Transcript Context - Pathology Informatics

Bar Code Specified Surgical Pathology
Workflow
Joy J Mammen MD; Richard Zarbo MD; Adrian
Ormsby MD; J. Mark Tuthill MD
Henry Ford Health System
Detroit, Michigan
Tuthill et al, Henry Ford Health Systen
Context
Introduction
• Automation of histopathology laboratory process have
been difficult due to the variability:
– specimen types
– the expression of disease in a given patient
– laboratory procedures required to arrive at pathologic
diagnosis.
• A key challenge has been to automate specimen labeling
– Manual labeling is tedious, error prone, and inefficient.
Tuthill et al, Henry Ford Health Systen
Context
Focus
• Revolutionary changes in materials available for
use in the histopathology laboratory have allowed
us to address this problem, automating cassette
and slide label generation
• This decreases intra-lab identification errors and
improves efficiency by driving workflow using
bar code technology.
Tuthill et al, Henry Ford Health Systen
Biopsy/Label
Patient & Sample Identification
Transport
Accession
Tissue Gross Exam
Processing
Embedding
Cutting/ Slide Label
Staining/Cover
Case Collation
Delivery
Microscopic Exam
Stain/Recut Order
Dictation
SP processes at risk of
mis-identification error
Transciption
Report Signout
Tuthill et al, Henry Ford Health Systen
Technology
Cassette Creation
• Misys CopathPlus™ MHv 2.4 (Misys Healthcare, Raleigh,
NC) LIS
• Custom interface to laser cassette etchers that use Labelase
™ software, both from General Data (General Data,
Cincinnati, OH).
– 2 Dimensional barcodes etched on the cassettes
– Cassettes are read at the microtomy stations using Dell
Optiplex 745 PC (Dell, Roundrock, TX) and Symbol
™ barcode scanners (Motorola Inc., Holtsville, NY)
Tuthill et al, Henry Ford Health Systen
Technology
Label Generation
• Stain-resistant slide labels (Stainershield ™,
General Data) on Intermec C4 (Intermec Inc.,
Everett, WA) direct thermal printers
• A report was developed in CoPathPlus™ that
retrieves stain orders for each block.
Tuthill et al, Henry Ford Health Systen
Design
Prior to automation
• Tissue cassettes were printed with human-readable identification
details using the
– Leica cassette printers (Leica Microsystems, Bannockburn, IL)
– Required re-entering demographic and case data into dedicated
software
• After processing, sections were cut and mounted onto slides
manually labeled with the case accession number and part number
• Stains were performed based on electronic requests that were
available at the histology department through the LIS
• After staining, labels were batch printed from the LIS and affixed
onto the corresponding slides.
Tuthill et al, Henry Ford Health Systen
Design
Automation
• Two General Data laser cassette etchers interfaced to
CoPathPlus were placed at the accessioning stations.
– During accession, cassettes are etched with the case
number, patient name, part type abbreviation, and a 2D
barcode.
• Once the block arrives at the microtomy station equipped
with a PC, barcode scanner and label printer, the 2D
barcode is scanned printing all slide labels for that
particular block’s stain orders from the LIS.
Tuthill et al, Henry Ford Health Systen
Design
Automation
• Labels are printed on “Stainershield” label stock, applied
to the glass slide and tissue sections are cut and placed
– Blocks are positively identified and slides definitively
labeled prior to staining.
– Manual labeling is eliminated (reduced)
– Cross matching slides with labels is eliminated
• Slide labels include all relevant data as well as a bar code
(code 128C).
Tuthill et al, Henry Ford Health Systen
Accession Station U-shaped Cell
CoPath terminal
Barcode label printer
-Lab tag
-Specimen containers
Lab tag scanner, bar code reader
Cassette etcher- 2D barcode
Microtome Station U-shaped Cell
CoPath terminal
2D Barcode reader
-Individual cassettes
Slide label printer
-Chemical resistant slide labels
-Print 1 cassette not batch
Tuthill et al, Henry Ford Health Systen
Tuthill et al, Henry Ford Health Systen
Tuthill et al, Henry Ford Health Systen
Tuthill et al, Henry Ford Health Systen
Tuthill et al, Henry Ford Health Systen
Barcode Specified Surgical Pathology Workflow
1
2
Create
Lab Tag & Specimen Container
Barcodes
Accession
CoPath
Scantron
Lab Tag
Imager
Cassette Etcher 3
Create cassette barcode
Verify original Lab Tag &
created barcode ID
Gross Tissue
Cutting
CoPath Scan container
barcode to
open case 2
in CoPath
Verify created container barcode
with CoPath and cassette ID
Histology
Pathologist Signout
- Scan slide barcode to
4
open case in CoPath &
- View scanned lab tag in
ThumbsPlus 1
Verify patient name, SP # on
Lab tag, slide and in CoPath
Scan cassette
3
barcode
Microtome
Create chemical resistant 4
slide labels by cassette barcode
Verify on cassette & slide SP#
and pt. name with CoPath
Biopsy/Label
Patient & Sample Identification
Transport
Accession
Tissue Gross Exam
Processing
Embedding
Cutting/ Slide Label
Staining/Cover
Case Collation
Delivery
Microscopic Exam
Stain/Recut Order
Dictation
SP processes targeted by barcode to
reduce human labor and
mis-identification error
Transciption
Report Signout
Tuthill et al, Henry Ford Health Systen
Results
• Most specimens received in the lab are currently being
processed using this system with slide labels printed on
demand at the microtomy station.
• Paper labels are still utilized for slides that requiring
microwave processing since the StainerShiel labels
undergo degradation
• Time required for labeling prostate biopsies having 36
slides was reduced from 20 minutes to 30-45 seconds
Tuthill et al, Henry Ford Health Systen
Results
• The CoPath interfaces saves time and eliminates
data entry errors related to re-keying data
– This saves about two minutes per case.
• Thus this technology has:
– saved time and effort as well as
– eliminating labeling errors
Tuthill et al, Henry Ford Health Systen
Results Post Bar Coding
All Surg Path Case Mis-identifications
45
40
45
62% reduction all misidentifications
85% reduction
Block & slide mis-ID
35
30
25
Number Mis-ID
Defects
Percent of
Cases
1.67%
18
20
15
0.62%
10
5
0
Baseline Barcode
2694
cases
4 Pre-analytic derived
2877
Tuthill
et al, Henry Ford Health Systen
cases
Conclusions
• Integration of the barcode technology into the
histopathology labeling process has resulted in
process improvement, by saving time and
reducing errors.
Tuthill et al, Henry Ford Health Systen