Informatics, digital & computational pathology

Machine learning & deep learning

Cognition and human - computer interaction in pathology

Editorial Board Member: Jerome Cheng, M.D.
Keefer Wu
Patricia Tsang, M.D., M.B.A.

Last staff update: 11 August 2023 (update in progress)

Copyright: 2023,, Inc.

PubMed Search: Human - computer interaction in digital pathology

Keefer Wu
Patricia Tsang, M.D., M.B.A.
Page views in 2023 to date: 183
Cite this page: Wu K, Tsang P. Cognition and human - computer interaction in pathology. website. Accessed September 21st, 2023.
Definition / general
  • Human - computer interaction in the field of pathology refers to the study and application of technology and user interfaces that facilitate the interaction between pathologists and computer systems for improved diagnostic processes, data analysis and decision making in pathology
Essential features
  • User friendly interactive interfaces for pathology applications should provide intuitive controls, clear visual feedback and efficient navigation to maximize user satisfaction
  • Usability characteristics: effective, efficient, engaging, error tolerant, easy to learn
  • Digital pathology product that has high usability may be interoperable with the existing laboratory information systems (LIS); may require a minimal number of mouse clicks to operate and can improve pathologists' productivity
  • Adoption of a new technology platform should involve human - computer interface considerations and assessments, such as usability testing, heuristic evaluation and cognitive walkthrough
  • Interactive interface: the visual or tactile means through which a user interacts with a computer system or software application
  • Usability: the ease of use and overall user experience when interacting with a system or software
  • Interoperability: the ability of different software systems or devices to seamlessly exchange data or perform tasks in a collaborative manner, allowing integrated functions across various systems (e.g., LIS, electronic health records [EHR] and digital imaging systems)
  • Heuristic evaluation: a process performed by usability experts to identify problems with a user interface based on a set of rules of thumb (heuristics) that makes systems easy to use
  • Best practice advisory: a functionality that provides users with real time guidance, recommendations or alerts based on established best practices or clinical guidelines
  • Digital pathology: technology for capturing, managing and interpreting pathology information, such as tissue samples and microscope slides, in a digital format, allowing pathologists to view and analyze high resolution images on computer screens instead of traditional microscopes and offering advanced image analysis tools for enhanced diagnostic capabilities
  • Computer assisted diagnosis (CAD): the use of computer algorithms and tools to aid in the interpretation of images; systems analyze digital pathology images and provide automated assistance in identifying potential abnormalities, quantifying positive versus negative results and making diagnostic predictions
Human - computer interaction design and cognitive concepts
  • Interactive interface design of digital products (JAMIA Open 2022;5:ooac070, Hum Factors 2017;59:101)
    • Objective: a software interface that has high aesthetic quality and one which users find simple to use even for complex tasks
    • Minimize the number of mouse clicks and amount of scrolling needed to complete a function
      • Example: when evaluating an anatomic pathology laboratory information system (APLIS), count the number of clicks needed to electronically order an immunostain
    • Streamline typing for the user
      • Dropdown menu with built in options
      • Autofill or autotext in word processing can automatically complete words to increase typing speed and minimize spelling errors
    • Clean and minimalist graphics with appropriate use of color
      • Example: green toggle for the on switch and gray toggle for the off switch
    • Draw attention to key features by altering font sizes of text, bold type or weighting, italics and capitals
      • Example: if there are concurrent accessions or previous pathology cases, corresponding buttons automatically change to bold font or different color to alert the pathologist
    • Icons and symbols should be designed using common visual metaphors
  • Usability (J Am Med Inform Assoc 2018;25:1197)
    • Defined as the ease of use and overall user experience when interacting with a system or software; high usability can reduce errors, improve productivity and enhance user satisfaction
    • 5 characteristics: effective, efficient, engaging, error tolerant, easy to learn (JAMIA Open 2022;5:ooac070)
    • Examples of usability features that make an AP digital product intuitive, predictable and simple to use
      • Layout should take into account the pathologist's natural workflow, which may involve entering the immunostain results prior to the diagnosis, followed by entering any flags for pending ancillary tests or second opinion and verifying the billing codes as the final step
      • Use well recognized acronyms to replace complex medical terminologies to improve readability (e.g., fluorescent in situ hybridization [FISH])
      • Fast and responsive interface as user moves from field to field and screen to screen
  • Interaction modalities
    • Besides the traditional mouse and keyboard controls, computer systems may use a variety of interaction modalities, such as touchscreen and touchless technologies (voice command and gesture based controls)
  • Usability features of AP information system may include the following (Adv Anat Pathol 2012;19:81, Stud Health Technol Inform 2007;129:434)
    • Interoperability: integration of the AP system with the clinical pathology laboratory information system (CPLIS) and electronic health record can facilitate pathologist workflow and care coordination
