2007 Breakout Sessions

Monday, September 10, 2007

A1  Imaging as an Emerging Specialty in Pathology
John R. Gilbertson MD
Presentation

This introductory presentation for the conference's imaging track focuses on the strategic importance of imaging to surgical pathology in the age of molecular medicine. It discusses the status of the core imaging technologies (optics, robotics, contrast agents, computational analysis, image management, display and systems integration), the importance of an  interdisciplinary approach, and the potential drivers for clinical implementation and the emerging development of imaging divisions in academic medical centers.

The relatively new ability to image large numbers of entire slides automatically, rapidly and at high resolution is changing the way pathologists are thinking about imaging in their practice. In this talk, Dr Brodsky will discuss the basics of whole slide Imaging systems, their current capabilities, limitations and ongoing development   and the challenges involved in integrating them in a working pathology environment. The discussion will stress advances in image capture and management as well as the issues involved in implementing a whole slide imaging device in a pathology department.

After attending this session, participants should be able to:

A2  Duling Hackers
James H. Harrison, Jr., MD,  PhD  and  Paul G. Catrou, MD
Presentation 1
Presentation 2

"Hacking," the art of rapidly developing small, useful computer programs can be an effective way to extend or add new features to clinical laboratory systems. These small programs can contribute to  laboratory workflow, reduce clerical time or enable new quality assurance activities by rapidly processing data extracted from clinical systems. Modern commercial and open source (free) programming  environments offer relatively low learning curves, short software development times and quick debugging. Drs. Harrison and  Catrou will simultaneously present and critique, in "point-counter-point" fashion, their own ideas about software development in the  laboratory including a survey of languages (C, C++ , Java, M/Mumps, Visual Basic, Python, Ruby and Perl) and examples from their own experience. The session will finish with a demonstration of the development of a short program in Visual Basic and Python.

By the close of the session, attendees will be able to:

B1  Towards the Goal of Clinically-Deployed Searchable Image Repositories
 Ulysses J. Balis, MD
Presentation

By the end of this presentation, the participant should be able to:   

Multispectral Imaging - Update
Michael D. Feldman, MD, PhD
Presentation

Multispectral imaging provides a methodology to illuminate one or more chromogenically of fluorescently labeled antibodies in surgical pathology. This technology facilitates the utilization of multiple simultaneous antibodies to study human disease. These antibodies can be in different or overlapping subcellular compartments. Applications of a system to study at the cytometric level, one or more antibodies in tissue sections will be described.

By the end of this presentation, the participant should be able to:

B2 Pathology as a Data Source for Public Health - Moderated by Raymond D. Aller, MD
Presentation

Implementation of Synoptic Pathology Reporting Processes and the Impact on Public Health Repositories
Anil V. Parwani, MD., PhD and Sharon B. Winters, MS, RHIA, CTR
Presentation

“Synoptic reporting” is becoming more common in the anatomic pathology community, however often times the end- result continues to be free-text based report rather than capturing discrete data elements in a structured report within the anatomic pathology laboratory information system (APLIS).  The College of American Pathologists (CAP) cancer checklists were created with the objective of improving the quality and uniformity of information in pathology reports. At our facility, we have implemented a synoptic reporting tool to incorporate the CAP checklists as discrete data elements, allowing for storage of data elements in a relational table within the APLIS. This also allows the cancer registry to obtain this information in a standardized manner. In this workshop, we will describe our experience regarding the utility, quality and completeness of synoptic reporting by our pathologists for surgical specimens related to cancers such as lung, colon, gynecologic sites, head and neck and hematologic sites. We will also present a brief summary of findings from collaborative projects funded by CDC and CAP with a focus on the utility of synoptic reporting for quality assurance and completeness of pathology data for distribution to public health repositories and archives such as population-based cancer registries.

