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Levy JJ, Chan N, Marotti JD, Kerr DA, Gutmann EJ, Glass RE, Dodge CP, Suriawinata AA, Christensen B, Liu X, Vaickus LJ. Large-scale validation study of an improved semiautonomous urine cytology assessment tool: AutoParis-X. Cancer Cytopathol 2023; 131:637-654. [PMID: 37377320 PMCID: PMC11251731 DOI: 10.1002/cncy.22732] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Adopting a computational approach for the assessment of urine cytology specimens has the potential to improve the efficiency, accuracy, and reliability of bladder cancer screening, which has heretofore relied on semisubjective manual assessment methods. As rigorous, quantitative criteria and guidelines have been introduced for improving screening practices (e.g., The Paris System for Reporting Urinary Cytology), algorithms to emulate semiautonomous diagnostic decision-making have lagged behind, in part because of the complex and nuanced nature of urine cytology reporting. METHODS In this study, the authors report on the development and large-scale validation of a deep-learning tool, AutoParis-X, which can facilitate rapid, semiautonomous examination of urine cytology specimens. RESULTS The results of this large-scale, retrospective validation study indicate that AutoParis-X can accurately determine urothelial cell atypia and aggregate a wide variety of cell-related and cluster-related information across a slide to yield an atypia burden score, which correlates closely with overall specimen atypia and is predictive of Paris system diagnostic categories. Importantly, this approach accounts for challenges associated with the assessment of overlapping cell cluster borders, which improve the ability to predict specimen atypia and accurately estimate the nuclear-to-cytoplasm ratio for cells in these clusters. CONCLUSIONS The authors developed a publicly available, open-source, interactive web application that features a simple, easy-to-use display for examining urine cytology whole-slide images and determining the level of atypia in specific cells, flagging the most abnormal cells for pathologist review. The accuracy of AutoParis-X (and other semiautomated digital pathology systems) indicates that these technologies are approaching clinical readiness and necessitates full evaluation of these algorithms in head-to-head clinical trials.
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Affiliation(s)
- Joshua J. Levy
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Department of Epidemiology, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
- Program in Quantitative Biomedical Sciences, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Natt Chan
- Program in Quantitative Biomedical Sciences, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Jonathan D. Marotti
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Darcy A. Kerr
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Edward J. Gutmann
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | | | | | - Arief A. Suriawinata
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Brock Christensen
- Department of Epidemiology, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
- Department of Molecular and Systems Biology, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
- Department of Community and Family Medicine, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Xiaoying Liu
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Louis J. Vaickus
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
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2
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Torous VF, Pitman MB, Heher YK. The value of monitoring amended reports in cytopathology quality programs: A biennial review. Cancer Cytopathol 2022; 130:860-871. [PMID: 35666141 DOI: 10.1002/cncy.22607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Quality and safety are the foundation of the practice of cytopathology. Review of key performance indicator (KPI) data can shine a light on laboratory vulnerabilities and potential areas for targeted improvement. The rate and content of amendment reports is a frequently monitored KPI in anatomic pathology, but few have studied its value in cytopathology. The goal of this study was to examine the frequency, classification, and outcome of amendments for a large cytopathology laboratory. METHODS All amendment reports issued for cases during a 2-year period from July 2019 to June 2021 were included in the study. Amendments were classified into three error type root causes: Specimen Identification Error, General Report Defects, and Diagnostic Error. RESULTS A total of 202 amendment reports were issued equating to a rate of 0.275%. A total of 83 (41.1%) were gynecologic cases and 119 (58.9%) were nongynecologic cases. Within the gynecologic cases, 13 (15.7%) cases were due to Specimen Identification Error, 13 (15.7%) cases were due to Diagnostic Error, and 57 (68.7%) cases were due to General Report Defects. Within the nongynecologic cases, 15 (12.6%) cases were due to Specimen Identification Error, 30 (25.2%) cases were due to General Report Defects, and 74 (62.2%) cases were due to Diagnostic Error with 32 of these due to true diagnostic change. Discovery methods included following re-review after additional clinical information was provided, reinterpretation after additional ancillary testing was performed, or conference review. There was no correlation with years in practice. CONCLUSIONS Studying amendment reports is an underrecognized and valuable quality assurance tool. Amendments can help provide information about types of errors, monitor laboratory processes, and help guide quality improvement endeavors.
