• MARCH 2008 FEATURE ARTICLES •
Laboratory Information Systems:
Case History
Automating Anatomic Pathology
Implementing an AP solution that integrates with your hospital's LIS can improve workflow and productivity.
By Mark Tuthill, M.D.
Pathology departments and laboratories within
hospitals are vitally linked in their workflow, and often serve
hundreds of personnel within a healthcare organization.
Automating many of the processes, and reducing or eliminating
redundancies between the systems, can result in tremendous
productivity improvements and benefits.
Henry Ford Health Systems and Hospitals
(HFHS), whose doctors are routinely named among America's best,
ranks sixth nationally in the Top 50 Exceptional U.S. Hospitals
listing by Consumers Digest. The hospitals cover a
tri-county area around Detroit and include the Henry Ford
Hospital, Henry Ford Cottage Hospital, Henry Ford Wyandotte
Hospital, Henry Ford Macomb Hospital, Henry Ford Macomb
Hospital-Warren Campus, Henry Ford Kingswood Hospital and Henry
Ford West Bloomfield Hospital.
Problem
When I first started at HFHS in 2003, we
didn't have a true anatomic pathology information system. We
were using an anatomic pathology module, but it had limited
management reports, the patient reports were not very pretty and
it had no ability to attach images. We also had a variety of
business problems we were trying to solve that centered on
trying to improve our overall efficiency, increase our ability
to extract information, enhance patient reporting capabilities
and shorten our turnaround times (TAT). Our goal was to
modernize and automate the pathology department as much as
possible.
Criteria
Choosing an anatomic pathology (AP)
information system was a strategic long-term decision and
commitment for HFHS. We based our decision primarily on how well
the AP system would integrate with our current laboratory
information system (LIS). The technology of the information
system also had to be a rock solid, modern, relational database
platform. After an informal review and consideration of several
other solutions on the market, Sunquest's CoPathPlus was the
only product for which we submitted a formal RFP. It met or
exceeded our requirements and priorities, and we felt it was the
most thoroughly fleshed out anatomic pathology system available.
We already had a very good relationship with
Sunquest in terms of doing development projects, which was
fortunate as there were several unique things we wanted added to
the AP system — an interface for structured data reporting, for
example, the first version of which was developed as part of our
implementation.
The Implementation
A "normal" implementation of an AP solution
for a small hospital usually takes around six months. However, a
large-scale AP implementation is quite complex because it is
widespread, with numerous departments and people being affected
by the system, including training people across the entire
organization on the new system. Therefore, a "normal" timeline
doesn't often apply. It is more important to do the job well
than fast. In HFHS's case, we were in for big changes.
The AP system implementation was more
sophisticated and larger than most, and also included custom
development of a structured data reporting module. Approximately
2.5 million anatomic pathology cases and reports were taken from
our legacy system and converted into electronic files in the
CoPathPlus database. Pathology labs rely heavily on prior
reports when reviewing cases, which are especially important
when the patient has a history of cancer, so this was a critical
step for us.
The overall system implementation included
anatomic pathology, surgical pathology, autopsy, hematology,
cytology and the histology lab. Reports from hematology, flow
cytometry and molecular diagnostics were transitioned into the
AP system. In addition, we trained hundreds of staff. In the
end, it took approximately 2 years before the system went fully
live, which is not uncommon for an implementation of this
complexity.
Improved Efficiency
Henry Ford Hospital is one of the most
technologically progressive health system networks in the
country. Major universities that are considered thought leaders
in pathology informatics are amazed during visits to our sites
when they see the scope and effectiveness of our implementation.
Two hundred lab pathology personnel doing
anatomic pathology, 30 pathologists, 15 residents, and
approximately 1,500 physicians who receive anatomic pathology
data, results and reports immediately benefited from the
implementation of the AP system. After the implementation,
HFHS's case volume increased to approximately 134,000 cytology
surgical cases per year, not including outlying hospitals.
We utilize a continuous process improvement
system, which is based on the Toyota Production System
principles, but which we call the Henry Ford Production System.
It's similar to "lean" or "Six Sigma" process improvement
techniques, but with a focus on organizational culture as well
as process improvements. It requires constant analysis and
evaluation of what our different departments and personnel are
doing, and how we interact to do our work. In particular, our
laboratory workflow is extremely well mapped out in a granular
way with charts and graphics to map out defects, which enables
us to implement improved processes and procedures. It's not all
about raw volumes, but about how much of the system is utilized.
In this respect, we fully and thoroughly utilize the AP system.
Much of our improved efficiencies came from eliminating and
reducing repetitive efforts and replacing multiple subsystems
and multiple databases.
For example, we now enter frozen section data
directly into the AP system instead of maintaining a separate
database. We can also order electronic histology orders, stains
and special studies directly out of the AP system, while
automatically maintaining histology logs. Many billing processes
are now automated, and we've also reduced internal lab
identification errors by 85 percent, by integrating a bar-coding
system.
Twenty-four-hour TATs for biopsies are down
from two to three days with improved clarity and completeness in
surgical pathology reports. There is significant reduction in
amended reports; we decreased transcription requirements by 80
to 90 percent; we've eliminated repetitive work, such as
manually labeling histology slides and cassettes. Additionally,
we've integrated anatomic pathology cases into our EMR, which
resulted in immediate clinical availability and decreased
requirements for paper report printing and distribution.
These improvements have forced us to redesign
our TAT's to report in units of hours, instead of days.
Future Plans
With our continued growth and expansion, HFHS
plans to support additional customers through the services of
our pathology and laboratory medicine product line. I expect we
will also continue working with Sunquest to develop new features
and functionality for CoPathPlus.
Choosing an anatomic pathology (AP) information system was a strategic long-term decision and commitment for HFHS. We based our decision primarily on how well the AP system would integrate with our current
laboratory information system.
We also plan to continue to implement
additional sites and to bring additional functionality online as
time and budgetary constraints allow. This includes adding AP
imaging with picture archiving and communications system
integration; adding an inbound orders interface between the AP
system and our electronic medical record, so that AP orders flow
directly into the system; and, new tracking methods for surgical
pathology specimens.
Recommendations
Don't try to do everything at once, don't
underestimate the complexity of training, and, don't
underestimate your own lack of understanding of your own
workflow and work processes in the laboratory, because most
people really don't know what the heck people are doing in the
labs. Build a very careful communications structure and involve
all parties. This includes top-down and bottom-up
communications. Adjust the workflow to fit the information
system and not the information system to fit your bad workflow.
Lastly, realize that once you go live on a
system, it's just the beginning — not the end.
J. Mark Tuthill, M.D., is head of the
division of pathology informatics at Henry Ford Health System in
Detroit. Contact him at mtuthil1@hfhs.org.