After attending this session, participant should be able to:

Death Investigation and Forensic Pathology Data – Uses and Issues in Public Health
Randy Hanzlick, MD
Presentation

This presentation will include discussion of the growing use of medical examiner and coroner data for public health purposes, along with descriptions of various data systems and programs that rely upon such data. Factors which hamper the standardized collection and use of medical examiner/coroner data will also be described. The history of CDC’s Medical Examiner/Coroner Information Sharing Program, and its decline, will be included. The positive and negative impact of data sharing on medical examiner/coroner offices will also be discussed.

After attending this session, participant should be able to:

B3 Evolution of Digital Pathology in the U.S. Military
Robert C. Zalme, MS, DDS; Bruce H. Williams, DVM, DACVP; Keith Kaplan, MD; Timothy Lacy, MD; and Scott Gilstrap
Presentation

Having medical centers widely scattered across the globe with limited access to experts, military pathologists are seeing obvious benefits in digitization of pathology, and especially in using telepathology to share those images with colleagues at remote locations.  All three military medical services and the AFIP have begun the development of digital capabilities utilizing whole slide imaging, robotic microscopes, repository collections, education, and remote conferencing with both video and  web technologies.  This session will discuss the multifaceted developments at the AFIP, the robust worldwide robotic network of the Army; the whole slide imaging and web conferencing of the Air Force; and the tumor board video conferencing of the Navy.  DoD support for these technologies and their role in advancing modernized military medicine will also be discussed.  While offering tremendous value, implementation of digital pathology telepathology still experiences significant growing pains, in particular, work flow shifts, staff resistance to new technologies, and enormous computer security certification issues.  We will share our experiences, the obstacles, successes and failures.    

API FOCUS SESSION: The Role of Pathology and Oncology Informatics in Translational Medicine

As part of a broad re-engineering effort to transform clinical and translational research in the US, the NIH has launched new initiatives such as the Clinical and Translational Science Award (CTSA) Consortium and the Rapid Access to Interventional Development (RAID) Pilot Program This session will focus on the role of pathology and oncology informatics in supporting these types of initiatives. The speakers will present examples of three programs at major academic centers aimed at providing informatics support to clinical and translational research. Discussion of national initiatives such as caBIG and the Clinical and Translational Science Awards as well as solutions for strategic issues with web tools will be presented.

By the end of the sessions the participant will be able to:

Role of Oncology Informatics and caBIG in Translational Medicine - Lessons Learned from Clinical and Translational Science Awards Program
Michael J. Becich, MD PhD
Presentation

The presentation will focus on the utility of oncology informatics, particularly the Cancer Biomedical Informatics Grid (caBIG) initiative in Translational Medicine.  The Nati10/15/2007 12 sites through the NIH Roadmap Initiative - Clinical and Translational Science Awards (CTSA).  CTSA is an innovative program that is focused on transforming clinical research.  The lecture will focus on how oncology informatics, particularly caBIG will significantly contribute to this important new program.

By the end of the session, the participant will be able to:

Enabling Clinical and Translational Research through Informatics
Rajesh C. Dash, MD
Presentation

Many academic medical centers are faced with barriers that hamper research due to suboptimal access to clinical care data.  While many institutions provide their faculty with outstanding clinical information systems for care of the individual patient, information systems for research have a very different set of requirements.  This presentation will present research enabling technologies and how they might be deployed to facilitate research at multiple levels.

By the end of the session, the participant will be able to:

Biomedical Informatics and the Duke Translational Medicine Institute
Ricardo Pietrobon, MD, PhD, MBA
Presentation

This presentation will demonstrate a series of Web applications currently used by the Duke Translational Medicine Institute to promote the tasks performed by sites while conducting multi-center clinical research projects.

Tuesday, September 11, 2007

C1 Technical Tutorial on Array Microscopy
Michael R. Descour, PhD
Presentation

The compound microscope made its first appearance in the late 1500’s.  This imaging instrument’s basic form has remained relatively unaltered to follow its function as an analog device that extends the capabilities of the human eye.  Starting with the invention in 1973 of the ch10/15/2007oscope and digital camera has become increasingly ubiquitous. 

