2005 Breakout Sessions

BREAKOUT SESSION DESCRIPTIONS

A1 The Virtual LIS (V-LIS) as an Emerging IT Architecture for the Clinical Laboratories

Bruce A. Friedman, MD

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The classic LIS has held sway in the clinical laboratories for more than three decades. It was designed as a multifunctional system to support hospital laboratory activities with particular emphasis on work and specimen flow for hospital inpatients and outpatients. The Mission and goals of the hospital lab are now changing rapidly with greater emphasis on such activities as point-of-care testing and outreach testing. In-vitro diagnostic companies are also entering the lab software field with so-called "middleware" products. The goal of this workshop will be to discuss a new LIS architecture that is emerging, the virtual LIS (V-LIS), consisting of a networked set of specialized modules, including the classic LIS , that will better serve the needs of the hospital lab of tomorrow. The greatest technical challenge of the V-LIS will be integration of these various modules, potentially from multiple vendors, in a simple and inexpensive way and also the integration of the V-LIS with clinical systems and databases operating at the health system enterprise level.

After attending this session, participants should be able to:

A2 Whole Slide Imaging: Implementing a Platform for Digital Pathology

John Gilbertson, MD and Jonhan Ho, MD

View Slide Presentation - Gilbertson
View Slide Presentation - Ho

Five years ago, machines designed and marketed as fully automated, high speed, high-resolution whole slide imaging systems were first introduced at APIII. This talk will be an update on whole slide imaging, including the current capabilities image captures platforms as well as issues surrounding enterprise deployment of Whole Slide Imaging for educational, research and clinical applications. The discussion will stress 1) the infrastructure required for capture, storage, presentation and archiving WSI in a large medical center 2) the results of clinical evaluations and 3) issues surrounding support of multiple vendors as well as 4) whole slide based image analysis.

After attending this session, participants should be able to:

A3 caBIG: A Community of Communities to Enhance Cancer Research

J. Robert Beck, MD

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To continue the momentum in oncology treatment and discovery powered by modern biomedical informatics, we must find ways to manage the volume of data and to facilitate collaboration across the spectrum of cancer research. The Cancer Biomedical Informatics Grid (caBIG) has been launched as a principal strategy to address these objectives. The concept underlying caBIG is an informatics infrastructure that will link teams of cancer and biomedical researchers together to enable them to better develop and share tools and data in an open environment with common standards. caBIG was conceived to create a voluntary virtual network (or grid) that would connect individuals and institutions both nationally and internationally, effectively forming a World Wide Web of cancer research. Tools developed to enable this vision are being guided by principles of open source software, open access to data, open development, and federated systems. The systems are interoperable both in their workings (syntactic) and in their use of terms and data structures (semantic). CaBIG is organizing itself to engage the broadest possible spectrum of the oncology research community, in order that its products be widely adopted.

In this talk we will review caBIG's first year of operation, emphasize points of interaction with pathology informatics, and outline progress toward the initiative's five-year goals.

B1 Lab Portals for Anatomic and Clinical Pathology – Nut and Bolts for Successful Selection and Implementation

Walter H. Henricks, MD

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Lab portals are systems that allow laboratories to provide Internet-based test order entry and result reporting for their referring clinicians. For pathology laboratories that expect to attract and maintain outreach business and specimen referrals, deployment of a lab portal system and its data management capabilities may offer a competitive advantage. To select and implement a lab portal system successfully requires assessment of clinical, business, and technical considerations. This session presents practical guidance for selection and implementation of a lab portal system appropriate for your laboratory. Participants will learn key elements in (1) performing a needs assessment relevant to a lab portal, (2) creating a request for proposal (RFP), (3) getting the most from vendor demonstrations and reference checks, (4) evaluating RFP responses and system demonstrations, and (5) implementing the system effectively. Following the formal presentation, the session will be opened for audience discussion.

