CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Raymond D. Aller, MD, and Hal Weiner
A conundrum: teaching pathology informatics to residents
Cerner to take over health system’s IT services
New meaningful use rule offers flexibility, more time
Sunquest and CellNetix announce collaboration
Technidata introduces system to boost LIS performance
GE to install telepathology network in Canada
A conundrum: teaching pathology informatics to residents
Just as high schoolers are prone to protest, “We’re never going to need to use quadratic equations/literary theory/the periodic table in real life,” pathology residents have been known to question the value of subjects for which they don’t envision a practical application—such as pathology informatics.
Whether to teach residents about pathology informatics and how to interest them in the discipline have both been debated extensively in recent years. “There’s a spectrum of opinion in the field,” says “Newsbytes” editor Raymond Aller, MD, director of informatics and clinical professor in the Department of Pathology, University of Southern California. “Just as we didn’t know for 25 years how to test for informatics knowledge, today we don’t know how best to teach informatics to residents—we’re still evolving.”
So how are residency programs addressing this challenge? Some by incorporating informatics into a required rotation, and others through the use of case studies, clinical vignettes, and other techniques. James Crawford, MD, PhD, executive director and senior vice president of laboratory services for North Shore–LIJ Health System, Lake Success, NY, has taken the former approach.
His institution’s pathology resident training program tackles informatics education from three angles: clinical, quality, and business. “We require third-year residents to do a clinical laboratory medicine rotation,” Dr. Crawford explains. “The resident is a member of the senior leadership team for the department and has to grapple with performance, safety, finances, and the highly complex nature of an integrated health system, so informatics hits them in the face. This rotation is a game-changer for at least half our residents, for whom it actually helps shape the trajectory of their career plans.
“They enjoy it tremendously,” he continues. “It was established as an elective rotation, and the residents themselves said, ‘This has to be required.’” Residents can subsequently choose to explore informatics further by spending two weeks with the system informaticists who perform the health system’s analytics.
In the Department of Laboratory Medicine at the University of Washington Medical Center, Seattle, assistant professor Brian Shirts, MD, PhD, finds that many junior residents have never heard of pathology informatics. “That’s a reflection of medical school training,” he says. “It’s not surprising that first-year residents are not aware of the field.” And once they are introduced to it? “Some hear about informatics and think, ‘This is not something I need to know about in order to read a slide,’ and others think, ‘This is something that underlies everything I do; it should be important.’”
To maximize residents’ engagement, Dr. Shirts relies on clinical vignettes and case studies. “When I teach the general residents, the thing they’re most interested in is hearing these case studies,” he says. “For example, suppose a medical director says, ‘We need to change our reference range for whole blood glucose.’ . . . There are multiple systems in which these ranges are reported—this request involves changing the definitions in about 30 different places. So residents see what goes on downstream. They understand, ‘Oh, this is something that could really impact a patient if it didn’t go right. My request to change the reference range is much more complex than I thought.’”
Another supporter of case studies is James Harrison Jr., MD, PhD, associate professor and director of biomedical informatics in the Department of Public Health Sciences and Pathology at the University of Virginia, Charlottesville. “The advantage of the method,” he tells CAP TODAY, “is that you can essentially stage a scenario that’s close to real life and, therefore, make the relevance of the material obvious to students. One of the problems in teaching pathology informatics is that it’s difficult in a traditional classroom setting for residents to see its relevance. That’s because you have to teach a good bit of introductory material before you can introduce practical topics, and you lose the residents during that task.”
As important as he believes it is for pathology residents to learn about informatics, Dr. Shirts acknowledges that the discipline can be difficult to teach because, until recently, of the lack of consensus among experts regarding core pathology informatics topics. “Clearly there’s little about it on the board exams,” he adds. “Informatics is a challenging field to create board-style questions for, because it’s not like biological reality. Biological reality is something we’ve discovered about nature, whereas informatics reality is something we’ve created for ourselves as a way to organize information. So there can be competing standards, with different strengths and weaknesses, and those standards highlight the work of the people who are proponents of those specific tools or measures. If you helped create LOINC [for example], then you’ll be a strong proponent of it.”
Despite the challenges, Dr. Crawford believes the value of learning about pathology informatics is self-evident. “I view pathology informatics to be woven into the fabric of what we do every day operationally,” he says. “I submit that any board-certified pathologist who has responsibilities, however small, as a medical director, needs to be familiar with how the different components of informatics help them provide leadership. You cannot function effectively as a laboratory medical director without knowledge of these things because you will be held accountable for them.”
Cerner to take over health system’s IT services
Cerner and Georgia Regents Health System, Augusta, have signed a 14-year, $400 million agreement in which Cerner is slated to take over the health care system’s information technology services.
