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
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BACKGROUND:This Question is Often Asked
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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…
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DESIGN:Workflow Informs Interface Requirements
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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
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ACTIVITY Accessioning Grossing Histology Case Review Diagnosis Entry Sign-OutPERSONTRIGGER
INPUTS
OUTPUTS
RESULT:Triggers Drive Workflow Actions
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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
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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
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PathologistWorkflow
Images
What tells pathologists a case is ready for review?How do pathologists manage their workload?
Slides
RESULT:Digital Workflow Requires Tight Integration
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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
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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.
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