Objectives:

After attending this session, participants should be able to:

B2 Will Whole Slide Imaging Change the Practice of Pathology? Point - Counter-Point

Ulysses J. Balis, MD and John H. Sinard, MD, PhD

View Slide Presentation - Balis
View Slide Presentation - Sinard

Despite the availability of equipment which can digitally capture an entire microscope slide, this technology has not yet penetrated down to the day-to-day practice of pathology. This presentation will describe how whole slide imaging differs from other, more traditional telemicroscopy technologies, and will discuss its advantages and disadvantages. Then, the two presenters will take opposite sides in a short debate as to whether or not this new technology will impact the clinical practice of anatomical pathology. Attendees will not only learn about whole slide imaging, but will also be able to assess whether or not there is a role for it in their pathology practices.

B3 The National Cancer Institute (NCI) Cancer Biomedical Informatics Grid (caBIG): Current Status and Lessons Learned in the First Year

Joyce C. Niland, PhD and Douglas B. Fridsma, MD, PhD

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The NCI introduced its national biomedical informatics initiative, caBIG, in the Summer of 2003. Since 2004, 46 cancer centers have been funded for the initial 3-year period of this ambitious project. The primary goal of caBIG is to provide for the sharing of common software tools, data, models, methodologies, knowledge, and expertise to facilitate and speed translational cancer research. Cancer center faculty and staff are participating as committee members, potential adopters, or developers in various efforts ongoing across three domain workspaces (Integrative Cancer Research, Clinical Trial Management Systems, and Tissue Banks and Pathology Tools) and two “cross-cutting” workspaces (Architecture and Vocabulary). This session will include representatives from two of the funded centers participating as developers in caBIG, City of Hope National Medical Center and University of Pittsburgh. As an introduction, Joyce Niland will give an overview of the caBIG framework and some of the progress made in the first year, particularly with respect to the Clinical Trials Workspace. The interface of caBIG with other national/international standard setting organizations will be discussed as well. Doug Fridsma then will present the status and lessons learned in developing a Structured Protocol representation that will support future clinical trial creation and management. Next Hemant Shah will discuss the emerging vocabulary processes and standards for representing concepts and data such that information can be readily shared across the grid. Finally, Rebecca Crowley will discuss a practical Tissue Banks and Pathology tool that is under development, the caTIES. An interactive discussion period will conclude the session.

C1 Synoptic Data Entry: Integration of CAP Checklist Data Elements into Pathology Reports

Anil Parwani, MD, PhD and Anthony L. Piccoli, BS

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The College of American Pathologist Cancer Checklists, most recent update Jan 2005, (http://www.cap.org/apps/docs/cancer_protocols/protocols_index.html) were created with the objective of improving the quality and uniformity of information in pathology reports. Starting Jan 1, 2004, the American College of Surgeons Commission on Cancer (ACS CoC) has mandated the use of the CAP checklists for pathology reports. Currently, most LIS Systems do not support discrete data elements for synoptic data elements thus, the CAP checklists have been incorporated as unstructured text blocks which are embedded in the pathology reports. The latter arrangement results in the presentation of pertinent pathology data in a cumbersome and difficult to access format. At UPMC, we have used a "synoptic reporting" tool (Cerner Copath Plus) to incorporate the CAP checklists as discrete data elements, allowing for storage of data elements in a relational table within the LIS. We have created these synoptic worksheets for select organ systems and malignancies such as prostate, melanoma, breast and lung. In this workshop, we will describe our experience in creating the synoptic tools with the overall goal of promoting easy data sharing between the Anatomic Pathology LIS, Cancer Registry and other Clinical and Research systems in Oncology.

Objectives:

The attendee will learn about:

C2 Uses and Limitations of Robotic Telepathology

Keith J. Kaplan, MD

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Telepathology is the practice of digitizing histological or macroscopic images for transmission along telecommunication pathways for diagnosis, consultation, or continuing medical education. Previous sessions have addressed static versus dynamic imaging in several specimen types with a wide variety of systems and communication pathways. There continues to be a growing body of literature validating the use of telepathology for use in routine clinical practice. There are a few telepathology services active in the United States. For a variety of reasons, telepathology has not gained wide acceptance among practicing pathologists. Robotic telepathology provides remote consultation via a remote microscope that can be controlled by the consulting pathologist.

This session will discuss the practical uses and limitations for this technology and how it has been used in a large health care system for consultation.

