Informatics tools useful in solving the credentialing and competency assessment standards of the Joint Commission on Accreditation of Healthcare Organizations, a comparison of manual slide vs. digital slide methods
Lewis, Allen, Hassell ; Oklahoma University;
Content:
The Joint Commission has in 2008 proposed new standards for the credentialing of physicians that pose challenges in pathology. We have elsewhere proposed a three tiered process for the assessment of competency of newly credentialed pathologists in anatomic pathology involving a test composed of locally representative materials, followed by proctored review of skills with live cases and then finally, selective review of specifically identified areas of weakness or unknown ability. We explore in this project the role of digitized slide images as an alternative to glass slides in the initial testing phase of this assessment.
Technology:
Whole slide digitized images of complete cases captured using the Aperio slide scanner and viewed using the Imagescope software. (Aperio Technologies, Vista, CA USA)
Design:
Overall diagnostic error standards were determined for existing staff using a retrospective review of cases from each sign-out service. Mean and standard deviation from a perfect score was established using a weighted scoring system. Representative cases from each service were selected as a test group for newly hired members of the department and for potential use as an on-going competency test for existing staff at the time of re-credentialing. Slides from these cases were scanned. A test scenario was composed of a representative volume of cases from a single days workload. New staff members were given the test, using validated but differing slide sets in both glass and digital formats. Diagnostic error and overall defect rates were collected and scored on the weighted scale and compared.
Results:
Three newly hired and three current staff pathologists with anatomic pathology privileges were assessed during the study period. The results from digital slide review were comparable in terms of diagnostic assessment overall, rare event detection, and subtle feature detection. Performance with glass slides was comparable to established standards by existing staff.
Conclusion:
These results show the utility of using digitized slides for competency assessment measures in anatomic pathology. This facilitates the process measures needed to address the concerns driving expanded credentialing stringency. We continue to emphasize the need for these assessments to be based on local materials and standards, rather than from centralized digital slide repositories.
