CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
February 2021—What is the one most important thing to look for in an anatomic pathology computer system? That is one of several questions CAP TODAY publisher Bob McGonnagle put to five people in a Dec. 14 call on the AP LIS and more—surgical pathology volumes amid COVID-19, data integration, practice consolidation.
The roundtable participants were Monica de Baca, MD, of Pacific Pathology Partners, Rick Callahan of NovoPath, Curt Johnson of Orchard Software, Joe Nollar of Xifin, and Mick Raich of Vachette Pathology. Their conversation follows.
CAP TODAY’s guide to AP computer systems begins here.
Monica de Baca, what is the latest in your laboratory with COVID? I ask that because there’s some indication that people are starting to stand down elective procedures again, which may have a big effect on surgical pathology.
Monica de Baca, MD, founder of MDPath and hematopathologist, Pacific Pathology Partners, Seattle: I work for a private practice in Seattle; we see mostly anatomic pathology that comes from small clients in the surrounding Seattle metropolitan and Pacific Northwest area, and between late March and late June our surgical pathology volumes dropped by about 75 percent. That had large implications for staffing for techs and pathologists alike. The volumes came back up, and the populace of the Seattle area has been good at using distancing and masking precautions, so at this point we haven’t started to see a reduction in numbers again. We have already figured out what we will do if the numbers do drop in terms of staffing and how people are going to be “able” to spend a little more time with their families again.
Nollar
Joe Nollar, are you seeing signs of a second round of diminished volumes in surgical pathology?
Joe Nollar, assistant VP, product development, Xifin: No, not yet, but the lab testing volume overall is up with COVID testing. Monica’s comments do resonate. One would expect the additional impact and burden on the hospital to have an impact on routine patient care and then a consequential impact on routine laboratory testing and services. But overall we’re seeing a significant increase in laboratory testing. We’re not at the level where everything is back to normal with routine testing, but across all segments we are looking at about a 94 percent return to normal testing volumes. As hospitals are further impacted by the COVID crisis, it is likely we will see another dip in routine testing.
Mick Raich, can you comment on that from what you’re hearing?
Mick Raich, founder, Vachette Pathology: We work with pathology groups across the nation, and two or three of them have said they’re preparing to shut down elective surgeries, and we had some health systems talk about shifting things around in case they have to shut down elective surgeries. But I’ll agree with Joe’s comment: Most of our pathology groups are at about 95 percent of what they were in February. They had a big rebound in July, and they’ve slipped back down, and depending how things go moving forward, it’s going to be interesting to see what early 2021 brings. We do have groups that are getting ready for it, and the health care systems are more prepared for it now.
Monica de Baca, what do you foresee in the quarter ahead, and what concerns are top of mind for you now in your anatomic pathology operation?
Dr. de Baca (Pacific Pathology Partners): Every day gives us the possibility of a need to reshuffle and rethink. Historically, pathology has been regulated, regimented, consistent—there is a process here and it doesn’t change—and the COVID environment has shown that we are more resilient and flexible than we thought. The pathology community deserves enormous kudos for how well it has done in the laboratory response to this pandemic: getting testing up and running, even though what has been broadcast is the negative part—of what didn’t happen. It’s difficult to have 300 million tests at the ready for a virus we didn’t know existed, but within a couple of months we had tests going. It’s not only the clinical laboratory that has demonstrated this capacity to be creative and to pivot and still maintain the quality we need but also the anatomic pathology world. We’ve had to deal with colleagues who have COVID, with a different pattern of workflow in terms of volumes and what kind of specimens are incoming. We are looking, in the next six months, to continue this daily evaluation of what’s happening in the world around us, which is changing so quickly, and trying to maintain viability and still support our communities.
Curt Johnson, it strikes me that anatomic pathology systems increasingly need to support more of the high-tech testing that surrounds basic surgical pathology, so a lot of biomarker testing, reference lab testing, which means amended reports, comprehensive reports, and other things. Is there a greater demand for proper code capture and billing, not necessarily because you’re billing through your AP system but because the system has to feed that function? Could you give me a sense of what you see going on among your clients in AP and in the questions you’re getting from prospective clients?
