Digital Pathology:
The Role of APLIS Integration in
Supporting the Pathologists’ Workflow
Curtis Stratman
Partha Boocha
Andrew Kotov
Vanja Kvarnstrom
Omnyx, LLC, Pittsburgh, PA
DISCLOSURES
Employee of Omnyx, LLC
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BACKGROUND:
This Question is Often Asked
How do APLIS and digital pathology systems work together
to enable an efficient all digital workflow for high-volume
routine use?
Interfaces exist today, but one has yet achieved this goal.
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BACKGROUND:
Values Cannot Be Achieved Without Solution
Save pathologist time:
• eliminate sorting of and searching for slides
• immediate access to prior cases
Optimize utilization of pathologists:
• distribute workload across locations
• route cases to knowledge experts
Provide additional tools:
• precision measurement
• document interpretation with tissue region
And more…
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DESIGN:
Workflow Informs Interface Requirements
Methodology to define integration needs:
1. Model the current state workflow
-
Identify when data is created
2. Design the future state workflow
-
Identify when data is used
3. Define the data interface specification
-
Provide the right information at the right time for the user
Balance technical trade-offs
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RESULT:
Leverage Tools from Service Modeling
ACTIVITY
PERSON
TRIGGER
Accessioning
Grossing
Histology
Case Review
Diagnosis Entry
Sign-Out
INPUTS
OUTPUTS
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RESULT:
Triggers Drive Workflow Actions
ACTIVITY
Accessioning
PERSON Accessoner
TRIGGER Specimen Delivery
Grossing
Grossing PA
Specimen Delivery
Histology
Histologist
Cassette Delivery
or Timepoint
Case Review
Pathologist
Slide Delivery
INPUTS
Protocols
Specimens
Cassettes
Study Orders
Gross Report
Study Orders
Cassettes
Slides
Slides
Clinician Request
Patient History
Study Orders
Diagnosis
Requisition
OUTPUTS Patient Record
Case Record
Diagnosis Entry
Pathologist
Case Diagnosed
# Cases Diagnosed
Time of Day
Diagnosis
Sign-Out
Pathologist
Report Entered
Time of Day
Time Duration
Report
Report
Signature
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RESULT:
Pathologists’ Workflow is Slide-driven
ACTIVITY
Accessioning
PERSON Accessoner
TRIGGER Specimen Delivery
Grossing
Grossing PA
Specimen Delivery
Histology
Histologist
Cassette Delivery
or Timepoint
Case Review
Pathologist
Slide Delivery
INPUTS
Protocols
Specimens
Cassettes
Study Orders
Gross Report
Study Orders
Cassettes
Slides
Slides
Clinician Request
Patient History
Study Orders
Diagnosis
Requisition
OUTPUTS Patient Record
Case Record
Diagnosis Entry
Pathologist
Case Diagnosed
# Cases Diagnosed
Time of Day
Diagnosis
Sign-Out
Pathologist
Report Entered
Time of Day
Time Duration
Report
Report
Signature
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RESULT:
Pathologists’ Workflow is Slide-driven
United States
United Kingdom
France
RESULT:
Images Alone Do Not Fill the Hole
Pathologist
Workflow
Slides
Images
What tells pathologists a case is ready for review?
How do pathologists manage their workload?
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RESULT:
Digital Workflow Requires Tight Integration
Digital Pathology
Workflow States
Accessioning
Grossing
Histology
Slide
Scanner
Digital
Workflow
APLIS
·Patient
·Vist
·Case
·Part
·Clinical History
(Documents,
Requisition)
Key Insights:
·Blocks
·Slides
·Gross Images
·Gross Notes
·Interoperative
Diag
·Parameters
Scanning
·Slide Image
URL
For each Prior case:
·Slide Images
·Clinical History
·Interoperative Diag
·Gross Notes
·Gross Images
·Doc Images
·Reports
Case Review
·Slide Images
Data used internally:
Case List
·Case ID
·Patient ID
·Case Assignment
·Part List
·Slide List
·Case, Part, Block,
Slide Status
·Other study result
Case Details
·Slide Images
·Clinical History
·Interoperative Diag
·Gross Notes
·Gross Images
·Doc Images
·Reports
·Prior Case List
Diagnosis Entry
·Image ROI URL
·Snapshot
Images
• Imaging workflow inserts activity of
Scanning between Histology and Case
Review
• Case review is triggered by imaging
activity of scanning
• Case Review is where data from APLIS
and imaging system come together for use
• Data from many points in workflow is
leveraged by pathologist at time of Case
Review
Report Sign Out
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CONCLUSION:
Neither System Can Deliver Alone
APLIS has data:
Digital imaging system has data:
- Patient and case records
- Case details and documentation
- Tissue and processing details
- Slide identification and tracking
- Slides images
- Additional slide tracking details
- Image archival management
- Documentation of image analysis
Workflow needs data from both to do:
- Assemble and present digital cases
- Alert to pathologist of ready work
- Organize and manage workload
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CONCLUSION:
Summary and Next Steps
Existing APLIS digital pathology interfaces focus on minimizing data transfer to:
- Attach images into the current slide-driven APLIS workflow
- Provide metadata to display around an image viewer
However, a slide-driven workflow will not function when images replace slides and
images alone do not provide a workflow
Therefore, a new image-driven workflow module is needed to deliver an efficient
value-add all digital workflow
And as neither an APLIS nor a digital pathology system can deliver this module
without the supporting data from the other
We conclude that even though the interface specification to provide workflow
integration across systems is more technical effort, doing so is necessary to enable
the adoption of digital pathology for routine use.
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