After attending this session, participants should be able to:

C3 Set the paraffin free … CaTIES a Tool for Annotation and Mobilization of Pathology Data From Free Text Reports

Rebecca S. Crowley, MD, MSIS and Michael Feldman, MD, PhD

View Slide Presentation - Feldman

The Cancer Text Information Extraction System (caTIES) project will utilize and contribute to caBIG Pathology Workspace. caTIES will focus on two important challenges of biomedical informatics; namely, information extraction from free text and access to tissue. Specifically, caTIES has three primary goals:

This presentation will focus on the three areas of caTIES:

At the conclusion of this presentation, participants will have

D1 Specialty Labs and the Electronic Medical Record: Thinking Outside the Box

Michael E. Sendek

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Specialty labs have traditionally presented problems when attempts are made to integrate them into the electronic medical record (EMR). The services provided to these facilities by both classic CP and AP systems are often lacking in one way or the other. CP supports numeric data entry very well and AP systems provide excellent support for textual data. But what happens when the numeric data needs to be heavily annotated with text? Problems arise when systems designed to do one or the other are cobbled together and make do systems result. Workflows are compromised and end-users are rarely satisfied. This discussion will center on one approach to solving these problems that makes use of tools that are not generally considered to be "lab tools" By thinking outside the normal boundaries of the LIS systems a better approach can be devised that leaves end users with a better product.

D1 Approaches to the Interoperable Electronic Surgical Pathology Report

Gunther Schadow, M.D., Ph.D.

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Healthcare information standards have been used successfully for submitting Pathology data into the Electronic Medical Record (EMR) for decades. For chemistry laboratory data, interoperable data submissions works very well and is in fact the most widely used form of interoperable communication of structured EMR data. Conversely, electronic reporting in Surgical Pathology is generally limited to electronic free text documents. While common conventions for formatting these text reports exist in the human Surgical Pathology community, these conventions are limited to section titles and the formatting of the final diagnosis section content. In the last decade we saw and increased interest among pathologists to provide data in a more fine-grained abstracted form, known as "synoptical reports". While these synoptical reports are in principle very well suited for electronic reporting and filing in EMR systems, practically this is next to impossible to do if the synoptic reports are just included in the middle of free text reports. In this talk I will show how the HL7 standard is used in pathology reporting in general, how the use of structured data in surgical pathology could be improved, and how synoptic reporting could be made more accessible to EMR systems and their clinician users.

D2 Virtual Slide Imaging Clinical Applications The Time is Now

Drazen M. Jukic, MD, PhD

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Virtual slide imaging is a technology which utilizes robotic scanning of glass microscopic slide (GMS) to create an image of the entire GMS and thus create a so-called “virtual slide or, more exactly, virtual microscopic slide (VMS). There are several scanners (robots) in existence, and so far, only one fully developed VMS graphic user interface (GUI). In essence, clinical applications of VMS revolve around ability of general pathologists and subspecialty pathologists to utilize computer driven VMS technology in the diagnosis and management of patients in the same way they would utilize microscope driven GMS technology (which is used for approximately 200 years).

In this lecture, we describe several platforms that are in use today and review pros and cons of each platform for potential and real clinical use. We also discuss in detail the structure and results of clinical trials that were carried out to evaluate diagnostic accuracy of VMS and GMS and compare each other for clinical applications. Clinical applications in use currently in our system will be highlighted.

At the end of the session the participant should be able to:

1. Describe the scanning robots, GUIs and hardware needed for creation of clinically driven VMS system
2. Describe the potential of evaluating the VMS over wide or local area network
3. Present use of VMS technology in the clinical environment and its comparison with GMS
4. Describe the basics of starting a clinical trial as it relates to VMS technology
5. Describe the appropriate niche VMS can occupy in your practice
6. Identifying areas of implementation of VMS in your environment, whether this is a large clinical center, university center, large private practice, or small private group

Computer assisted education using whole slide Images

Fred R. Dee, MD

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At the end of the session the participant should be able to:

1. Describe the various educational venues in which WSI may have a role.
2. Describe the various technologies and resources available for implementing WSI into these venues; and their relative cost.
3. Compare the advantages and disadvantages of using WSI vs. traditional microscopy, digital photomicrographs and video microscopy.
4. Evaluate the potential benefits and drawbacks of implementation of WSI in their educational environment.
5. Discuss the future impact WSI may have on the way we teach and learn microscopic anatomy and pathology.