We will discuss a new form of light microscope resulting from the trend towards digital imaging in microscopy:  The array microscope.  This imaging device combines tens of miniature microscope objectives in one instrument.  As a result, the trade-off between higher resolution and reduced field of   view is severed.  Furthermore, the array microscope enables ultrafast imaging of objects such as microscope slides.  The array microscope is finding use in pre-clinical research, in education, and in research clinical applications.          

At the conclusion of the presentation, the participant will be able to:

Evaluating in Vivo Biomarkers with Multi-Modality Molecular Imaging
Mark D. Pagel, PhD
Presentation

Molecular imaging can evaluate in vivo biomarkers with CT, PET and SPECT10/15/2007l imaging modalities.  Biomedical applications include evaluations of gene expressions, protein interactions, and enzyme activities, and identifications of receptors and metabolites.  To simultaneously investigate multiple biomedical applications, new methods have been developed to simultaneously detect multiple biomarkers with a single imaging modality or with multiple modalities. However, many hurdles remain before in vivo molecular imaging of multiple biomarkers can be applied as a surrogate endpoint for detecting pathological tissues and monitoring therapeutic efficacies.  This presentation will highlight the current progress and remaining hurdles for applying multi-modality molecular imaging to detect multiple in vivo biomarkers. 

After attending this session, participant should be able to:


C2  Information Systems for Molecular Diagnostics and Other Specialty Laboratories 
Dr. Carter and Dr. Monzon
Presentation 1
Presentation 2

Specialty laboratories within Pathology Departments, such as Molecular Diagnostics or Tissue Typing,  have data management needs that are not adequately supported by AP or CP laboratory information systems. These needs have often been met by adapting existing solutions with varying degrees of success. This session, will provide an overview of the challenges and existing solutions for information management in these laboratories.

By the end of this presentation, the participant will gain knowledge about:


D1  Image Management (PACS 2007 Session) The Challenges of Healthcare Enterprise Image Data Management
John S. Koller
Presentation

This session will cover unique issues of the management of the large data objects and large data   volumes generated by digital pathology.  We will discuss the evolution of other imaging departments / modalities, the lessons learned and the requirements / challenges for an enterprise solution design perspective. 

Performance Issues with Whole-Slide Imaging
Ole Eichhorn
Presentation

This session will discuss various issues and solutions for whole-slide imaging in Pathology, including acquisition time, image quality, file size, compression techniques, and interoperability, as well as viewing considerations (rapid pan and zoom, incremental data transmission), image analysis processing, and storage considerations, including compatibility with standards such as DICOM and interfaces to existing medical imaging systems such as PACS.

By the end of this presentation, the participants should be able to: 

D2  Laboratory Informatics: Becoming a Key Hub in the Hospital Information Network
Anand Dighe, MD, PhD
Presentation

This presentation will examine the current and future roles of the laboratory in providing clinical decision support, from test ordering to result interpretation. It will demonstrate how the laboratory can become an integral hub in an information network that broadly supports quality and patient safety throughout the organization.   Also examined will be the pivotal role that the laboratory can play in re-inventing healthcare systems as high reliability organizations.


Survival Guide for a Pathologist Informatician in a Large Healthcare System
Bruce A. Friedman, MD
Presentation

By the end of this presentation, the participants should be able to: 

CAP Today / CAP FOCUS SESSION: Improving Patient Care with Health Information Technology: Successes & Challenges

This focus session will provide attendees the opportunity to hear about three specific projects aimed at improving patient safety through the development and implementation of health information technology (HIT) tools. Tools that will be discussed include an ontology modeled in OWL that may allow standardization of adverse event and near miss incident reporting, a clinical decision support system designed to allow for more complex reasoning and the use of more extensive clinical knowledge, and a computerized order entry system that allows for improved compliance with clinical guidelines. Investigators will discuss both the successes and the challenges they have experienced with implementation of HIT.

