More visibility for pathologists

For several decades pathologists worldwide have been under increasing pressure to handle a steady increase in laboratory tests with a steady decrease in finance and staff.

Photo: More visibility for pathologists

The importance of pathology informatics is evident when you add in the escalating volume of increasingly complex, sophisticated testing.

The Association for Pathology Informatics (API) held its annual Pathology Informatics Summit in Pittsburgh, Pennsylvania, this May. This is the only conference of its kind that discusses innovation and problems that informatics technology may have the potential to resolve.

In 1990, European Hospital interviewed the man who coined the term ‘pathology informatics’ – Dr Bruce A Friedman, emeritus professor of pathology at the University of Michigan Medical School, in Ann Arbor. He explained that the conference, which ran over three and half days and covered a wide swath of topics, and focused on six major areas.

Among these, the key theme was the burden of decreasing resources and escalating workloads. Several speakers urged attendees to speak out to their healthcare administrators about the power of clinical laboratory testing and anatomic pathology services to deliver big gains in patient outcomes and the associated costs of care. Friedman noted that pathology laboratories at a typical hospital cost about 5-6% of the annual budget, but that about 75% of patient treatment is based on findings from laboratory tests. The consensus among the session speakers was that clinical pathologists need to make themselves, and the importance of this specialty, more visible.

Laboratory information system (LIS) functionality continues to be under close scrutiny by pathology informaticists. In the USA, LIS software was for years dominated by a handful of specialised best-of-breed vendors. With the US government push for the national adoption of electronic health records (EHR), EHR vendors are adding LIS modules to their offerings. According to Dr Friedman, many of these are not robust enough, nor provide vitally important broad functionality. To offset this, the API developed a LIS Functionality Assessment Toolkit (LIS-FAT).

The toolkit contains a list of 850 functionality statements that can be used to determine, in detail, a metric to measure whether specific functionalities are absent or present in any LIS. As of mid-June, the free-of-charge toolkit has been downloaded approximately 2,000 times (www.pathologyinformatics.org/toolkit). ‘With this degree of acceptance, the toolkit is taking on some of the characteristics of a quasi-standard,’ Friedman said. ‘Some LIS vendors are even developing their individual responses to the 850 statements and making them available to clients. We are going to take advantage of this opportunity and add more functionality statements to make the toolkit in order for it to more closely resemble an IT standard.’

The broad deployment of digital pathology has been held back by US federal regulatory issues, so the field has not evolved as rapidly as initially envisioned.

One data-intensive field that is increasingly gaining attention is lab analytics. The lab analytic of business intelligence software enables the lab professional to better understand managerial and clinical changes in their labs using various dashboards. Anatomic pathology dashboards, for example, can display turnaround time for urgent biopsies, or specimens that were held up for various reasons. The goal for lab analytics is to provide faster, better, and less expensive services.

Other areas of growing interest are computational pathology, cancer genomics, and support for point-of-care (POC) testing. Cancer genomics is a particularly exploding field. The ability to identify abnormalities and defects in a cancer’s DNA can be used to helps identify the therapeutic agents that exploit the tumour’s genetic weaknesses.

Companion diagnostics is also attracting increased attention because healthcare payers want to know that extremely expensive drugs – some can cost as much as $100,000 annually – are effective for the diseases for which they are being used. Testing for efficacy for expensive chemotherapeutic agents will become the norm, Friedman predicts, because as much as 50% of these treatments are not successful. Healthcare payers, he said, are becoming more demanding in wanting to know whether expensive drugs are appropriately prescribed.

Finally, with POC testing a fact of life and increasingly being demanded by physicians who want rapid test results, pathologists need to find ways to have managerial control over decentralised testing – a challenge also discussed at great length at the summit.

The API is considering whether to make its 2015 summit an international event. ‘Pathologists throughout the world are increasingly turning to pathology informatics as a means to provide quality and cost-effective diagnostic services.’ Friedman concluded: ‘We think it is time to make this meeting global in scope.’

03.07.2014

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