2005 Scientific Session Abstracts
Out of the LIS and into the EMR: Taking Control of the Functional Display of Anatomic Pathology Data
Mark Routbort, MD, PhD 1 (mark.routbort@mdanderson.org) and Michael Riben, MD 2, Departments of 1Hematopathology and 2Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
Context : Pathology reports delivered electronically are typically sent over Health Level 7 interfaces to hospital information systems (HIS), with a requisite conversion to ASCII text in many systems resulting in a loss of textual formatting. Using the HL7 results interface of our anatomic pathology information system resulted in inconsistent formatting and display in our electronic medical record. This inconsistency between the printed and electronically displayed pathology report in some cases led to the potential for clinician misinterpretation. In order to rectify this, we decided to “take control” of our pathology reports by building an electronic viewer directly into the software application used at our institution by clinicians to view patient records.
Technology : We implemented a Visual Basic 6 ActiveX client control which functions as a drop-in component in our institutional electronic medical record. An associated server object communicates with the anatomic pathology system database directly to extract the rich-formatted text (RTF) which represents the native report document as signed out by the pathologist. The RTF is delivered to the client component via an XML-based Simple Object Access Protocol message. The client control component for visualizing and parsing the RTF is embedded directly in the electronic medical record application.
Design : Functional aspects of the Pathology Report component include:
- Lack of dependence on HL7 message interface for display of reports
- Improved fidelity of the pathology report between pathologist and clinician
- “Navigation buttons” which facilitate scrolling to or highlighting significant areas of the report such as a diagnosis or addendum section
- Detailed user- and event-level logging to support future usage and pattern analysis
Results : In the first full month of operation (May 2005), our Pathology Report component was used to view 414,513 pathology reports. User activity followed a clear diurnal pattern with inflection at predictable daily intervals, peaking at over 3000 reports viewed hourly. Preliminary analysis of detailed audit functions suggests that clinicians follow several different patterns of behavior when viewing pathology reports.
Conclusion : Pathology reports are the major means by which pathologists communicate with clinicians. Creation of a custom report viewer has enabled us to take control of the visual and functional presentation of anatomic pathology results within the architecture of the electronic medical record. Potential enhancements include support for increased user interactivity such as embedded hyperlinked references or user-specific notification upon report addendums or amendments. Usage pattern analysis and stewardship over the electronic presentation of the pathology report have the potential to improve results communication and clinical decision-making.