Digital Pathology: The Role of APLIS Integration in Supporting 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

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.

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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

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

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RESULT: Leverage Tools from Service Modeling ACTIVITY PERSON TRIGGER Accessioning INPUTS OUTPUTS Grossing Histology Case Review Diagnosis Entry Sign-Out 6

RESULT: Triggers Drive Workflow Actions ACTIVITY Accessioning PERSON

Accessoner TRIGGER Specimen Delivery

Grossing

Grossing PA Specimen Delivery

Histology

Histologist Cassette Delivery or Timepoint

INPUTS

Requisition Protocols Specimens Cassettes Study Orders OUTPUTS Patient Record Case Record Gross Report Study Orders Cassettes Slides

Case Review

Pathologist Slide Delivery Slides Clinician Request Patient History Study Orders Diagnosis

Diagnosis Entry

Pathologist Case Diagnosed # Cases Diagnosed Time of Day Diagnosis

Sign-Out

Pathologist Report Entered Time of Day Time Duration Report Report Signature

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RESULT: Pathologists’ Workflow is Slide-driven ACTIVITY Accessioning PERSON

Accessoner TRIGGER Specimen Delivery

Grossing

Grossing PA Specimen Delivery

Histology

Histologist Cassette Delivery or Timepoint

INPUTS

Requisition Protocols Specimens Cassettes Study Orders OUTPUTS Patient Record Case Record Gross Report Study Orders Cassettes Slides

Case Review

Pathologist Slide Delivery Slides Clinician Request Patient History Study Orders Diagnosis

Diagnosis Entry

Pathologist Case Diagnosed # Cases Diagnosed Time of Day Diagnosis

Sign-Out

Pathologist Report Entered Time of Day Time Duration Report Report Signature

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RESULT: Pathologists’ Workflow is Slide-driven United States United Kingdom France

RESULT: Images Alone Do Not Fill the Hole

Pathologist Workflow Slides Images What tells pathologists a case is

ready

for review?

How do pathologists manage their

workload

?

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RESULT: Digital Workflow Requires Tight Integration

Digital Pathology Workflow States Accessioning Grossing Histology Scanning Case Review Diagnosis Entry APLIS · Patient · Vist · Case · Part · Clinical History (Documents, Requisition) · Blocks · Slides · Gross Images · Gross Notes · Interoperative Diag Digital Workflow · Slide Image URL

For each Prior case:

· Slide Images · Clinical History · Interoperative Diag · Gross Notes · Gross Images · Doc Images · Reports · Image ROI URL · Snapshot Images · Parameters · Slide Images

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 Slide Scanner 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 Report Sign Out

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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

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 12

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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