By the end of the sessions the participant will be able to:

Building an Ontology of Adverse Event and Near Miss Data: Information Gleaned from The Patient Safety Event Taxonomy (PSET) Project  
Mariana Casella dos Santos, MD
Presentation

Concerns about safety in patient care have called attention to the need for governmental agencies and private sector accrediting bodies to work together with health care organizations to coordinate the monitoring, reporting, and analysis of medical errors.  Toward an Optimal Patient Safety Information System (TOPSIS) is a three year health information technology/patient safety grant funded by the DHHS Agency for Healthcare Research and Quality. It is being conducted by the Joint Commission in conjunction with Joint Commission Resources and the Survey Research Laboratory at the University of Illinois (Chicago).  The HIRO ontology was developed using the Patient Safety Event Taxonomy and de-identified hospital incident reports.  The entire ontology, including terminologies, is modeled in OWL to allow maximal expressivity. HIRO will demonstrate the feasibility and clinical value of using an  ontology to combine, compare, and analyze data from across many public and private incident reporting systems in collecting adverse events and near misses for patient safety.  

By the end of the session, the participant will be able to:

Automating Clinical Practice Guidelines with ATHENA Decision Support System
Mary K. Goldstein, MD, MS in HSR
Presentation

Clinical decision support systems integrated with electronic medical records can bring up-to-date guideline
recommendations, individualized to the patient's clinical data, directly to the health care provider at the time of clinical care.  Newer knowledge-based systems can go far beyond clinical reminders to allow for more complex reasoning and more extensive clinical knowledge to be used in generating recommendations.  Computer graphics can present information in ways that make it easier for clinicians to see relationships and patterns in the clinical data.  This session will describe the development, implementation, and evaluation of ATHENA-Hypertension, a knowledge-based clinical decision support system for managing hypertension in primary care clinics.

By the end of the session, the participant will be able to:

Clinical Guideline Implementation with Order Sets in a Commercial Emergency Department Information System
Phillip V. Asaro, MD
Presentation

Clinical guidelines may improve patient care, but effective implementation is challenging. Computerized provider order entry offers an opportunity for enhancing compliance with guidelines, but commercial systems are limited in functionality. This presentation will include a description of the implementation of a guideline for acute coronary syndrome, an analysis of its effectiveness, and a discussion of the challenges involved.

Objective: Awareness of the challenges involved in using order sets in computerized provider order entry to deliver clinical guidelines.

Wednesday, September 12, 2007

E1 Telepathology to Support Patient Care at Remote Facilities
Bruce E. Dunn, MD
Presentation

Telepathology involves the transmission and viewing of video and static images for the purposes of rendering primary or consultative diagnoses by pathologists at a distance. Since mid-1996 we have operated a routine telepathology service using a commercially available, robotic, hybrid dynamic store-and-forward system between the Iron Mountain (MI) and Milwaukee (WI) Veterans Affairs Medical Centers which are separated by a distance of over 220 miles. Pathologists located in Milwaukee can control slide movement, adjust the focus and change the objectives and lighting intensity on the robotically controlled microscope located in Iron Mountain. This service was implemented as a cost- effective alternative to maintain frozen section diagnostic capability and to provide more timely routine pathology service upon the retirement of a single on-site pathologist. Our initial feasibility study of 100 cases published in 1997 demonstrated that for routine surgical pathology cases the accuracy of robotic HDSF pathology was not significantly different from that of light microscopy compared to consensus diagnoses. Subsequent work published in 1999 involving our first 2200 cases validated these observations. To date, we have rendered over 9,000 primary diagnoses by robotic telepathology. Based on the success of the Iron Mountain-Milwaukee program in surgical pathology, non- robotic telepathology units were installed at all other facilities in Veterans Integrated Service Network 12 (headquartered in Chicago) in 1999 to support clinical laboratory functions such as review of gram stains, review of peripheral blood smears and provision of real-time conferences. In general, clinician satisfaction with telepathology services has been very high.

