CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Editors: Liron Pantanowitz, MD, director of anatomical pathology, Department of Pathology, University of Michigan, Ann Arbor, and David McClintock, MD, associate chief medical information officer for pathology, Department of Pathology, University of Michigan.
Teleneuropathology using contemporary robotic microscopy
November 2020—Telepathology is a leading application for digital pathology. The ability to easily share a digital image in practice offers pathology laboratories clinical, operational, and financial benefits. This is best demonstrated by the longstanding success of telepathology in allowing pathologists to remotely perform intraoperative consultations—that is, to read frozen sections. Neuropathologists were one of the first specialists to leverage digital pathology for this clinical use. The authors, all of whom were from the University of Pittsburgh Medical Center, performed teleneuropathology at their institution, which implemented the practice 17 years ago. Historically, UPMC used older robotic technology—that is, the Trestle system. However, it switched to more contemporary hybrid robotic devices, including the Aperio LV1, once vendor support for its older instruments ended. Employing robotic microscopy allowed UPMC’s neuropathologists to overcome focus issues often caused by artifacts, such as air bubbles, encountered during frozen sections. Compared to their institution’s prior robotic microscopy instruments, the Aperio LV1 hybrid scanner offered better optics (2.5×, 5×, 10×, 20×, 40×, and 63× objectives) and software that provided such functionality as simultaneous live viewing of multiple regions on the same slide. It also had faster slide-loading time, less lag phase when navigating or changing magnification, and fewer errors that caused downtime. The authors conducted a cross-sectional comparative study to evaluate the impact of the hybrid scanner on their deferral and concordance rates in teleneuropathology. They compared data (193 cases) from three remote hospitals in the UPMC network to intraoperative neuropathology consultation performed by conventional glass slide examination at a light microscope (310 cases) in the main hospital, where neuropathology staff are located. The authors determined that the deferral rate was 26 percent for intraoperative teleneuropathology and 24.24 percent for conventional glass slide reads (P = .58). The concordance rate was 93.94 percent for teleneuropathology and 89.09 percent for conventional glass slides (P = .047). Based on these data, the authors concluded that UPMC’s new hybrid robotic devices for performing intraoperative teleneuropathology were as effective as conventional glass slide interpretation. Moreover, they found a noticeable change in the deferral rate compared to prior years and a marked improvement in the concordance rate using the new hybrid scanner.
Baskota SU, Wiley C, Pantanowitz L. The next generation robotic microscopy for intraoperative teleneuropathology consultation. J Pathol Inform. 2020. doi:10.4103/jpi.jpi_2_20
Correspondence: Dr. Swikrity Upadhyay Baskota at upadhyaybaskotas@upmc.edu
Use of secure text messaging to improve turnaround times for critical value notifications
Clinical laboratory critical values have consistently been related to communication and patient safety issues. Laboratory accreditation requirements of the Joint Commission and College of American Pathologists state that all critical values should be communicated to the care provider in a timely manner—typically less than 60 minutes—with documentation of the provider to whom the results are reported. Most critical value workflows involve laboratory staff using a manual telephone callback process, which can lead to additional steps that delay patient care. The authors described herein an automated critical value communication, escalation, and documentation process using a HIPAA-compliant secure text messaging (STM) application at Geisinger Medical Center. The process involves using an agile team-based approach that employs multiple development sprints to create a system that passes critical values from the laboratory information system to a custom callback application. That application can trigger an STM that is sent to providers based on preprogrammed schedules in an electronic phone book or on-call list. When a provider acknowledges the critical value by replying to the initial text message, the callback application logs the response time, date, provider, and other metadata for regulatory and quality auditing purposes. If there is no response to the initial text message, the system directs a client service representative to send an STM to the next provider on the escalation list. The last escalation step sends an STM to the on-call pathologist. Using this system, the authors reported a statistically significant reduction in critical value mean turnaround time (TAT) of eight minutes (pre-STM implementation TAT, 11.3 minutes; median, seven minutes; range, 0–210 minutes/post-STM implementation TAT, 3.03 minutes; median, 0.89 minutes; range, <1–95 minutes). Furthermore, a post-implementation Likert survey revealed that 85 percent of surveyed providers reported increased efficiency using the critical value STM versus the traditional phone-based critical value workflow, and 92.5 percent preferred to keep the STM system. The authors concluded that the STM system demonstrates how clinical laboratories can use innovative, secure communication technologies to improve critical value reporting, expediting patient management and advancing patient care.