Summary
Pathologist Scott Robertson, MD, PhD, developed PIRO, a web-based search platform that converts narrative information in pathology reports into searchable concepts. PIRO integrates well with Epic Beaker and is free and open source, though it requires IT expertise for installation. It is easier to use than other tools, allowing pathologists to efficiently search archives for specific cases, aiding in teaching, research, and routine sign-out.
Editors: Raymond D. Aller, MD & Dennis Winsten
Pathologist creates open-source tool to search free text in reports
March 2026—The good and the bad is that pathology reports often contain large amounts of information‑dense, narrative data. But free text can be difficult to search, diminishing its value. That’s why pathologist Scott Robertson, MD, PhD, developed the Pathology Information Retrieval Optimizer, or PIRO, a Web‑based search platform for converting narrative information in pathology reports into discrete, searchable concepts. As such, its rapid search functionality transforms the pathology diagnostic archive from a static record to a dynamic resource.
“It’s basically as easy to use as Google,” explains Dr. Robertson, who is also codirector, Center for Diagnostics and Artificial Intelligence, Cleveland Clinic. The tool has a simple search box on its main page for entering and submitting requests. “It does have a lot more advanced features for searching, but you can design a basic search that gives you results within just a few seconds,” he adds.
PIRO integrates especially well with Epic Beaker, Dr. Robertson says. He and his colleagues have even written much of the code that migrates data from Beaker into the platform. Institutions that use Beaker can leverage this code for their own data migration.
PIRO is free, with no licensing costs. And it recently became open source, so interested parties can access the PIRO repository and download the code at https://github.com/ClevelandClinicCDAI/PIRO.
Yet installation of the platform requires institutional information technology expertise, Dr. Robertson says. A system administrator typically will need to set up and configure the necessary servers, and a database expert will need to map the pathologist’s inputs or data sources to PIRO’s database schema.
But once PIRO is installed, “pathologists don’t need to experience a huge learning curve to start using it,” Dr. Robertson says, citing a study that he led (Robertson S, et al. J Pathol Inform. doi:10.1016/j.jpi.2025.100436). “We published a paper about PIRO, which shares how we tracked its usage over the course of about eight months,” comparing pathologists’ use of PIRO to that for Epic’s SlicerDicer analytics and data-visualization tool, he explains. The study found that 67 percent of Cleveland Clinic pathologists and trainees surveyed used PIRO on a regular basis, while only nine percent performed SlicerDicer searches, due to the complexity of the latter. Overall, pathologists found PIRO easier to use, with better search capabilities and query speed. This translated into pathologists submitting an average of 12,288 queries per month through PIRO compared with 384 through SlicerDicer.
“If you’re working in a pathology practice, especially if you’re in an academic pathology practice, the ability to search your archives for specific cases is really important for a variety of reasons,” says Dr. Robertson, who notes that laboratory information systems have a reputation for offering limited or rudimentary search functionality.
Unlike with a typical LIS, teaching pathologists can use PIRO to find past cases of specific diagnoses so they can capture representative images of lesions to integrate into presentations. On the flipside, trainees in residency and fellowship programs have real-time access to archived diagnoses that they can use to help craft their own diagnoses. And the tool lends itself to research use as well.
PIRO too can be used as an aid in the pathologist’s routine sign-out. It’s especially valuable, Dr. Robertson says, when pathologists examine a case and recognize it as a specific but unusual diagnosis that they haven’t seen in some time. “I might wonder how my colleagues, who may be more expert in these areas, would write up a diagnosis for an unusual case,” he explains, noting that a pathologist may want to read a colleague’s report to help decide what specific features to describe or what ancillary tests to order. “So, some of us use it like this as a real-time way to learn from our peers.”
Even though PIRO is fully functional and can be used for a variety of purposes, Dr. Robertson would like to expand its abilities. “There’s a wish list of things I still want to add to it,” he says. He hopes that, because PIRO is now open source, some institutions that install it will also develop new features for the platform and thereby contribute to the project. “Ideally,” he adds, “it will become kind of a community of institutions with multiple contributors.”
—Nicola Parry