After attending the session, participants should be able to:


“Frozen Section Interpretation by Telepathology:  Lessons Learned from Neuropathology”
Craig M. Horbinski, MD, PhD
Presentation

Over the past decade the technology to distribute microscopic images in a real time fashion has progressed to the stage that telepathology can now be seriously considered as a economical means of distributing pathology expertise. Six years ago the Division of Neuropathology at UPMC began to utilize an evolving variety of imaging technologies to distribute Neuropathology intra-operative consultations to an affiliate hospital. While we believed that clearing the technological hurdles would guarantee the success of the system, in reality numerous hidden human engineering issues presented substantial obstacles to successfully implanting the consultation service.

By the end of this presentation, the participant will gain a better appreciation for the non-technical issues related to telepathological intra-operative consultation. The participant will learn what issues need to be considered before implementing a telepathology consult and how to circumvent some of the many pitfalls.

E2 Pathology and Oncology Informatics-An International Perspective Pathology Informatics in Korea: Past and Present
Hee-Jae Joo, MD

 Despite its short fifteen years history, the pathology informatics has been well established in Korea.  This presentation will introduce a brief history of the Pathology informatics and its current status of application in the field of diagnosis, education and research in Korea.

Application for Acquisition and Management of Pathology Image in Korea
Sang-Yeop Yi, M.D, PhD
Presentation

Automatic digital gross photography system (DGPS) using hands-free control of digital camera provides adjust image frame through a large-size live video in a photography stand. This system is efficient for automatic image sorting, file naming, tracking, and transferring of images to an image server. It is useful gross image archival system for microscopic diagnosis, conferences, and other academic activities. The DGPS changes the conventional gross  workflow markedly easier.

Pathology-oriented PACS (PathPACS) for systematic management of digital images including gross, microscope, and molecular work is efficient for automatic digital image acquisition and management. It is easy to search and retrieve reports and images with customized parameters. This system supports DICOM protocol for PACS integration providing either a subsystem of PACS or a stand-alone PACS for the Pathology Department. It can support remote customer service and management. These systems are practical, convenient, and efficient for Pathology Department. This presentation will talk the installation and use of DGPS and PathPACS in Korea.

Genome-wide Scanning to Discover Genetic Determinants of Colorectal Cancer Risk
Brent Zanke MD PhD FRCPC
Presentation

By the end of this presentation , the participants should be able to:   

F1 Whole Slide Imaging Development of a consultative practice at UCD
Jose Galvez, MD
Presentation

 This presentation will cover the current issues surrounding WSI and what needs to be done to improve the WSI model for the routine delivery of pathology to scientific colleagues.  Specifically how are these images currently being used by our colleagues, and how can we better serve their needs.  This presentation will also include discussion regarding current issues surrounding WSI such as method of delivery, images analysis and use of images in publications. 

By the end of this presentation, attendees should be able to:

Applications of Digital Imaging in an Academic Pathology Department
Anil Parwani, MD, PhD
Presentation

Imaging plays a pivotal role in modern pathology practice and is a driving technology requirement within the laboratory environment. Many LIS vendors are incorporating digital images in their systems and we are beginning to see an increase in capture, storage, and retrieval of images handled by the APLIS.

Pathology images present significant challenges in labeling, storage, and management and in many academic pathology departments, significant effort is put into applications of digital images both static and whole slide images. At our  institute, digital images have been used for many years and are used in multiple clinical settings including their deployment in pathology reports, conferences, presentations, quality assurance studies and creation of teaching sets of rare and archival material, and telepathology applications. These images are also published as a collection archived images on the Internet or local intranet for teaching. 

We also use digital images for teaching conferences, tumor boards, publications, and medical meetings. Using webcasting, hundreds of conferences are delivered across a community of hospitals within or outside our networks for teaching, professional training and quality assurance studies. Other applications for digital images at our institute are for remote pathology applications including consultations and frozen section diagnosis.

