Informatics, digital & computational pathology

Laboratory information systems


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PubMed Search: Anatomic pathology / laboratory information system [title]

Michael Mihalik
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Cite this page: Mihalik M. AP LIS. website. Accessed February 8th, 2023.
Where are my slides?
How could we have mixed up the slides for two different patients?
Why are my slides difficult to read?
We lost a slide!!!

These are the types of issues an Anatomic Pathology Laboratory Information System (APLIS) should help your laboratory to address. As its core objective, an APLIS should help the laboratory to record, track, and distribute the results of the efforts of a myriad of individuals working together to produce an accurate and detailed diagnosis from the samples provided to the laboratory.

The pathologist's position in this collective effort lies at the end of the chain, and there are quite a few things that can go wrong before the pathologist views the initial case slide.

Consider a breast case where multiple samples can each yield multiple blocks, which in turn can each yield multiple slides. A patient sample that started out as two or three sample containers can result in thirty or forty related material samples. Now, multiply this by tens or hundreds of cases a day. Take into consideration that this material is handled by several different people and instruments, and it becomes quite easy to see why the typical Anatomic Pathology Laboratory is at a higher risk of error than other areas.

An APLIS should address these concerns by allowing all pertinent information to be entered into a system whereby this information is easily retrievable by the pathologist or anyone else connected to the workflow process.

What does this mean?

Consider the information needs of each person who has anything to do with a patient sample, be it the order entry clerk, the PA, the histotechnologist, the secretary, or the pathologist. What information do they need quickly and accurately in order to do their job? For instance:

  • What special instructions did the requesting clinician provide?
    • Call the results?
    • Process the sample stat?
    • Special instructions?
  • When the sample was grossed, were there particular observations to be noted? Are these recorded and easily viewable to the pathologist?
  • At embedding, are there any special embedding instructions?
  • As the histotechnologist prepares the various slides, can they view the pathologist's instructions?
    • Are the instructions easily viewable?
    • Can the tech enter comments that will be easily viewable by the pathologist or anyone else?
  • As slides are distributed, is it easy to determine that all slides are at hand?
  • When the pathologist receives a tray of slides:
    • Is it easy to determine that all slides for a case have been received?
    • Is patient history easily and accurately viewable?
    • Can additional stains be ordered easily?

This is just a sample of the types of issues an APLIS should address. Consider your workflow and consider the information requirements and each step of the process. Then, work backwards and ensure that each piece of information is available to everyone who needs that information.

Software functionality is certainly a large part of the equation when one considers an APLIS. However, it is far from the only consideration. Perhaps the most salient point is that you will get out of an APLIS exactly what you put into it. If you believe an APLIS is simply a necessary evil, then that's what you will get out of it. If you look at your APLIS as a tool that will pay dividends over the long run, then if you work with the software and if you work with the vendor you will be the recipient of higher quality and more accurate workflow day in and day out.

