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Introducing New Technology into an Old Grossing Facility: Hands-Free Computing to Facilitate Grossing Workflow
Mark J. 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: The limitations to technology implementation with in most grossing laboratories include physical space shortages, lack of auxiliary requirements such as power and network availability, cultural and social resistance to change, and potential contamination/ hazards in the harsh grossing room environment. Each of these formed a challenge to implementation of workflow optimization in our grossing room, which was predicated on computer access to drive workflow, but for which a complete facility overhaul was not feasible.
Technology: PathStation, a custom VB.NET application which is capable of synchronizing case and patient context across several unrelated institutional applications, was used as the foundation to our new grossing workflow. Touch panel monitors (Elo), articulated mounting arms (Ergotron), and USB-based bar code scanners (Symbol) were used to bring computer access and workflow integration to the grossing stations. The computers themselves were small form-factor machines mounted remotely above the grossing workbench. Customized touch panel keyboards using a freeware application (Click-N-Type, Lake Software) were used to drive the user login process.
Design: Our modified workflow begins with on-demand printing of specimen and requisition bar code labels, which are subsequently used to automatically drive downstream dictation and other workflow at the grossing stations. Our integration approach to running PathStation eliminates the need to routinely interact with the computer during the grossing process, but still allows users to easily look up required patient- or case-specific information on demand via a touch-driven interface.
Results: Implementation pilots showed that users had a strong preference to remain completely “hands-free” in the grossing process with respect to the computer. This resulted in iterative improvements to the integration solution. For instance, custom integration of a foot pedal driver was used to “overload” pedal function by way of double-clicks in order to provide a wider dictionary of foot-driven commands.
Conclusion: Our workflow optimization engine software facilitates an innovative implementation of hands-free grossing, in a legacy grossing facility. Inadequate space concerns, poorly located power and network jacks, users resistance to keyboard/mouse interactions during the grossing process, and requirements to keep computer hardware free of contamination all represented challenges to implementation. Using touch screen computers, barcode driven application automation, small form factor computers, and multifunction foot pedals, we have successfully overcome these challenges in a manner which provides a framework for future workflow and functional enhancement.