Histology Asset Tracking Dashboard: Real-time monitoring and dynamic work lists

Pathology Informatics 2010

John H. Sinard, MD, PhD Neil Mutnick Peter Gershkovich, MD, MHA

Pathology Informatics Yale University School of Medicine

Tracking Software “Complexity” • Level I: Auditing •Post events for each asset (what, when, who) •Allows auditing and workflow analysis • Level II: Constrained Status Progression •Assures appropriate asset used at appropriate time •Promotes patient safety • Level III: Drive Workflow •Dynamic to-do lists •Identify assets which are falling behind real-time John H. Sinard, MD, PhD

Barcodes in Tracking Software • Barcodes are not magical • Simply allow easy and accurate entry • Makes it feasible to “enter” asset location at many time points • “Entry” can be accompanied by checks / constraints • Human readable ID vs an internal key?

• Usability outside of the system holding the key • Resistance to damage of the barcode • Backward compatibility with unlabeled assets • Conversion from one LIS to another • Length of identifier (and thus size of the barcode) John H. Sinard, MD, PhD

Prerequisites for Successful Tracking • Individually identify each asset • Blocks already done • Slides: block and stain not sufficient • Assure accurate asset labeling • Just-in-time labeling: generate label at same time as asset • One piece workflow – no batching • Validate labeling if asset and label generated asynchronously • Compatibility with workflow and resources • Clever people will find a way to circumvent constraints John H. Sinard, MD, PhD

Slide Number • Sequentially number slides as they are cut from the block •Can follow lesions through successive levels •When ordering a stain on an unstained slide, can specify the level to be used •Places additional constraints on tracking system • Have to assign slide number at the time of slide cutting, not ordering • Using an existing slide (eg unstained) requires modifying the information about that slide; can’t add a new stain with a comment of “use level 5” John H. Sinard, MD, PhD

Assuring Accuracy of Asset Labeling • Blocks: •Pre-make cassettes with unique block numbers •Enter blocks into LIS by scanning • Assures correct case number (patient safety) • Confirms uniqueness of block number • Slides: •Scan block at microtome: print labels for slides •Tentative slide numbers locked in by scanning the cut, labeled slide to confirm successful cutting • Just because a label prints doesn’t mean there is a slide John H. Sinard, MD, PhD

Ordering Blocks in LIS after Preprinting John H. Sinard, MD, PhD

S10-5010 01-01 Barcoded Block Wizard John H. Sinard, MD, PhD

Asset Status Progression • Control Workflow •Only allow assets to progress to a new status from an appropriate old status(es), and in the correct context •Need additional statuses to accommodate alternative workflow pathways • Drive Workflow •Use asset status to determine not where it has been but rather where it is going •Status of asset (and perhaps associated assets) should determine next process, independent of asset history John H. Sinard, MD, PhD

Block Status Progression Cassette Printed CheckedOut Block Ordered Received OnBatch CheckedIn Embeded Filed Missing Cancelled ReProcess ReEmbed John H. Sinard, MD, PhD

Ordered Block Status Progression Received ReProcess OnBatch ReEmbed Embeded CheckedIn Filed CheckedOut Processor batch not yet started Processor batch marked finished Processor batch started; not marked finished No slide for this block has a status of “Ordered” At least one slide for this block has a status of “Ordered” John H. Sinard, MD, PhD

John H. Sinard, MD, PhD

John H. Sinard, MD, PhD

Slide Status Progression Ordered Cut for H&E Collected For Unstained Slides Ordered On Unst.

Relabeled Stained Verified John H. Sinard, MD, PhD

Ordered Slide Status Progression Cut Ordered On Unst.

Relabeled Collected Stained Verified Block not yet embedded Block Filed or Checked out Block Embedded or Checked in John H. Sinard, MD, PhD

John H. Sinard, MD, PhD

Effect on Overtime in Histology John H. Sinard, MD, PhD

Block/Slide Tracking Errors John H. Sinard, MD, PhD

Block/Slide Tracking Errors John H. Sinard, MD, PhD

Take Home Messages • There are different degrees to which an asset tracking system can be implemented •Know what it is you want to achieve • Dashboards can be a useful tool for...

...monitoring and driving workflow ...generating real-time to-do lists John H. Sinard, MD, PhD