Informatics, digital & computational pathology

Other applications

Surgical pathology


Editorial Board Member: Lewis A. Hassell, M.D.
Editor-in-Chief: Debra L. Zynger, M.D.
Syeda F. Absar, M.D., M.P.H.
Jeffrey W. Prichard, D.O.

Last author update: 10 August 2022
Last staff update: 10 August 2022

Copyright: 2020-2023, PathologyOutlines.com, Inc.

PubMed Search: Informatics surgical pathology

Syeda F. Absar, M.D., M.P.H.
Jeffrey W. Prichard, D.O.
Page views in 2022: 207
Page views in 2023 to date: 20
Cite this page: Absar SF, Prichard JW. Surgical pathology. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/informaticssurgicalpathology.html. Accessed February 3rd, 2023.
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
  • 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

    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

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

      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)

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 specimen types and the associated RVU

    CPT codes for various specimens and associated RVU

    Chart showing diversity of the caseload in a pathology practice

    Diversity of caseload in a pathology practice

    CPT codes for discretionary testing and the associated RVU

    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

    Similar stain ordering patterns

    Different 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
  • 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 of informatics in surgical / anatomic pathology Incorporating informatics into surgical / anatomical pathology

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)

  1. Analytic informatics tool
  2. Preanalytic and analytic informatics tool
  3. Preanalytic informatics tool
  4. Postanalytic informatics tool
Board review style answer #1
D. Postanalytic informatics tool

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Reference: Surgical pathology
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