Digital Pathology:The Role of APLIS Integration inSupporting the Pathologists’ Workflow

Curtis Stratman

Partha Boocha

Andrew Kotov

Vanja Kvarnstrom

Omnyx, LLC, Pittsburgh, PA

DISCLOSURES

Employee of Omnyx, LLC

2

BACKGROUND:This Question is Often Asked

3

How do APLIS and digital pathology systems work together to enable an efficient all digital workflow for high-volume routine use?

Interfaces exist today, but one has yet achieved this goal.

BACKGROUND:Values Cannot Be Achieved Without Solution

Save pathologist time:• eliminate sorting of and searching for slides• immediate access to prior cases

Optimize utilization of pathologists:• distribute workload across locations• route cases to knowledge experts

Provide additional tools:• precision measurement• document interpretation with tissue region

And more…

4

DESIGN:Workflow Informs Interface Requirements

5

Methodology to define integration needs:

1. Model the current state workflow- Identify when data is created

2. Design the future state workflow- Identify when data is used

3. Define the data interface specification- Provide the right information at the right time for the user- Balance technical trade-offs

RESULT:Leverage Tools from Service Modeling

6

ACTIVITY Accessioning Grossing Histology Case Review Diagnosis Entry Sign-OutPERSONTRIGGER

INPUTS

OUTPUTS

RESULT:Triggers Drive Workflow Actions

7

ACTIVITY Accessioning Grossing Histology Case Review Diagnosis Entry Sign-OutPERSON Accessoner Grossing PA Histologist Pathologist Pathologist PathologistTRIGGER Specimen Delivery Specimen Delivery Cassette Delivery Slide Delivery Case Diagnosed Report Entered

or Timepoint # Cases Diagnosed Time of DayTime of Day Time Duration

INPUTS Requisition Protocols Cassettes Slides Diagnosis ReportSpecimens Study Orders Clinician Request

Patient HistoryOUTPUTS Patient Record Gross Report Slides Study Orders Report Signature

Case Record Study Orders DiagnosisCassettes

RESULT:Pathologists’ Workflow is Slide-driven

8

ACTIVITY Accessioning Grossing Histology Case Review Diagnosis Entry Sign-OutPERSON Accessoner Grossing PA Histologist Pathologist Pathologist PathologistTRIGGER Specimen Delivery Specimen Delivery Cassette Delivery Slide Delivery Case Diagnosed Report Entered

or Timepoint # Cases Diagnosed Time of DayTime of Day Time Duration

INPUTS Requisition Protocols Cassettes Slides Diagnosis ReportSpecimens Study Orders Clinician Request

Patient HistoryOUTPUTS Patient Record Gross Report Slides Study Orders Report Signature

Case Record Study Orders DiagnosisCassettes

United Kingdom France

United States

RESULT:Pathologists’ Workflow is Slide-driven

RESULT:Images Alone Do Not Fill the Hole

10

PathologistWorkflow

Images

What tells pathologists a case is ready for review?How do pathologists manage their workload?

Slides

RESULT:Digital Workflow Requires Tight Integration

11

Accessioning

APLISSlide

ScannerDigital

Workflow

Grossing

Histology

Scanning

Case Review

Diagnosis Entry

Report Sign Out

·Slide Image URL

·Parameters

·Slide Images

·Image ROI URL·Snapshot

Images

For each Prior case:·Slide Images·Clinical History·Interoperative Diag·Gross Notes·Gross Images·Doc Images·Reports

·Patient·Vist·Case·Part·Clinical History

(Documents, Requisition)

·Blocks·Slides·Gross Images·Gross Notes·Interoperative

Diag

Data used internally:Case List

·Case ID·Patient ID·Case Assignment·Part List·Slide List·Case, Part, Block,

Slide Status·Other study result

Case Details·Slide Images·Clinical History·Interoperative Diag·Gross Notes·Gross Images·Doc Images·Reports·Prior Case List

Digital Pathology Workflow States

Key Insights:

• Imaging workflow inserts activity of Scanning between Histology and Case Review

• Case review is triggered by imaging activity of scanning

• Case Review is where data from APLIS and imaging system come together for use

• Data from many points in workflow is leveraged by pathologist at time of Case Review

CONCLUSION:Neither System Can Deliver Alone

APLIS has data:

- Patient and case records- Case details and documentation- Tissue and processing details- Slide identification and tracking

12

Digital imaging system has data:

- Slides images- Additional slide tracking details- Image archival management- Documentation of image analysis

Workflow needs data from both to do:

-Assemble and present digital cases-Alert to pathologist of ready work-Organize and manage workload

CONCLUSION:Summary and Next Steps

Existing APLIS digital pathology interfaces focus on minimizing data transfer to:- Attach images into the current slide-driven APLIS workflow- Provide metadata to display around an image viewer

However, a slide-driven workflow will not function when images replace slides and images alone do not provide a workflow

Therefore, a new image-driven workflow module is needed to deliver an efficient value-add all digital workflow

And as neither an APLIS nor a digital pathology system can deliver this module without the supporting data from the other

We conclude that even though the interface specification to provide workflow integration across systems is more technical effort, doing so is necessary to enable the adoption of digital pathology for routine use.

13