consist of an advanced assemblage of hardware and software designed to optimize workflow, process efficiency and quality assurance specifically for the histology department.

    Additionally, the H-WAM would support histology processes and procedures, provide management reports and collect appropriate charges for technical component billing. It would complement any existing LIS or APLIS as a sub-system or could be used as an independent stand-alone system for histology. It would need to be scaleable and economically practical for small to large anatomic pathology laboratories.

    H-WAM Functions

    Potential uses or functions of the H-WAM could include:

  • acquisition of patient, specimen, case and order information (data entry or interface);
  • organize, schedule and optimize the work to be performed (optimize histotech time, equipment and reagent utilization);
  • generate schedule/sequence of processing appropriate for the specimen(s) and creation of worklists by process and/or by histotech;
  • generate required block and slide labels (barcoded);
  • interface with slide processing, staining equipment;
  • monitor inventory (e.g., supplies, reagents);
  • monitor and report the status and physical location of work-in-process (input from processing instruments and/or barcode scans);
  • collect statistics on turnaround time, processing time by case/specimen type;
  • maintain an audit and quality assurance trail;
  • produce management reports, including utilization, productivity, turnaround time;
  • create charges file for technical component (for transfer to billing system);
  • record index of slides and slide current location (in-lab or on loan); and
  • acquire/retain images of selected slides (optional).

    The H-WAM is not intended to supplant the traditional roles of the LIS or APLIS; rather, the H-WAM can supplement those systems with functions and features specifically to support histology. If an LIS or APLIS already exists, the H-WAM would interface to those systems and only perform those functions not provided (or inadequately provided) by the LIS/APLIS. If no LIS/APLIS is available, the H-WAM could provide full, extended functionality and operate on a stand-alone basis, interfacing only to the histology tissue processing and staining equipment.

    H-WAM Benefits

    Potential benefits of the H-WAM include improved utilization of equipment, enhanced patient safety, increased productivity of staff and better utilization of reagents and supplies. Recovery of “lost” (not posted) technical charges, improved specimen/slide tracking and more extensive operational management statistics are additional benefits.

    While the H-WAM approach is promising, many laboratories should first require a cost-benefit and return-on-investment (ROI) analysis, especially if a competent LIS or APLIS is already in use. Cost-benefit analyses based on a small, medium and large AP laboratory model could develop data for ROI for an H-WAM.

    The ROI model could be based on:

  • number of cases
  • number of blocks/slides
  • number and type of processing equipment
  • paid hours Ð histologists
  • utilization and cost of reagents and/or supplies
  • detected “error” rates, including re-works
  • detected misidentifications of specimens
  • number of “misplaced” or “misrouted” slides
  • number of technical component charges
  • recapture of lost charges
  • cost/configuration of H-WAM

    Under Review

    The H-WAM concept is being investigated by several LIS/APLIS/middleware companies to determine the costs to develop, market and install such a system. According to Jacques Baudin, executive vice president and general manager, Technidata America, “With the automation of the histology lab, the connectability of devices, cassette/slide printers, instruments and imaging systems, the associated workflow is evolving rapidly. As to fully benefit from that automation, it is essential to connect the dots. This is where an H-WAM, or middleware solution for histology, becomes very valuable. In collaboration with device manufacturers, we are working on extending the capabilities of our IT solutions for the histology lab.”

    Michael Ferrie, CEO of PathSync, adds, “Two elements lead the way in defining the need for H-WAMs—patient care and profitability—with each inextricably tied to the other. For patient care, mistakes can impact patients’ lives, increase risk associated with medical malpractice insurability, undermine confidence in the practice of pathology or laboratory medicine and cost huge sums in legal costs and medical-legal judgments. At the same time, future profitability in AP laboratories, whether hospital-based, independent, small or large, depends on wringing out what savings remain in operations—reimbursement increases are long gone. An H-WAM can be a significant resource that will make a difference by mitigating negative impacts for patients and creating opportunities for improvements in processes and, ultimately, profitability.”

    To further the rapid development of such a product, an expressed interest on the part of laboratories to their LIS/APLIS/Middleware vendors or other potential suppliers could support a more timely availability of H-WAM capabilities for their histology laboratories.

    Dennis Winsten is president of Dennis Winsten & Associates Inc. (DWA)., a healthcare systems consulting firm with headquarters in Tucson, AZ ( www.dwinsten.com, dwinsten@msn.com). An ADVANCE editorial advisory board member, he has more than 30 years’ computer experience, including over 25 years in healthcare systems.

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