Application of informatics in the work of a pathologist: guidelines for learning how to create and use a digital archive of gross images

Pathology informatics has been developing as a response to a large amount of diagnostically relevant morphological information and attempt to the best store and use it. The main components of pathology informatics include digital images of histological slides and gross photographs, telepathology, and electronic data collection. Photo documentation of gross specimens is an integral part for efficient work of a pathologist. Currently, many grossing stations are equipped with continuously recording video cameras. A logical and detailed description of the macroscopic specimens, supported by properly obtained digital photographs, should be the standard of a modern pathology report. However, with the increasing workload of the pathologists, they have less and less time to take gross photographs. That is why, in our opinion, it is important to ask questions such as: what is necessary to photograph, how to take a photo of the gross specimen, and in which order? There are only a few publications on this topic in both domestic and foreign literature. This paper attempts to summarize the literary data on this topic, based on which a list of medical use cases that require a mandatory photo documentation has been created. Practical recommendations have been developed and are outlined for gross photographs. In the context of widespread use of digital photography as a resource for deep learning of neural networks and digital analysis, this article will be useful not only for postgraduate education of pathologists, but also for physicians of other specialties.

Pathology Informatics Education during the COVID-19 Pandemic at Memorial Sloan Kettering Cancer Center (MSKCC)

<p>This review details the development and structure of a four-week rotation in pathology informatics for a resident trainee at Memorial Sloan Kettering Cancer Center (MSKCC) in New York City so that other programs interested in such a rotation can refer to. The role of pathology informatics is exponentially increasing in research and clinical practice. With an ever-expanding role, training in pathology informatics is paramount as pathology training programs and training accreditation bodies recognize the need for pathology informatics in training future pathologists. However, due to its novelty, many training programs are unfamiliar with implementing pathology informatics training. The rotation incorporates educational resources for pathology informatics, guidance in the development, and general topics relevant to pathology informatics training. Informatics topics include anatomic pathology related aspects such as whole slide imaging, laboratory information systems, image analysis, and molecular pathology associated issues such as the bioinformatics pipeline and data processing. Additionally, we highlight how the rotation pivoted to meet the department’s informatics needs while still providing an educational experience during the onset of the COVID-19 pandemic.</p><p><strong>Conclusion</strong>. As pathology informatics continues to grow and integrate itself into practice, infor- matics education must also grow to meet the future needs of pathology. As informatics programs develop across institutions, such as the one detailed in this paper, these programs will better equip future pathologists with informatics to approach disease and pathology.</p>

Evidence-Based Alignment of Pathology Residency With Practice II: Findings and Implications

This article presents findings from a 4-year series of surveys of new-in-practice pathologists, and a survey of physician employers of new pathologists, assessing how pathology graduate medical education prepares its graduates for practice. Using the methodology described in our previous study, we develop evidence for the importance of residency training for various practice areas, comparing findings over different practice settings, sizes, and lengths of time in practice. The principal findings are (1) while new-in-practice pathologists and their employers report residency generally prepared them well for practice, some areas—billing and coding, laboratory management, molecular pathology, and pathology informatics—consistently were identified as being important in practice but inadequately prepared for in residency; (2) other areas—autopsy pathology, and subspecialized apheresis and blood donor center blood banking services—consistently were identified as relatively unimportant in practice and excessively prepared for in residency; (3) the notion of a single comprehensive model for categorical training in residency is challenged by the disparity between broad general practice in some settings and narrower subspecialty practice in others; and (4) the need for preparation in some areas evolves during practice, raising questions about the appropriate mode and circumstance for training in these areas. The implications of these findings range from rebalancing the emphasis among practice areas in residency, to reconsidering the structure of graduate medical education in pathology to meet present and evolving future practice needs.

Pathology Informatics and Robotics Strategies for Improving Efficiency of COVID-19 Pooled Testing

The global rise of the coronavirus disease 2019 pandemic resulted in an exponentially increasing demand for severe acute respiratory syndrome coronavirus 2 testing, which resulted in shortage of reagents worldwide. This shortage has been further worsened by screening of asymptomatic populations such as returning employees, students, and so on, as part of plans to reopen the economy. To optimize the utilization of testing reagents and human resources, pool testing of populations with low prevalence has emerged as a promising strategy. Although pooling is an effective solution to reduce the number of reagents used for testing, the process of pooling samples together and tracking them throughout the entire workflow is challenging. To be effective, samples must be tracked into each pool, pool-tested and reported individually. In this article, we address these challenges using robotics and informatics.

Optimizing COVID-19 testing capabilities and clinical management using pathology informatics

Coronavirus disease 2019, first reported in China in late 2019, has quickly spread across the world. The outbreak was declared a pandemic by the World Health Organization on March 11, 2020. Here, we describe our initial efforts at the University of Florida Health for processing of large numbers of tests, streamlining data collection, and reporting data for optimizing testing capabilities and superior clinical management. Specifically, we discuss clinical and pathology informatics workflows and informatics instruments which we designed to meet the unique challenges of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. We hope these results benefit institutions preparing to implement SARS-CoV-2 testing.

What’s in a Name? Comparative Analysis of Laboratory Test Naming Guidelines as Applied to Common Confusing Test Names

Introduction/Objective Laboratory test names frequently do not enable easy understandability or promote correct test utilization, which leads to difficulty for providers in finding the correct test and results in unnecessary cost and medical errors. Laboratory test names are also largely unstandardized and are not named by a consistent set of conventions. To address these issues, the TRUU-Lab (Test Renaming for Understanding & Utilization) initiative aims to generate a consensus test naming guideline for better human understandability of laboratory test names. These studies address the first aim of the TRUU-Lab initiative: to identify root causes and challenges in understanding and using laboratory test names. Methods We conducted survey studies to capture the most problematic laboratory test names, then performed analysis of these names to identify aspects of these names that led to confusion among providers. A subset of these test names were used to evaluate five existing laboratory test naming guidelines (LOINC, ONC TigerTeam, Pan- Canadian iEHR Viewer Name, Standards for Pathology Informatics (Australia), and ARUP Laboratories internal style guides) for their ability to produce understandable test names. Results 274 survey responses yielded ~100 unique laboratory tests cited as confusing, and highlighted substantial diversity both in the names of these tests between institutions and in respondent opinion on the best alternative names. The top 10 most commonly-cited tests yielded ≥ 3 unique names, and the top 2 tests (Vitamin D and anti- factor Xa) yielded ≥ 10 unique names. Post-survey analysis identified eight characteristics associated with poor understandability of a test name, including ambiguity, abbreviations, homophones, multiple indications for a single test, proprietary names, synonyms, truncation, and “panels” where components are obfuscated. Existing guidelines produced highly variable names given the same prompt, and varied in their ability to avoid pitfalls associated with poor understandability. Conclusion These studies highlight aspects of existing laboratory test names that lead to confusion among ordering providers, and identify the inability of existing laboratory test naming practices to adequately address these issues. Efforts are ongoing within TRUU-Lab to use these results to inform novel laboratory test naming guidelines to promote universal human understandability.

What’s in a Name? Comparative Analysis of Laboratory Test Naming Guidelines as Applied to Common Confusing Test Names

Laboratory test names frequently do not enable easy understandability or promote correct test utilization, which leads to difficulty for providers in finding the correct test and results in unnecessary cost and medical errors. As a further complication, laboratory test names are largely unstandardized and are not named based on a consistent set of conventions. To address these issues, the TRUU-Lab (Test Renaming for Understanding & Utilization) initiative aims to generate a consensus laboratory test naming guideline for better human understandability of laboratory test names. These studies address the first and second aims of the TRUU-Lab initiative: 1) to identify root causes and challenges in understanding and using laboratory test names, and 2) to share resources related to potential solutions. We initially conducted survey studies to capture the most commonly problematic laboratory test names, then performed analysis of these names to identify aspects of these names that led to confusion among providers. 274 survey responses yielded ~100 unique laboratory tests that respondents felt were confusing, and highlighted substantial diversity both in the names of these tests between institutions and in respondent opinion on the best alternative names, with the top 10 most commonly-cited tests having at least 3 unique names, and the top 2 tests (Vitamin D and anti-factor Xa) having at least 10 unique names. Post-survey analysis identified eight common characteristics associated with poor understandability of a test name, including ambiguity, abbreviations, homophones, multiple indications for a single test, non-descriptive proprietary names, synonyms, truncation due to software limitations, and €œpanels where test components are obfuscated. A subset of the survey-identified confusing test names were used to evaluate existing laboratory test naming guidelines for their ability to produce understandable test names. Five guidelines, including LOINC, ONC TigerTeam, Pan-Canadian iEHR Viewer Name, Standards for Pathology Informatics (Australia), and ARUP Laboratories internal style guides, were evaluated, and produced highly variable names given the same test name prompt. Further, existing guidelines also varied in their ability to avoid pitfalls previously identified as associated with poor understandability. Together, these studies highlight the aspects of existing laboratory test names that lead to confusion among ordering providers, and identify the inability of existing laboratory test naming practices to adequately address these issues. Efforts are ongoing within TRUU-Lab to use these results to inform novel laboratory test naming guidelines that promote universal human understandability. Work is also ongoing to apply these novel guidelines to generate new candidate test names, and conduct survey analysis to evaluate the effects of new test naming guidelines on understandability and correct test utilization.