    • Allows the pathologist to remain in an active window for the case while accessing one click links to previous pathology reports, surgical procedure reports, radiologic reports and clinical laboratory data
    • Periodic vendor driven updates of built in synoptic templates for reporting cancer (structured, standardized style of reporting cancer data elements to ensure completeness)
    • Barcode scanning of slides to ensure fast and error free patient identification
    • Customizable toolbar menu and dropdown menu options that are rank ordered logically (e.g., alphabetical order or going from normal to malignant)
  • Tools for enhancing usability of CPLIS (J Pathol Inform 2017;8:40)
    • Common word processing tools (such as drag and drop, cut and paste, tab to indent, etc.) can improve ease of use for pathologists reporting clinical pathology interpretations
    • Customizable templates and shorthand codes that can easily be edited or added to the database
    • Personalized flagging and retrieval of interesting patient results or cases warranting follow up
    • Convenient and secure provider to provider communication within the LIS
  • Human - computer interactive considerations for placing laboratory orders (J Am Med Inform Assoc 2018;25:1197)
    • Best practice alert or advisory: popup warning that a laboratory order does not meet guidelines (e.g., ordering a genetic test for an inherited disorder more than once a lifetime)
    • Hard stop (no permission to proceed with laboratory order once a built in rule is violated) versus soft stop (allowing the user to overcome an alert and proceed with the order)
Evaluation and implementation
  • Choosing technology systems with a user friendly human - computer interface can positively impact workflow efficiency and patient safety (J Biomed Inform 2018;77:62)
  • Human - computer interface is a critical factor that should be analyzed systematically before adopting a new LIS or digital pathology solution for computer assisted diagnosis
  • Steps and considerations that should be taken include the following (J Biomed Inform 2004;37:56, Hum Factors 2017;59:101, Stud Health Technol Inform 2014;205:910)
    • Investment in infrastructure, software, equipment and data storage
    • Training and education: should include hands on exposure to promote active learning
    • Interoperability with existing systems: should ideally be seamlessly integrated with the other existing LIS and electronic health record for efficient data management and sharing
    • Usability testing: involves observing users as they interact with the product to identify usability issues and gather feedback; can be done through task based scenarios where users are asked to perform specific actions using the system (Stud Health Technol Inform 2011;169:915)
    • Heuristic evaluation: usability experts assess the product against a set of established usability principles or rules of thumb (heuristics), identify usability issues and provide recommendations for improvements (J Med Syst 2014;38:35, BMC Med Inform Decis Mak 2022;22:157)
      • Assessment may include user control and freedom, consistency and standards, recognition rather than recall and helping users recognize and recover from errors
    • Cognitive walkthrough: experts evaluate the product from the perspective of the users' thought processes; evaluators simulate user interactions and systematically analyze the system's interface to identify any potential difficulties or causes for confusion (BMC Med Inform Decis Mak 2022;22:157)
      • Use cognitive psychology principles with a focus on ease of learning the system
    • Task analysis: breaks down complex tasks into smaller steps or actions to identify potential bottlenecks, errors or inefficiencies in the workflow, allowing for targeted improvements to enhance usability
    • Data analytics: used for analyzing user interactions and usage patterns, which can provide insights into common user pathways, frequently used features and areas where users may encounter difficulties or errors; analyzing user data can help prioritize usability improvements based on real world usage patterns
  • Improved diagnostic accuracy: human - computer interaction tools can enhance pathologists' ability to analyze and interpret pathology images, leading to more accurate diagnoses
  • Enhanced efficiency: image analysis systems with computer assisted quantification can streamline workflow processes and speed up tedious tasks (e.g., automatic quantification of positive cells with pathologist verifying the area of interest), improving pathologists' productivity
  • Access to large datasets: digital pathology systems with efficient interactive interfaces for storage, retrieval and annotation of slides provide pathologists with access to vast repositories of digitized slides, enabling research and education on a large scale
  • Data driven insights: human - computer interactive tools have simplified the manipulation of complex data, allowing the pathologist to gain new insights in a more intuitive manner
  • Reference: J Pathol Inform 2010;1:3
  • User fatigue of best practice alerts in LIS: too many popup messages can lead to sensory overload and distraction, causing users to miss or ignore important messages (JAMIA Open 2022;5:ooac070)
  • Copying and pasting patient record within the EHR for improved usability could lead to inaccuracies in documentation and should follow best practice guidelines, which may include identifying the copied text with a different font color as an alert (Appl Clin Inform 2017;8:12)
  • Standardization and interoperability: ensuring compatibility and standardization across different digital pathology platforms and tools can be a challenge, hindering seamless integration and data exchange
  • Learning curve and training: pathologists may require additional training to adapt to new interactive interfaces and analysis tools, potentially affecting workflow efficiency during the initial adoption phase

