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Optimized Document Management in Anatomic Pathology – Two Paths to a Common Workflow with Analysis of Benefits

Mark Routbort MD PhD1; Erin Grimm, MD2; Rodney Schmidt MD PhD2. (schmidtr@u.washington.edu); 1Department of Hematopathology, MD Anderson Cancer Center, Houston, TX; 2University of Washington, Seattle, WA.

Context:

  • The management of paperwork associated with anatomic pathology workflow can be logistically daunting
  • Traditional systems to manage and archive paper can be complex and expensive
  • Our two institutions took independent approaches to convert to electronic document management, yet converged on similar final systems and workflow
  • We each analyzed our workflow and the benefits of implementation

Technology:  Both institutions used Canon 3080 CII high-speed scanners and developed middleware software (Microsoft VB/C#/.Net 2.0 and C#/.Net 2.0) to insert images into the AP-LIS (PowerPath, IMPAC, Mountain View, CA) via TWAIN interfaces.

Design:  In the UW baseline process, paperwork was copied at the time of accessioning, the originals archived and additional copies prepared as needed.  UW first implemented document scanning into PowerPath using "out-of-the-box" system functionality.  A cost-benefit analysis revealed poor scanning workflow as the largest remaining ‘cost’.  A new middleware application was written to optimize workflow and a follow-up survey was done.

The baseline MDACC process was entirely paper-based up until the point of case finalization; then, documents were scanned by a third-party vendor and imported into an existing electronic document management system (Documentum).  MDACC first built a middleware application with scanning functionality then implemented document scanning at the time of accessioning.  System validation was done and benefits assessed.

Results:  Both institutions achieved direct savings including copying costs and consumables. Obviation of the MDACC external archival scanning process in particular resulted in a single step savings of  over $50,000/yr.  Experience at UW clearly demonstrated the value of optimizing workflow during the scanning step.  Both institutions also achieved large indirect benefits of having the document imaging integrated within the AP-LIS, including instant and 24x7 access to paperwork, streamlined conference preparation, visibility at remote locations, and research support. 

Conclusion:  UW and MDACC had different baseline processes for handling paperwork and both embarked on independent approaches to optimizing their process, yet both converged on similar solutions.  Our experience confirms that electronic archiving of paperwork has large dir07/18/2006P-LIS is of great value, and that workflow during the scanning step is critically important.