The following sections discuss how to choose an APLIS and how to implement and manage an APLIS.
Choosing an anatomic pathology / laboratory information system - general
  • Based on our experience in the computer field for over 30 years and without any influence from advertisers, we recommend that you consider the following general factors in choosing any computer system:
    • Speak to several vendors. You probably can't meet with all of them but as you talk to several. You will educate yourself and become aware of the differences and similarities between them.
    • Talk to users that are similar to your pathology group, unless you anticipate a dramatic change in your practice. Talking to users makes sense, because it is difficult to get a feel for how a system will work for you until you actually use it. However, other users can tell you about the system features that they like or that make them angry.
    • Think about system maintenance. Determine in advance the procedures to follow if there is a problem with your system and test whether they work. If you do billing at night, verify that support personnel are available then and how easy it is to contact them.
    • Try not to buy features you won't use. We have made this mistake ourselves many times. All of us want to be on the cutting edge but most of us lack the time and energy to change our practices to incorporate the latest technology. So try to be realistic about what features you are likely to use in the next 1 - 2 years and don't waste money on those features you won't use.
    • We also recommend you think about the various issues identified in our surveys, to the extent they relate to your practice.
How to choose an anatomic pathology / cytology / molecular laboratory information system - detailed
  • Resources available
    • You have a lot of choices and material to help you choose an AP / LIS:
      • CAP Today produces an annual listing of AP / LIS vendors
      • The Association for Pathology Informations has an LIS Functionality Assessment Toolkit with a section for anatomic pathology
  • How to start
    • Before plunging into the details of an RFP or compiling a list of specific questions, consider your overall objectives - what specifically do you want to get out of your AP / LIS
      • AP / LIS is a major expenditure of time, money and effort
      • It is a decision that you will likely live with for > 10 years
      • It is a decision that you will interact with on each and every case, multiple times an hour, a day, a month, a year
      • Making a bad decision may drive you crazy on a daily basis or bankrupt your organization
    • Recommended to start at a global level and determine the important details for your use:
      • Reporting system
      • Tracking system
      • Dashboard system
      • Metrics system
      • Interface engine
    • After determining these global details, use the API toolkit to define what these concepts mean to your organization
      • Consider not only current problematic workflow areas but workflow aspects that work well, which you do not want damaged by the AP / LIS
      • Review the literature, paying attention to workflow aspects relevant to your own organization
      • Disregard issues not important to you, even if important to other organizations
        • Example: interface engines are overkill if you are only sending results to 2 outside providers
  • Evaluation of vendors
    • Consider not only IF a vendor provides a sought after functionality, but HOW the vendor provides it
      • Products that take 20 steps versus 10 steps to accession the same case may lead to lost productivity, considering the thousands of cases handled each year
    • Consider not only software functionality but your future relationship with the vendor of this software, which will be important regarding:
      • How do you get the software fixed
      • How do you get the software updated
      • How do you get the software adapted to your environment
        • Software changes may not be important if AP / LIS role is only to meet regulatory compliance
        • Software changes are important if AP / LIS intended to be critical component of daily operations, to give you an advantage over competitors
Implementation and management of an AP / LIS
  • Implementation and management of an AP / LIS is vitally important to your organization; it is a task that never ends
  • AP / LIS touches the daily lives of every person in your organization; to implement and manage this system effectively, one must put mechanisms into place that will communicate and work with the entire organization
  • Every AP / LIS vendor has some version of a "cookbook" to guide the laboratory with implementation; many tasks will have to be completed and communication and understanding your laboratory's specific workflow is essential, which is why the most important aspect of implementing and managing an AP / LIS is selection of a system administrator
  • Selection of a system administrator
    • System administrators coordinate the efforts of each laboratory member and are the voice of the laboratory in communications with the vendor
      • Must be an excellent communicator and have the ability to understand and communicate minute details of your laboratory
      • Although many organizations are tempted to use an individual with IT experience, a laboratorian or secretary with excellent communication skills and laboratory workflow knowledge may be preferable, because it is generally easier to understand the logic of a computer system than to maneuver the vagaries of human interactions
    • It is critical to map out your current workflow for ALL scenarios and project this workflow onto the new AP / LIS - the last thing you want are surprises; even if there has to be a manual workaround, it is far better to go into the first day of a new AP / LIS with known issues than unknown surprises
  • Maintenance
    • Once your AP / LIS is up and running, you're not done - you are just beginning; your system administrator will be busy with:
      • Management or data reports
      • Instrument interfaces
      • EMR or laboratory interfaces
      • Regulatory changes
      • Workflow changes
      • Version upgrades
    • You have just purchased an AP / LIS and it manages your workflow well but how well; that%s where management or data reports come in
      • On a daily, weekly or monthly basis, there is a constant demand for the information that only the AP / LIS can provide
      • Without this information, the laboratory is operating blindly
    • As technology evolves, there is more and more reason to interface instrumentation and of course, EMRs and laboratories
      • AP / LIS can send demographics and orders to stainers, receive orders from EMRs and send results to EMRs
      • It can additionally send orders to sendout laboratories and receive results
      • AP / LIS software can be used to speed and enhance all of this interaction
        • Software comes with more than a financial price and that is the requirement to validate and test each of these functional modules
        • In larger organizations, whole departments are dedicated to interface validation
    • Perhaps not on a daily basis but more often than one would think, there are workflow and regulatory changes that require a reconfiguration and validation of the existing workflow; these changes can affect the workflow of one or many people and all of it needs to be envisioned, tested, and implemented
    • Depending on your organization's desire to obtain the vendor's latest offerings, the need to update the entire AP / LIS must be addressed
      • This effort can be quite significant depending on the number of changes in the AP / LIS
      • This is generally a multiple month process
    • Good AP / LIS can enhance the productivity and efficiency of any laboratory but poor implementation and management can wreck the best efforts of all parties
      • Pay attention to the initial and ongoing efforts required of this effort and your organization will reap the rewards for years to come; ust keep in mind, the effort never ends
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