Over the life of the deal, called the Jaguar Collaborative, Georgia Regents expects to save $70 million, or 15 percent of projected costs, the health care system reports. As much as $10 million of the savings is anticipated to come from hosting data remotely at Cerner’s headquarters, in Kansas City, Mo. The health care system announced that it plans to use some of the capital to purchase new technology and expedite departmental projects.
Cerner reported that it will offer staff positions to the majority of the employees involved in IT at Georgia Regents, which has been a Cerner client for 12 years.
“Cerner and GRHealth [Georgia Regents] have a long history of working together,” Joanne Burns, senior vice president and chief strategy officer at Cerner, told CAP TODAY. “This new alignment combines the knowledge and expertise of doctors, nurses, health professionals, engineers, and IT experts to fundamentally change the way health and care are delivered. The other opportunity is to leverage GRHealth’s innovative relationship with Royal Philips. As part of the Jaguar Collaborative, Cerner, GRHealth, and Philips will work together on seamless device and data integration for the EHR.”
Georgia Regents and Royal Philips formed an alliance last year under which Philips agreed to provide the health care system with numerous services and technologies over a 15-year term.
Cerner, 866-221-8877
New meaningful use rule offers flexibility, more time
The Department Health and Human Services has published a final rule that provides eligible health care providers with a longer timeline and more flexibility in meeting meaningful use requirements under the federal EHR incentive program, established through the 2009 HITECH Act.
“We listened to stakeholder feedback and provided CEHRT [certified electronic health record technology] flexibility for 2014,” said Centers for Medicare and Medicaid Services administrator Marilyn Tavenner, in a press release.
Under the recently released final rule, providers struggling to implement the 2014 edition CEHRT can use the 2011 edition CEHRT, or a combination of 2011 and 2014 edition CEHRT, for an EHR reporting period in 2014. Effective next year, eligible providers will be required to use the 2014 edition CEHRT.
“By providing this flexibility, more providers will be able to participate and meet important meaningful use objectives, like drug interaction and drug allergy checks, providing clinical summaries to patients, electronic prescribing, reporting on key public health data and reporting on quality measures,” according to the CMS website.
The final rule also extends meaningful use stage two through 2016 for certain providers and pushes back the beginning of stage three by one year, to Jan. 1, 2017, for the first cohort of adopters.
Sunquest and CellNetix announce collaboration
Sunquest Information Systems and Seattle-based CellNetix Pathology & Laboratories have entered a strategic partnership to develop additional functionality for Sunquest’s PowerPath anatomic pathology system.
CellNetix, a provider of subspecialty anatomic pathology services and a long-time Sunquest client, is working with the vendor to “redefine the pathology workflow, addressing key industry challenges around case reporting, integration of molecular and genetics, and easy synoptic reporting,” Sunquest reports.
Sunquest Information Systems, 520-570-2000
Technidata introduces system to boost LIS performance
Technidata has launched TD-Supervision as a complement to its TD-Synergy suite. TD-Supervision is intended to maximize the availability and performance of Technidata’s TD-Synergy suite of laboratory information systems.
“TD-Supervision is an approach that is, on the one hand, corrective—with immediate and precise diagnostics on infrastructure, applications, and communications—and, on the other hand, preventative—with analysis of weak points and implementation of corrective actions,” says Renan Legeas, product manager at Techni-data. “The aim is two-fold—to reduce time spent monitoring and maintaining configurations and increase efficiency to minimize downtime.”
TD-Supervision provides real-time surveillance, tracing and highlighting critical data. Simple dashboards and predefined reports provide a concise and quick view of key information, such as availability rates, number and duration of outages, and time to resolve issues. The information is presented in a single view for easy monitoring, both for single-site and multisite configurations.
Technidata, 855-550-5705
GE to install telepathology network in Canada
The Newfoundland and Labrador Centre for Health Information has announced that it will install a province-wide telepathology network from GE Healthcare.
The project will provide slide scanners and viewing software to four sites in Canada: James Paton Memorial Regional Health Centre, Gander; Central Newfoundland Regional Health Centre, Grand Falls-Windsor; Western Memorial Regional Hospital, Corner Brook; and Charles S. Curtis Memorial Hospital, St. Anthony. A future complementary project will connect systems in Newfoundland and Labrador to those in Ontario and Manitoba.
The $2.5 million telepathology network is being jointly funded by the government of Newfoundland and Labrador and Canada Health Infoway, a federally funded nonprofit group focused on digital health solutions.
GE Healthcare, 262-544-3011
[hr]Dr. Aller is director of informatics and clinical professor in the Department of Pathology, University of Southern California, Los Angeles. He can be reached at raller@usc.edu. Hal Weiner is president of Weiner Consulting Services, LLC, Florence, Ore. He can be reached at hal@weinerconsulting.com.