D3 HIPAA, Tissue Banking, and Data Aggregation: New Tools to solve Old Problems

Rajiv Dhir, MD and Susan J. Urda, BS, CTR

View Slide Presentation - Dhir
View Slide Presentation - Urda

Research endeavors involve aggregation of biological materials and data. The tissue support facility is responsible for disbursing the required materials (biological samples and data) to researchers in a de-identified fashion. This need for de-identification has become even more significant with the advent of HIPAA regulations. In addition recent modifications of OHRP regulations provide opportunities for further streamlining, and enhancing, data aggregation for research purposes.

Maintaining the confidentiality of protected health information is very critical and must be addressed appropriately by every research resource. This session will discuss the basic aspects of HIPAA, introduce the concept of an honest broker, discuss basic and expanding data needs, introduce software tools for the tissue and data providers, and demonstrate an honest broker software tool being used routinely by the Tissue Bank and Research Registry teams involved in a collaborative honest broker service at the University of Pittsburgh.

This session will reveal methods for developing a Collaborative Honest Broker Service to support Tissue Banking, Research Information Services and Clinical Trials Research. These collaborative efforts result in the reduction of duplication of activities and streamline the process for de-identification and integration of pathology, tissue bank and cancer registry data. An in-depth overview of the development and management of this collaborative service, examples of processes used in de-identification and tools used to monitor the use of data from multiple data sources will be presented .

Objectives:

At the end of the session the participant should be able to:

1. Describe biological specimen and data annotation in a large academic center.
2. Define HIPAA regulations and OHRP guidelines.
3. Define the functions of an Honest Broker.
4. Define software tools for honest broker activities.
5. Describe integrating and streamlining research workflow.

E1 CIO Panel – Integrating Pathology Data into Oncology and EMR Systems

Ronald D. Workman, MD

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Chief Information Officers of hospitals and health systems will discuss the opportunities, challenges and requirements for integrating data elements from anatomic pathology reports into Tumor Registry, Medical and Radiation Oncology systems in a cancer service line, for coordination of patient treatment plans and outcomes research. The panel will also compare and contrast the options of providing essential pathology IT capabilities within an Electronic Medical Record suite versus from a stand-alone Pathology IT System, and the challenges of integrating pathology reports into the Electronic Medical Record and related systems such as physician and patient portals.

E2 The Technology of Implementing Digital Pathology

Edward M. Smith, ScD, FACNP and David L. Weiss, MD

View Slide Presentation - Smith, part 1
View Slide Presentation - Weiss, part 2
View Slide Presentation - Smith, part 3

Using radiology as a model for the digital pathology information system, there are five components:

This presentation will discuss the latter four components using radiology as the model realizing pathology workflow, visualization and information reporting is quite different than that of radiology. However, from a technological, ergonomic and HIPAA perspective there are great similarities.

E3 Integration of Current Technologies: An Interactive Gathering of Tools Available for the Pathology and Oncology Research Community

Ashokkumar A. Patel, MD

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This session will showcase current tools available for several aspects of tissue banking, research registry, clinical trails, along with imaging and bioinformatics analysis tools for researchers. The demonstration will lead into a hands on, interactive gathering allowing attendees to observe how current technologies are being utilized at several academic medical centers. Discussions will also focus on how utilizing these technologies have impacted the workflow in these key areas. Many of the features shown will be further developed by the caBIG developers.

CLOSING - "Pathology and Oncology Informatics - Opportunities and Threats"

Michael J. Becich, MD, PhD

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Advancing Practice, Instruction and Innovation through Informatics (APIII) was launched in 1996 in collaboration with the Lab InfoTech Summit (LIS, formerly Automated Information Management in the Clinical Laboratory) and is celebrating its 10 year anniversary with the 2005 meeting. Many accomplishments have resulted from the collaboration of APIII and LIS with the Association for Pathology Informatics (API) which was founded in 2001. The goal of this lecture will be to do a SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis in the areas of Pathology and Oncology Informatics and paint a clear picture of the future. The overall objectives include: