October 2011

Stanley J. Robboy MD

A warm and welcoming team

As young assistant professors 40 years ago at the Massachusetts General Hospital, my colleagues and I approached tumor boards with mixed feelings. We looked forward to presenting the cases but were always a bit anxious about very recent biopsies. Because only manual logs were available at the time, it was rarely possible to identify the responsible pathologist until the case was signed out, typically at least 24 hours later. If asked about the status of a biopsy the day before, the only option was to confess ignorance.

I was certain it would be possible to design a completely automated anatomic pathology computer system that would enable more rapid results. Although my superiors were skeptical, the hospital CEO was supportive. A medical student, Raymond Aller, MD (who would become a renowned expert in pathology informatics), assisted me.

Disk space at that time was so limited it was impossible to store even complete diagnoses and comments as text. We needed a powerful language capable of storing diagnoses as code that could be converted to readable English when an inquiring physician accessed the report. The coding language would have to accommodate a wide range of syntactical linkages (such as “arising in,” “suggestive of,” and “due to”) as well. Only the CAP had what we potentially needed.

A key to our success was the CAP-developed Systematized Nomenclature of Medicine (SNOMED). In 1974, I discussed our dilemma with the College and volunteered for the SNOMED Committee. There I had the opportunity to learn from many experts, including the chair, Roger Coté, MD, a visionary in multiple ways. Dr. Coté, like all CAP leaders I have since come to know, understood leadership and teamwork.

Long story short, our new system went live in 1976, enabling us to handle the diagnostic, scientific, administrative, financial, long-term storage, educational, and intersystem collaborations for 30,000 new cases annually, years before personal computers and word processing appeared. (An update: In 2003, the U.S. National Library of Medicine adopted SNOMED as a standard, and four years later it became an international standard, now maintained by the International Health Terminology Standards Development Organisation and its 17 member countries.)

The College is often the only place to find robust and elegant solutions (or a solution of any kind at all) to clinical and scientific challenges in pathology. This was my first experience with the intellectual muscle and welcoming environment of the CAP, where some of the brightest minds in medicine collaborate to create novel and powerful tools to measure and improve the quality of patient care. The College, I have learned, is a collegial community whose members welcome one another and new ideas with energy and enthusiasm.

I have been continually impressed by how consistently College leaders are willing to consider and pursue novel proposals. As a result of this mindset, colleagues and patients have come to depend on such far-reaching programs as proficiency testing, laboratory accreditation, and cancer protocols. It was also this can-do mindset that led leaders within the CAP Foundation to launch “See, Test and Treat” when they learned that many women lacked access to routine preventive care. Today, See, Test and Treat volunteer teams take pathology to the patient, providing cervical cancer screening and immediate treatment in underserved communities.

Most recently, the College has launched a multifaceted campaign for transformation of the specialty. The CAP Case for Change initiative enables member-driven research into workforce supply and demand, evolving practice settings, potential business models, and new technologies. Accelerated educational opportunities for our members through the newly launched Learning Portal continue to grow. The CAP Pathology and Laboratory Quality Center, where pathologists work with other specialists and patient advocates to develop and elaborate on best practices, holds great potential as a collaborative model across specialties and related interest groups.

This is an era of great promise and challenge for pathology, and it is no surprise our members have stepped up. More than 3,500 volunteers contributed 180,000 hours to the CAP this past year. If you were not one of them, please go to the Web site and access the member/nonmember engagement form (found by clicking on the Member tab on the home page and then Leadership and Service Opportunities). By volunteering for the CAP, you become part of a diverse and open community that enables all who hope to participate to do so in a meaningful way.

I am deeply grateful for the opportunity to serve in the challenging and gratifying position of CAP president and look forward to the next two years with considerable optimism. Please e-mail me at the address below to share your thoughts on our plans and progress.