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Affiliation(s)
- Vanda F Torous
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Martha B Pitman
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yael K Heher
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
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3
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Pantanowitz L, Layfield LJ, Baloch ZW. The growing demand for informatics in cytopathology. Diagn Cytopathol 2019. [DOI: 10.1002/dc.24104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Liron Pantanowitz
- Department of Pathology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Lester J. Layfield
- Department of Pathology and Anatomical Sciences; University of Missouri; Columbia Missouri
| | - Zubair W. Baloch
- Department of Pathology and Laboratory Medicine; University of Pennsylvania; Philadelphia Pennsylvania
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4
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Sundling KE, Kurtycz DFI. Standardized terminology systems in cytopathology. Diagn Cytopathol 2018; 47:53-63. [PMID: 30499199 DOI: 10.1002/dc.24103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/26/2018] [Accepted: 10/05/2018] [Indexed: 01/21/2023]
Abstract
There has been increasing pressure for systemization in cytopathology. Lack of uniformity in categorization, variation in opinion based regional practice, and technologic advancement have created an environment disposed toward creation of more consistent evidence-based approaches to diagnostic problems. This review provides an overview of the major standardized terminology systems in cytology, with historical perspectives and commentary on current uses of these systems. These systems now include gynecologic, thyroid, pancreaticobiliary, urinary, salivary gland, and breast cytology. We summarize major classification systems supported by national and international professional organizations, outlining the structure and goals of each system. Specific benefits and potential pitfalls in the implementation of each system are given. Finally, we address potential criticisms of standardized terminology systems and proposed future directions to continue the evolution of standardized terminology to improve clinical practice.
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Affiliation(s)
- Kaitlin E Sundling
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health Wisconsin State Laboratory of Hygiene, Madison, Wisconsin
| | - Daniel F I Kurtycz
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health Wisconsin State Laboratory of Hygiene, Madison, Wisconsin
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5
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Hewer E, Hammer C, Fricke-Vetsch D, Baumann C, Perren A, Schmitt AM. Implementation of a 'lean' cytopathology service: towards routine same-day reporting. J Clin Pathol 2017; 71:395-401. [PMID: 28974539 DOI: 10.1136/jclinpath-2017-204504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/28/2017] [Accepted: 08/23/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To systematically assess the effects of a Lean management intervention in an academic cytopathology service. METHODS We monitored outcomes including specimen turnaround times during stepwise implementation of a lean cytopathology workflow for gynaecological and non-gynaecological cytology. RESULTS The intervention resulted in a major reduction of turnaround times for both gynaecological (3rd quartile 4.1 vs 2.3 working days) and non-gynaecological cytology (3rd quartile 1.9 vs. 1.2 working days). Introduction of fully electronic reporting had additional effect over continuous staining of slides alone. The rate of non-gynaecological specimens reported the same day increased from 4.5% to 56.5% of specimens received before noon. CONCLUSIONS Lean management principles provide a useful framework for organization of a cytopathology workflow. Stepwise implementation beginning with a simplified gynaecological cytology workflow allowed involved staff to monitor the effects of individual changes and allowed for a smooth transition.
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Affiliation(s)
- Ekkehard Hewer
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Caroline Hammer
- Institute of Pathology, University of Bern, Bern, Switzerland
| | | | - Cinzia Baumann
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Aurel Perren
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Anja M Schmitt
- Institute of Pathology, University of Bern, Bern, Switzerland
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6
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Hanna MG, Pantanowitz L. The role of informatics in patient-centered care and personalized medicine. Cancer Cytopathol 2017; 125:494-501. [PMID: 28609000 DOI: 10.1002/cncy.21833] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 01/05/2023]
Abstract
The practice of cytopathology has dramatically changed due to advances in genomics and information technology. Cytology laboratories have accordingly become increasingly dependent on pathology informatics support to meet the emerging demands of precision medicine. Pathology informatics deals with information technology in the laboratory, and the impact of this technology on workflow processes and staff who interact with these tools. This article covers the critical role that laboratory information systems, electronic medical records, and digital imaging plays in patient-centered personalized medicine. The value of integrated diagnostic reports, clinical decision support, and the use of whole-slide imaging to better evaluate cytology samples destined for molecular testing is discussed. Image analysis that offers more precise and quantitative measurements in cytology is addressed, as well as the role of bioinformatics tools to cope with Big Data from next-generation sequencing. This article also highlights the barriers to the widespread adoption of these disruptive technologies due to regulatory obstacles, limited commercial solutions, poor interoperability, and lack of standardization. Cancer Cytopathol 2017;125(6 suppl):494-501. © 2017 American Cancer Society.
