APIII - Advancing Practice, Instruction & Innovation Through Informatics

Specialty Labs Informatics: Opportunities and Challenges in Clinical Laboratories That Do Not Fit the AP/CP Paradigm 

Federico A. Monzon, MD1 (monzfa@upmc.edu); Michael Sendek, BS 2; Mary V. Mueller, BS, MLT(ASCP) 2; Anthony J. Kondisko, BS, MT(ASCP) 2; Geoff J. Shullo, BS. MT(ASCP) 2; Amy L. Woelke, ADBA ; Patricia Arndt 2 and William C. Gross 2; 1 Department of Pathology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA; 2 Division of Pathology Informatics, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA; 3 Department of Pathology, Saint Vincent College, Latrobe, PA

Content: The landscape in pathology has changed significantly in the past decade. In addition to the traditional anatomic and clinical pathology laboratories, most medical centers now have laboratories that perform specialized testing such as: molecular diagnostics, flow cytometry, cytogenetics, and others. These specialty laboratories have shown significant growth in the past 5 years and represent an area with tremendous growth potential. From the informatics standpoint, specialty labs do not conform to the current anatomic/clinical pathology (AP/CP) paradigm used in current laboratory information systems (LISs), and they represent a new challenge for information management in pathology informatics.

Technology: Most of these laboratories have unique workflows, which are constantly changing, with specific and more diverse information management requirements that are not adequately addressed by current LISs. At UPMC the Division of Pathology Informatics provides service to the anatomic and clinical pathology environments with CoPath (Cerner/DHT) and Misys Laboratory ( Misys Healthcare Systems). However, development of  information systems robust enough to support Molecular Pathology and other specialty areas have lagged behind those in anatomic and clinical Pathology.

Design: For the most part, support for specialty Laboratories at UPMC has been provided through the current LISs and home-grown databases. This has required the adaptation of laboratories to the AP or CP informatics solutions and processes, and not the LIS to the laboratories’ needs. These solutions in general address accessioning and reporting, without providing support for the workflow process in the labs. Apart from the strategic hurdles of system-wide integration for home-grown databases and the duplication of effort to accession cases in two separate systems, these databases present security concerns for protected patient health information.

Results: A team of systems analysts with laboratory experience was created to address the requirements of these specialty laboratories. This team has focused on delivering custom and commercially available solutions to specialty laboratories. As an initial project, the HLA module on the Cerner PathNet platform was implemented in the Tissue Typing Laboratory at UPMC.

Conclusions: A specialized team with expertise from Anatomic and Clinical pathology, as well as specialty areas, is required for providing adequate support for Specialty Labs. Our team is now developing solutions, based on the Cerner PathNet platform and other applications, for the Cellular Products, Hematopoietic Stem Cell and Molecular Diagnostics Laboratories at the University of Pittsburgh Medical Center.