Curt Johnson, chief operating officer, Orchard Software: COVID has brought advancements and sped up the integration of molecular testing into the laboratory area, and I think we will see more of that as we move into pathology. Where clinical pathology and anatomic pathology overlap will be called molecular medicine, and from an integration point of view, you’re talking about different types of data—sometimes a lot of data, other times it’s as simple as a reportable result. You have to be in a position and be prepared within your systems to not only integrate that data off of the analyzers and the lab-developed tests but also to integrate the data to the other systems, such as a billing system.
If you’re going to be integrating new testing from a billing perspective, it’s becoming more imperative that the LOINC codes, the SNOMED codes, all that information is not only captured but also able to be transmitted and integrated. One of the values we will find from all of this is that the vast amount of compiled data, from integration and analytical points of view, will lead us into the future to where, when these things happen, we can minimize the time from when it hits to the time we have solutions based on what we’re learning now. And that will take place in the integration of these systems along with using discrete data, which means having the right SNOMED and LOINC codes as we go forward.
Callahan
Rick Callahan, you and I have spoken often about the increasing complexity around anatomic pathology and the fact that many of your clients are integrating a lot of clinical pathology results into their system. Would you care to comment on the same question I posed to Curt?
Rick Callahan, VP of sales and marketing, NovoPath: Yes, the requests for combining multiple results from the clinical lab and anatomic lab onto one report have increased in frequency. Thus, we do interface to the clinical pathology modules and bring those results back into our system, or we would send our results to the clinical pathology module so they’re all in one report. Recently this has been an increasingly popular trend. Regarding integration, in the past we’ve always integrated to various types of instruments, so that hasn’t changed. However, the type of instruments that we’re now integrating with is changing and becoming more and more important to our clients. As the newer instruments—such as those used in molecular testing—come out, we’re quickly learning to integrate to them and to then pull the results into one report.
Regarding the capture of charges, it has always been an important part of the laboratory to make sure the charge is captured. We’ve historically done that. What we’re seeing now is more analytics going on with the charges, so we are providing tools to aid in these analyses.
Is it fair to say that the bar is being set ever higher for the vendors of anatomic pathology lab information systems?
Rick Callahan (NovoPath): It’s an expectation now. In the past I believe we’ve done a good job at integrating, and the development of interfaces to the newer instruments is expected to continue.
Dr. de Baca
Monica de Baca, can you comment on this increasing expectation for functionality in what we call traditionally AP systems?
Dr. de Baca (Pacific Pathology Partners): First I would agree that a lot of headway has been made in terms of integration and opening systems for interoperability. Hematopathology is everyone’s nightmare because we use information from the clinical laboratory, from flow cytometry, molecular diagnostics, cytogenetics, and the AP side. At my institution that means I create an integrated report. I am opening data strings or finding data on about eight different platforms, and I use cut and paste a lot, which is not the ideal way to do it. There are many other institutions or health systems where there is much more integration. I like the idea of merging the clinical and anatomic pathology realms. That’s why I like hemepath: It stands with its foot in all camps. But just as a person can be thought of as many different, separate organs, the development of information technologies can be viewed similarly.
We’re arriving at a place where our knowledge of disease is demonstrating that the logical silos we made in the early phase of a computerized worldview of medicine are going to have been the first baby steps to getting to where we need to be, which is an integrated view of diseases, not only at the medical level but also to follow with the data so that it’s obtainable and easily integrated. Cut and paste allows me to provide a lot more information for the clinician than not cut and paste, but if I had ways to do trending analysis, for instance, on a certain parameter, let’s say a blast count in acute myelogenous leukemia, and create a graph that I could easily put into the report, that might take information from a historical perspective that I don’t have now. If I wanted to do that, I would have to not only create my own trend from data but also have to try to figure out if it were possible to create a graph in the reporting styles I have available to me.
The opportunities are amazing, and we’re at a place where every silo now is well enough established that creating the links among them is going to be the logical next step.
Mick Raich, if a pathology group calls you out of the blue, they know generally what you do in consulting and billing and your expertise in that area, and you begin to talk with them. How soon do you ask them, “What sort of an AP system do you have?” Does that happen right away, or is that down the road?
Mick Raich (Vachette): That’s down the road. Usually when we get into auditing, for example, we’ll look at when the case was collected, when was it finalized.