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Affiliation(s)
- Matthew G Hanna
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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7
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Heher YK, Chen Y, VanderLaan PA. Measuring and assuring quality performance in cytology: A toolkit. Cancer Cytopathol 2017; 125:502-507. [DOI: 10.1002/cncy.21831] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/14/2016] [Accepted: 01/03/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Yael K. Heher
- Department of Pathology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Yigu Chen
- Department of Pathology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Paul A. VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
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8
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Crema M, Verbano C. Investigating the connections between health lean management and clinical risk management. Int J Health Care Qual Assur 2015; 28:791-811. [DOI: 10.1108/ijhcqa-03-2015-0029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to investigate connections and overlaps between health lean management (HLM) and clinical risk management (CRM) understanding whether and how these two approaches can be combined together to pursue efficiency and patient safety improvements simultaneously.
Design/methodology/approach
– A systematic literature review has been carried out. Searching in academic databases, papers that focus not only on HLM, but also on clinical errors and risk reduction, were included. The general characteristics of the selected papers were analysed and a content analysis was conducted.
Findings
– In most of the papers, pursing objectives of HLM and CRM and adopting tools and practices of both approaches, results of quality and, particularly, of safety improvements were obtained. A two-way arrow between HLM and CRM emerged but so far, none of the studies has been focused on the relationship between HLM and CRM.
Originality/value
– Results highlight an emerging research stream, with many useful theoretical and practical implications and opportunities for further research.
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Frisch NK, Nathan R, Ahmed YK, Shidham VB. Authors attain comparable or slightly higher rates of citation publishing in an open access journal (CytoJournal) compared to traditional cytopathology journals - A five year (2007-2011) experience. Cytojournal 2014; 11:10. [PMID: 24987441 PMCID: PMC4058908 DOI: 10.4103/1742-6413.131739] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 03/31/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The era of Open Access (OA) publication, a platform which serves to better disseminate scientific knowledge, is upon us, as more OA journals are in existence than ever before. The idea that peer-reviewed OA publication leads to higher rates of citation has been put forth and shown to be true in several publications. This is a significant benefit to authors and is in addition to another relatively less obvious but highly critical component of the OA charter, i.e. retention of the copyright by the authors in the public domain. In this study, we analyzed the citation rates of OA and traditional non-OA publications specifically for authors in the field of cytopathology. DESIGN We compared the citation patterns for authors who had published in both OA and traditional non-OA peer-reviewed, scientific, cytopathology journals. Citations in an OA publication (CytoJournal) were analyzed comparatively with traditional non-OA cytopathology journals (Acta Cytologica, Cancer Cytopathology, Cytopathology, and Diagnostic Cytopathology) using the data from web of science citation analysis site (based on which the impact factors (IF) are calculated). After comparing citations per publication, as well as a time adjusted citation quotient (which takes into account the time since publication), we also analyzed the statistics after excluding the data for meeting abstracts. RESULTS Total 28 authors published 314 publications as articles and meeting abstracts (25 authors after excluding the abstracts). The rate of citation and time adjusted citation quotient were higher for OA in the group where abstracts were included (P < 0.05 for both). The rates were also slightly higher for OA than non-OA when the meeting abstracts were excluded, but the difference was statistically insignificant (P = 0.57 and P = 0.45). CONCLUSION We observed that for the same author, the publications in the OA journal attained a higher rate of citation than the publications in the traditional non-OA journals in the field of cytopathology over a 5 year period (2007-2011). However, this increase was statistically insignificant if the meeting abstracts were excluded from the analysis. Overall, the rates of citation for OA and non-OA were slightly higher to comparable.