Examples of digital pathology platforms and their respective select usability features (Mod Pathol 2022;35:23, Hepatology 2021;74:133, Sci Rep 2017;7:16878)
Digital pathology platform Functionalities Select usability features
PathAI AISight: a web based, digital pathology slide viewing platform that enables algorithm driven automated analysis of whole slide images
  • Cloud native software that is interoperable with major scanners
  • Interactive algorithm overlay and heatmap viewer with pen tool to exclude or include regions
Philips IntelliSite Pathology Solution: slide scanner / image management and analysis system
  • Clickless image panning manipulation for the pathologist
  • Offers scalable, tiered server / storage options
QuPath An open source digital pathology software that enables image analysis and annotation of digital slides using an object based model
  • Wide range of flexible annotation and visualization tools (e.g., cell segmentation, tissue classification and measurement of features of interest)
  • Command history can be used to create analysis workflows that can be edited and customized
Diagrams / tables

Images hosted on other servers:
NovoPath Anatomic Pathology

NovoPath Anatomic Pathology

VitalAxis VitalDx

VitalAxis VitalDx

CoPathPlus Application Manager

CoPathPlus Application Manager icons

Board review style question #1

Which of the following features of a health information system is considered to be the most desirable in human - computer interactive design?

  1. Anatomic pathology information system that is interoperable with the digital pathology software and patient electronic health record
  2. Best practice popup warning when a blood transfusion order is placed showing the total number of previous blood transfusions the patient had over their lifetime
  3. Clinical pathology laboratory information system that allows up to 5 patient records to be opened at one time to facilitate copying and pasting of pathologist interpretation
  4. Surgical pathology information system that standardizes the pathologist's workflow and allows 1 field to open at a time in a predetermined order, starting with the clinical information and ending with the sign out step
Board review style answer #1
A. Anatomic pathology information system that is interoperable with the digital pathology software and hospital information system. Interoperability can improve efficiency and facilitate seamless flow of information. Answer B is incorrect because excessive best practice alerts can lead to user fatigue. Answer D is incorrect because an inflexible pathology reporting workflow can lead to frustration for the user. Answer C is incorrect because copying and pasting clinical pathology interpretative comments in a batch of 5 open records can easily lead to error.

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Reference: Cognition and human - computer interaction in pathology
Board review style question #2
Which of the following is a characteristic of high usability in a digital pathology product?

  1. Economically priced
  2. Intuitive icons
  3. Reimbursable by insurance
  4. Wide adoption in the market
Board review style answer #2
B. Intuitive icons make the product easy to learn and simple to use. Answers A and C are incorrect because usability is not related to pricing or insurance coverage. Answer D is incorrect because commercial success does not define usability.

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Reference: Cognition and human - computer interaction in pathology
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