Informatics, digital & computational pathology
Laboratory information systems
Surgical pathology
Editorial Board Member: Lewis A. Hassell, M.D.
Editor-in-Chief: Debra L. Zynger, M.D.
Last author update: 10 August 2022
Last staff update: 10 August 2022
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PubMed Search: Informatics surgical pathology
Table of Contents
Definition / general | Essential features | Terminology | Applications | Diagrams / tables | Board review style question #1 | Board review style answer #1Cite this page: Absar SF, Prichard JW. Surgical pathology. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/informaticssurgicalpathology.html. Accessed April 19th, 2024.
Definition / general
- This topic discusses data analysis, billing and other subjects related to surgical pathology not described elsewhere in the informatics chapter
- See also: Barcoding and tracking
Essential features
- Specific applications of informatics in surgical pathology include
- Barcode and radio frequency identification (RFID) scanning data applications for specimen tracking and quality management
- Digital imaging and virtual microscopy
- Telepathology and remote consultation
- Laboratory information systems (LISs) and interface with electronic health record (EHR)
- Applications in quality and error reduction
- Applications for billing data
Terminology
- Radio frequency identification (RFID)
- Digital workflow
- Whole slide imaging (WSI)
- Anatomical pathology laboratory information system (APLIS)
- Quality assurance (QA)
Applications
Collection and analysis of data for quality management applications
Applications of laboratory information systems (LISs) in surgical pathology (Arch Pathol Lab Med 2015;139:319)
Applications for billing data in surgical pathology
Value of structured AP data (Pathol Lab Med Int 2015;7:11)
- Crowdsource the collection of quality issues occurring throughout the testing process across all sites and all staff by linking a structured data set of potential problems to the LIS
- By automating the collection of the patient and case context in the LIS when inputting a quality issue, issue entry is simplified and encouraged; linking this context to a quality issue enabled queries into data contained in the LIS for root cause analysis and quality improvement
- Structuring the issue input enables counting and trending issues over time; computers can be made to identify significant changes in issue trends for better or worse and alert staff to the change
- Associating quality issues with cost, delay and risk can give insight into significance of an issue beyond simple frequency
Quality assurance tracker
- Informatics tools for ensuring quality and error reduction in anatomic pathology (Clin Lab Med 2008;28:207)
- Preanalytical (e.g., surgical pathology specimen tracking)
- Ensure where a specimen is within the workflow at a specific point in time, learn how long the specimen spends in a given process and identify bottlenecks within the workflow
- Analytical (e.g., applying statistical quality control to immunohistochemistry through digital imaging)
- Quantitation of test kit controls using image analysis
- Application of common laboratory control methods to the results
- Establishing quantifiable acceptable limits for control results to monitor variability between runs and detect process errors
- Postanalytical (e.g., results reporting)
- Ensure that all results from LIS reach their respective repositories
- Detect, correct and resend any filing errors within 24 hours
- Reduce the number of filing errors to within a 6 sigma standard
- Preanalytical (e.g., surgical pathology specimen tracking)
Applications of laboratory information systems (LISs) in surgical pathology (Arch Pathol Lab Med 2015;139:319)
- Designed to meet workflow requirements in the laboratory and interface with electronic health record (EHR) and billing systems
- Anatomic pathology LIS handles workflows related to surgical specimens
- Patient identification
- Unique patient identifiers allow LIS to transmit patient data across multiple institutions, personal health records or state and federal registries for mandatory reporting
- Splitting samples
- Tracking requirements for dividing specimens between anatomic pathology (AP) and clinical pathology (CP)
- Ordering procedures for anatomical pathology (AP) orders entered in operating rooms (e.g., resections), surgery centers (e.g., endoscopies) and outpatient clinics
- Appropriate clinical information accompanies the specimen electronically to facilitate pathologist sign out
- Frozen section workflow in operating room
- Electronic order is created in the EHR and processed by the LIS either before or after specimen delivery, with or without an already existing specimen
- Specimen type in order interface
- Determined by the specimen type assigned for each part received
- Results in the number of cassettes printed and fee codes submitted
Complex items that may be required in AP orders
- AP results in the EHR
- Accessible and interpretable by clinicians
- Can be sent to the physician's office for an outreach specimen
- Either unstructured free text (with or without formatting and images) or in PDF format
- Display supported by EHR
- Linked with a test order
- Can be amended (i.e., new report clearly replaces the existing report and not displayed as a second report)
- Patient identification
Applications for billing data in surgical pathology
- Each surgical pathology specimen has a discrete Common Procedural Terminology (CPT) billing code indicating the complexity of the evaluation of that specimen
- These are 5 digit CPT codes the begin with 883??, ranging from a gross examination only code of 88300 to a comprehensive consultation core of 88325
- Each of these billing codes is associated with a relative value unit (RVU) to correspond the complexity of the CPT code
- Charting the complexity of the specimen billing codes can bring insight into the diversity of the caseload in a pathology practice
- A different set of CPT codes can be used to reflect on the discretionary test ordering patterns for stains
CPT codes for various specimens and associated RVU
Diversity of caseload in a pathology practice
CPT codes for discretionary testing and associated RVU
- When combining the specimen CPT codes with the discretionary staining CPT codes, a chart can show how stain ordering practices can be similar or vary greatly between pathologists
- This type of analysis can be used to identify whether or not a standard of care or a care gap exists in a peer group
Similar stain ordering patterns
Different stain ordering patterns
Value of structured AP data (Pathol Lab Med Int 2015;7:11)
- Synoptic reporting in surgical pathology is a process for reporting specific data elements in a specific format based on cancer protocols
- Ensures:
- Completeness, timeliness, accuracy and clarity
- Follow guidelines published by pathology associations
- For pathologists
- Ease of creating report using format required by the College of American Pathologists (CAP) Laboratory Accreditation Program (LAP) checklist
- Inter and intrainstitutional collaborative clinicopathologic efforts
- For clinicians
- Accurate extraction of relevant information
- Permits rapid use of prognostic systems for patient therapy
- Scalability of data capture, interoperability and exchange
- For researchers and cancer registrars
- Raw data available within hours after report is released
- Allows digital extraction and categorization
- Use of natural language search modalities
- For researchers and cancer registrars
- Completeness, timeliness, accuracy and clarity
- Advantages of web based synoptic user interface:
- Ordering ancillary studies
- Utilizing diagnostic algorithms
- Quality assurance
- Creating pathology reports through automation with web based reporting systems with ability to populate data from ancillary studies, such as genomic data
Diagrams / tables
Images hosted on other servers:
Applications / incorporation of informatics into surgical / anatomical pathology
Board review style question #1
Ensuring that anatomic pathology results are accessible in the electronic health record is a(n)
- Analytic informatics tool
- Preanalytic and analytic informatics tool
- Preanalytic informatics tool
- Postanalytic informatics tool
Board review style answer #1