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Affiliation(s)
- Nora K. Frisch
- Address: Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center and Detroit Medical Center, Old Hutzel Hospital, Detroit, MI 48201, USA
| | - Romil Nathan
- Address: Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center and Detroit Medical Center, Old Hutzel Hospital, Detroit, MI 48201, USA
| | - Yasin K. Ahmed
- Address: Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center and Detroit Medical Center, Old Hutzel Hospital, Detroit, MI 48201, USA
| | - Vinod B. Shidham
- Address: Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center and Detroit Medical Center, Old Hutzel Hospital, Detroit, MI 48201, USA
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10
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11
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Crema M, Verbano C. Guidelines for overcoming hospital managerial challenges: a systematic literature review. Ther Clin Risk Manag 2013; 9:427-41. [PMID: 24307833 PMCID: PMC3845536 DOI: 10.2147/tcrm.s54178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The need to respond to accreditation institutes' and patients' requirements and to align health care results with increased medical knowledge is focusing greater attention on quality in health care. Different tools and techniques have been adopted to measure and manage quality, but clinical errors are still too numerous, suggesting that traditional quality improvement systems are unable to deal appropriately with hospital challenges. The purpose of this paper is to grasp the current tools, practices, and guidelines adopted in health care to improve quality and patient safety and create a base for future research on this young subject. METHODS A systematic literature review was carried out. A search of academic databases, including papers that focus not only on lean management, but also on clinical errors and risk reduction, yielded 47 papers. The general characteristics of the selected papers were analyzed, and a content analysis was conducted. RESULTS A variety of managerial techniques, tools, and practices are being adopted in health care, and traditional methodologies have to be integrated with the latest ones in order to reduce errors and ensure high quality and patient safety. As it has been demonstrated, these tools are useful not only for achieving efficiency objectives, but also for providing higher quality and patient safety. Critical indications and guidelines for successful implementation of new health managerial methodologies are provided and synthesized in an operative scheme useful for extending and deepening knowledge of these issues with further studies. CONCLUSION This research contributes to introducing a new theme in health care literature regarding the development of successful projects with both clinical risk management and health lean management objectives, and should address solutions for improving health care even in the current context of decreasing resources.
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Affiliation(s)
- Maria Crema
- Department of Management and Engineering, University of Padova, Vicenza, Italy
| | - Chiara Verbano
- Department of Management and Engineering, University of Padova, Vicenza, Italy
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Abstract
Advances in computing speed and power have made a pure digital work flow for pathology. New technologies such as whole slide imaging (WSI), multispectral image analysis, and algorithmic image searching seem poised to fundamentally change the way in which pathology is practiced. This article provides the practicing pathologist with a primer on digital imaging. Building on this primer, the current state of the art concerning digital imaging in pathology is described. Emphasis is placed on WSI and its ramifications, showing how it is useful in both anatomic (histology, cytopathology) and clinical (hematopathology) pathology. Future trends are also extrapolated.
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Affiliation(s)
- Seung Park
- Division of Pathology Informatics, Department of Pathology, UPMC Shadyside Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA.
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13
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Park S, Pantanowitz L, Parwani AV, Wells A, Oltvai ZN. Workflow organization in pathology. Clin Lab Med 2012; 32:601-22. [PMID: 23078662 DOI: 10.1016/j.cll.2012.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
New technologies, analytic techniques, and computer-assisted diagnosis algorithms will change the way pathologists and clinicians interact with and use clinical data. Simultaneously, the artisanal nature of the culture and clinical practice of medicine have made them resistant to change. An understanding of workflow science will help pathologists prepare for the changes that lie ahead in anatomic and clinical pathology, better care for patients, and make better and more respectful use of existing human and other resources. This article provides a primer on workflow science, including historical perspective, review of current literature, and extrapolation of future trends.
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Affiliation(s)
- Seung Park
- Department of Pathology, University of Pittsburgh Medical Center, UPMC Shadyside Hospital Suite, Pittsburgh, PA 15232, USA.
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Abstract
The modern anatomic pathology laboratory depends on a reliable information infrastructure to register specimens, record gross and microscopic findings, regulate laboratory workflow, formulate and sign out report(s), disseminate them to the intended recipients across the whole health system, and support quality assurance measures. This infrastructure is provided by the Anatomical Pathology Laboratory Information Systems (APLIS), which have evolved over decades and now are beginning to support evolving technologies like asset tracking and digital imaging. As digital pathology transitions from "the way of the future" to "the way of the present," the APLIS continues to be one of the key effective enablers of the scope and practice of pathology. In this review, we discuss the evolution, necessary components, architecture and functionality of the APLIS that are crucial to today's practicing pathologist and address the demands of emerging trends on the future APLIS.
