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Automating Anatomic Pathology J. Mark Tuthill, MD Division of Pathology Informatics, Henry Ford Hospital Detroit, MI 48202 ASCP 2014, Tampa, FL Disclosures • No financial or relationship conflicts of interest to disclose • Customer relationships with Sunquest Information Systems, Dako, Ventana, Milestone, and General Data Objectives • Describe how automation and the future of the Anatomic Pathology LIS (AP-LIS) are inextricably related • List the areas of anatomic pathology that are capable of being automating • Enumerate some of the pre-requisites for anatomic pathology automation and LIS interfaces • Present examples of evolving automation and associated AP-LIS Requirements 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 What Can We Envision Automating? The Big Picture • Electronic order to AP-LIS • Biopsy/Label (sample procurement) Imagine • Transport including tracking and routing automating and • Accession • Tissue Gross Exam integrating these • Processing, including fixation • Embedding process using • Cutting/ Slide Labeling • Routine Staining/Cover slipping computerization • Case Collation and advanced • Delivery • Microscopic Exam robotics! • Special Stains/Re-cut Orders/materials retrieval • Diagnosis • Dictation • Transcription The Future of the • Report Sign out • Materials filing and storage AP-LIS Interfacing Anatomic Pathology Prerequisites 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 • The extent of manual processes – 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 Anatomic Pathology orders • Bar code labeled assets with the laboratory – Assets with unique identifiers • Development of robotic technologies 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 accessing – Decrease errors – Increased throughput
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