After attending this session, participants should be able to:

F2 An Introduction to Healthcare Interoperability      
Duane Falk
Presentation

Interfaces among healthcare computer applications have enhanced the availability of data to healthcare professionals.  However, interfaces alone are not enough to achieve integration and presentation of information in ways that maintain its meaning and full value across systems. As healthcare systems recognize the need to span disparate clinical systems within their own organization or to work with other organizations in regional groups, another layer of integration technology is getting more attention: ‘interoperability’. The promise of interoperability is not only to move data among systems, but to unify and preserve the meaning of the data using standard vocabularies and semantic concepts.  In addition interoperability solutions provide a framework which allows access to the full healthcare dataset via standard methods and provides a basis on which decision support and rules processes can run, supporting enterprise-level clinical and administrative services.

This presentation will describe the challenges that healthcare professionals face as a result of partial data availability and how interoperability can help address those. It will cover the technology approaches and the clinical process and policy challenges of implementing interoperability as well as the opportunities that is presents for enhancing IT support of healthcare.

By the end of this presentation, the participants should be able to:   

Interoperability of Pathology Data through the EHR
Gunther Schadow, MD, PhD  
Presentation

This session will provide an overview of present standards and strategies for integrating pathology data within and  across the enterprise through the Electronic Health Record. Questions addressed are:

The approach will emphasise on the role of standards, both HL7 version 2 and version 3 to supports this vision. In particular, the benefits of a consistent model across all aspects of health care (including EHR, laboratory automation, and pathology data) will be demonstrated, and a glimpse of a future advanced interaction between LIS and EHR will be provided.


HL7 Person – John Gilbertson

Association for Pathology Informatics (API) Membership Meeting

The Association for Pathology Informatics (API), a joint-sponsor of APIII, will hold an annual business meeting and informational session at APIII 2007. This meeting is open to members, as well as non-members, who may be interested in joining API. The mission of the API is to advance pathology informatics as an academic discipline and a rapidly expanding clinical subspecialty of pathology.

The main goal of the business meeting will be to update members and prospective members on API organizational activities and progress. The meeting also provides an opportunity for prospective members to meet the API leadership and learn about API's member services and active projects. Anyone involved in or interested in any aspect of pathology informatics is strongly encouraged to join API. Membership application materials, for those wishing to join API, will be available through the APIII conference and are also available on-line at http://www.pathologyinformatics.org.

G1 Virtual Pathology: Imaging, the internet and the US Labs experience
Dennis P. O'Malley, MD
Presentation

An increasing trend in pathology practices is to develop partnerships with reference laboratories. These partnerships expand the capacities of the referring lab by allow the reference laboratory to maintain the staff and infrastructure for specialized or rarely used assays, but allow the referring lab to continue to perform the interpretational aspects of these procedures.

This session will discuss the use of references laboratories (specifically US Labs) to enhance the capacities and functionalities of your own pathology laboratory. Specific topic and demonstrations will include the use of:

By the end of this presentation, the participants should be able to:   

Development and Distribution of Transplant Pathology Utilizing Internet and Imaging Tools
Anthony J. Demetris, MD
Presentation

The presentation will describe use of the internet and imaging tools to create and distribute expertise in a specialty area of pathology.  The developments will be traced over a period of 10 years when the service evolved from a web page intended to educate and standardize practice to current use of a "digital pathology suite" used to conduct multi-center trials and create "community research resources".

By the end of this presentation, the participants should be able to:  

G2 Showcase of Selected Pathology Informatics Programs
Ulysses J. Balis, MD and Mark J. Routbort, MD, PhD  
Presentation

This session is oriented to pathology informatics trainees and will provide an overview the Pathology Informatics programs at two institutions: University of Michigan, which has a long standing reputation for excellence in pathology informatics, and MD Anderson Cancer Center who is one of the new up and coming programs. The speakers will present their initiatives on service, research and training in Pathology Informatics.