jesus ellin, h.t./paascp - an early adopters digital pathology experience in the anatomic pathology...

Going Where No One Has Gone Before – A Grass Roots Approach to Success

In the Digital World               

Jesus Ellin, HT, PA, Anatomic Pathology Supervisor, Yuma Regional Medical Center

Speaker has received a fee from Ventana Medical

Systems, Inc. for this presentation.

30% of workload scanned to include IHC stains in to Pathologist, 10:30 am at 40x

65 slides in 5.5 hours period

No additional FTE budgeted or required

Searchable electronic QA/QC Data within APLIS, to correlate with traditional workflow and improved outcomes

Positioning facility for Traditional and Digital pathology workflows/ Hybrid!!

Yuma Regional’s Accomplishments to Date

A Grass Roots Solution

Materials Management (Bar-coding/tracking)

QA/QC of the Process (sample and image combo)

Downstream effect with Imaging (Vendor Collaborations)

Storage and Image Approach (Business case for Success)

Leadership (A practice shift from being largely morphologically based to integrating prognostic information into decision making, collaboration with others providing diagnostic data—radiology, pharmacy, etc.)

WORKFLOW!- Inline vs batching and workflow integration within LIS

Workflow considerations to minimize “tidal effect” (traffic jams)

Batching drives throughput rate – especially in staining/drying

Batches of 10 slides each, allowed two scanners to image 60 to 80 slides at 40X ( 300 minutes of work) while only adding 20 minutes to the run (redo rate = 0, QA time = 0)

Case size drives throughput rate

Imaging QA time is a major impact throughput rate (scan time + QA time)

Imaging redo kills throughput rate especially at rates above 5% or with large cases

How to Go Digital Without Killing Throughput

Elimination of batching, case reconciliation, low QA time and minimum imaging failures are key

Changed size of batches between stations and redo rate.

Run the simulation for 0, 1, 2, scanners

Scanner images at 1-2 minutes per slide at 20x

Scanners imaged at 4-6 minute per slide at 40x

Image QA time 0 – 2 minutes (integrated in APLIS)

Image redo rate 0 – 5%

Staff Identifications (Ownership)

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Quality Issues are Amplified in Digital

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Quality Issues are Amplified in Digital

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Quality Issues are Amplified in Digital

Quality Metrics and Continuous Improvement

Identifying variance real time

Improvement to process

Quality Metrics and Continuous Improvement

Real time assessment

Quality Metrics and Continuous Improvement

Quality Metrics and Continuous Improvement

Quality Metrics and Continuous Improvement

Quality Metrics and Continuous Improvement

Correlation with Traditional QA/QC

Quality Metrics and Continuous Improvement

Integrated Imaging WorkflowWith the Help of the LIS

Integrated Imaging WorkflowWith the Help of the LIS

Integrated Imaging WorkflowWith the Help of the LIS

Integrated Imaging WorkflowWith the Help of the LIS

Integrated Imaging WorkflowWith the Help of the LIS

Integrated Imaging WorkflowWith the Help of the LIS

Integration of Voice Recognition with applications (Natural Language Processing)

Interface logic to increase efficiency with Digital workflow (SOA)

Digital Education among technologist and support staff to understand the key point of new technology

Establishing new services Digital Pathology can bring to clients (Pathologist Cockpit, Collaborations, E-consultants)

Future Results

It’s Knocking!!There has never been a greater need for Pathology expertise and resources.

Much Bigger Opportunity Lies Ahead!

Informatics

Therapeutics

Molecular Testing

Genomics

Impact Medical Outcomes

…through integration of information

Broaden our sphere of influence

Expand beyond the tissue on the slide—all diagnostic tools are available to you

Market our services for consults

Expand value by influencing prognosis and treatment

Interact with Patients and Clinicians

…as member of the disease management team

Acknowledgements

Yuma Regional Medical Center (Dr. Victor Alvarez, Dr. Stanley Sprei, Dr. Andrew Kim, Robin Davis and Staff)

Ethel Macrea; Ventana Medical Systems, Inc.

Sunquest Information Systems (Sunquest PowerPath®)

Ventana Medical Systems, Inc.: Jace Doshier

YRMC Histology Department (Liz, Dawn, Maria, Kristy)

Dr Keith Kaplan: Carolinas Pathology Group

University of Nebraska Medical Center (David Muirhead)

Elizabeth Chilpala: Premier Laboratories

Digital Pathology Association

Amanda Lowe: Digital Pathology Consultants

THANK YOU!