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Modery J, Khalbuss WE, Pantanowitz L. All aboard: Cytotechnology student training in pathology informatics. J Pathol Inform 2012; 3:6. [PMID: 22439126 PMCID: PMC3307225 DOI: 10.4103/2153-3539.93403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 12/04/2011] [Indexed: 12/02/2022] Open
Affiliation(s)
- Judith Modery
- Cytotechnology and Histotechnology Schools, Pittsburgh, USA
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16
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Khalbuss WE, Pantanowitz L, Parwani AV. Digital imaging in cytopathology. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:264683. [PMID: 21785680 PMCID: PMC3140195 DOI: 10.4061/2011/264683] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Accepted: 03/30/2011] [Indexed: 11/20/2022]
Abstract
Rapid advances are occurring in the field of cytopathology, particularly in the field of digital imaging. Today, digital images are used in a variety of settings including education (E-education), as a substitute to multiheaded sessions, multisite conferences, publications, cytopathology web pages, cytology proficiency testing, telecytology, consultation through telecytology, and automated screening of Pap test slides. The accessibility provided by digital imaging in cytopathology can improve the quality and efficiency of cytopathology services, primarily by getting the expert cytopathologist to remotely look at the slide. This improved accessibility saves time and alleviates the need to ship slides, wait for glass slides, or transport pathologists. Whole slide imaging (WSI) is a digital imaging modality that uses computerized technology to scan and convert pathology and cytology glass slides into digital images (digital slides) that can be viewed remotely on a workstation using viewing software. In spite of the many advances, challenges remain such as the expensive initial set-up costs, workflow interruption, length of time to scan whole slides, large storage size for WSI, bandwidth restrictions, undefined legal implications, professional reluctance, and lack of standardization in the imaging process.
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Affiliation(s)
- Walid E Khalbuss
- Division of Pathology Informatics, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA
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17
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Smith MA, Roy S, Nestler R, Augustine B, Miller D, Parwani A, Nichols L. University of Pittsburgh Medical Center Remains Tracker: A novel application for tracking decedents and improving the autopsy workflow. J Pathol Inform 2011; 2:30. [PMID: 21773061 PMCID: PMC3132995 DOI: 10.4103/2153-3539.82055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 02/03/2011] [Indexed: 11/04/2022] Open
Abstract
All hospitals deal with patient deaths. Multiple departments and personnel must be coordinated to ensure that decedents are safely managed. Prior to 2004, at the University of Pittsburgh Medical Center (UPMC), when a patient passed away, the process of alerting involved personnel, transporting the decedent, and tracking the completion of clinical documents was cumbersome and inefficient. In order to address these concerns, UPMC Remains Tracker, a web-based application, was developed to improve the efficiency and simplify the logistics related to the management of patient deaths. The UPMC Information Services division developed UPMC Remains Tracker, an application that tracks decedents' locations, documentation status, and autopsy status within UPMC hospitals. We assessed qualitative improvement in decedent remains tracking, decedent paperwork management, and staff satisfaction and compliance. UPMC Remains Tracker improved the process of tracking decedents' locations, identifying involved personnel, monitoring autopsy requests, and determining the availability for funeral home transportation. Resident satisfaction with UPMC Remains Tracker was generally positive and scored as "Improved efficiency" and makes identifying and tracking decedents "Much easier". Additionally, the nursing staff reacted favorably to the application. A retrospective review of the use of the application in the management of 100 decedents demonstrated a 93% compliance rate. Among the cases requiring an autopsy, there was a 90% compliance rate. The process of tracking decedents, their paperwork, involved staff, and decedent autopsy status is often inefficient. This assessment suggests that incorporating new technologies such as UPMC Remains Tracker into the management of hospital deaths provides accurate tracking of remains, streamlines the administrative tasks associated with deaths, and increases nursing and resident satisfaction and compliance.
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Affiliation(s)
- Matthew A Smith
- Department of Pathology, University of Pittsburgh Medical Center, A711 Scaife Hall 3550 Terrace Street, Pittsburgh, PA 15261, USA
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18
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Shidham VB. Thank you CytoJournal reviewers and authors - 2008 through 2010. Cytojournal 2010. [PMCID: PMC3029998 DOI: 10.4103/1742-6413.75668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Affiliation(s)
- Vinod B Shidham
- Address: Executive Editor and Co-Editor-in-Chief, CytoJournal, Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Institute, and Detroit Medical Center, Detroit, MI, USA,*Corresponding author
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Kim JY, Gudewicz TM, Dighe AS, Gilbertson JR. The pathology informatics curriculum wiki: Harnessing the power of user-generated content. J Pathol Inform 2010; 1:10. [PMID: 20805963 PMCID: PMC2929539 DOI: 10.4103/2153-3539.65428] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Accepted: 04/30/2010] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The need for informatics training as part of pathology training has never been so critical, but pathology informatics is a wide and complex field and very few programs currently have the resources to provide comprehensive educational pathology informatics experiences to their residents. In this article, we present the "pathology informatics curriculum wiki", an open, on-line wiki that indexes the pathology informatics content in a larger public wiki, Wikipedia, (and other online content) and organizes it into educational modules based on the 2003 standard curriculum approved by the Association for Pathology Informatics (API). METHODS AND RESULTS In addition to implementing the curriculum wiki at http://pathinformatics.wikispaces.com, we have evaluated pathology informatics content in Wikipedia. Of the 199 non-duplicate terms in the API curriculum, 90% have at least one associated Wikipedia article. Furthermore, evaluation of articles on a five-point Likert scale showed high scores for comprehensiveness (4.05), quality (4.08), currency (4.18), and utility for the beginner (3.85) and advanced (3.93) learners. These results are compelling and support the thesis that Wikipedia articles can be used as the foundation for a basic curriculum in pathology informatics. CONCLUSIONS The pathology informatics community now has the infrastructure needed to collaboratively and openly create, maintain and distribute the pathology informatics content worldwide (Wikipedia) and also the environment (the curriculum wiki) to draw upon its own resources to index and organize this content as a sustainable basic pathology informatics educational resource. The remaining challenges are numerous, but largest by far will be to convince the pathologists to take the time and effort required to build pathology informatics content in Wikipedia and to index and organize this content for education in the curriculum wiki.
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Affiliation(s)
- Ji Yeon Kim
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thomas M. Gudewicz
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anand S. Dighe
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - John R. Gilbertson
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Elsheikh TM, Kirkpatrick JL, Fischer D, Herbert KD, Renshaw AA. Does the time of day or weekday affect screening accuracy? A pilot correlation study with cytotechnologist workload and abnormal rate detection using the ThinPrep Imaging System. Cancer Cytopathol 2010; 118:41-6. [PMID: 20099317 DOI: 10.1002/cncy.20060] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Workload is extensively regulated in gynecologic cytology. However, sensitive monitors of excessive workload are not available. METHODS We measured the variation in abnormal (atypical squamous cells [ASC], low-grade squamous intraepithelial lesion [LSIL], and high-grade squamous intraepithelial lesion [HSIL]) rates for 4 cytotechnologists (CTs) among different days of the week and at different times during the day while they were performing primary screening with the ThinPrep Imaging System. RESULTS Three of 4 CTs detected significantly less abnormal cases on 1 day of the week than another (1 Monday, 2 Friday). Two of those CTs detected significantly fewer total abnormal cases in the afternoon than in the morning; this was strongly correlated with increased speed in the afternoon and decreased detection of ASC cases. HPV + rates for ASC cases dropped as the abnormal rate dropped. The third CT detected significantly fewer ASC cases in the morning; this was counterbalanced by an increase detection of LSIL cases, suggesting a shift in diagnostic threshold between the AM and PM. The difference in abnormal detection rates between morning and afternoon correlated with a false-negative fraction of 0.96. CONCLUSIONS There are significant differences in detection rates of abnormal cases between days of the week and the morning and afternoon. Correlating abnormal rates and workload between the morning and afternoon may represent a sensitive way to detect excessive workload. Because individual CTs may have different responses to workload and no overall pattern emerged, data on their workload and performance need to be tracked individually.
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Affiliation(s)
- Tarik M Elsheikh
- Department of Pathology, Ball Memorial Hospital, Muncie, Indiana 47303-3499, USA.
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