Rajendra Singh, MD
Director of Dermatopathology
Nick Trentadue, MD
Presenting a Path for integration of a digital pathology system with the laboratory information system to create innovative pathology-centric workflows
Background: Conventionally, the Laboratory information system (LIS) is the central hub of Anatomic Pathology (AP). Digital pathology is becoming mainstream and integration of digital pathology workflows with the LIS is a fundamental part of any digital pathology implementation, however has yet to be realized by many pathology departments. All laboratory workflows, primary diagnosis, and consultation services are centered around the LIS, along with linkages to prior reports, gross images and descriptions. The LIS also links to the EMRs to showcase associated clinical information and radiology reports. With the use of whole slide imaging (WSI) for primary diagnosis or consultations, messaging standards (e.g. HL7) engines help connect the WSI to clinical metadata. With AI integration, 'intelligent worklists' are being developed that could supplement the LIS for slide review, image reporting, and machine learning outputs. An LIS-centric workflow where all WSI's from anywhere in the world, from any scanner, could link up in the LIS and allow the pathologist to sign out the case would provide the 'best of both worlds' solution for AP.
Methods: A digital pathology platform was developed and integrated in a large hospital setting with clinical workflows to bring WSI (all common file formats) into the LIS for consultations, primary diagnosis as well as facilitate transfer of information between institutions using the same LIS.
Results: Patient metadata uploaded manually or automated through barcode assembly via a watch folder on the scanner server was transferred to the LIS via secure HL7 messaging/FHIR Server. External consultations insourced to the hospital allow internal accession numbers generated in LIS to link to WSI and radiology DICOM images. Reports generated in LIS were transferred securely back to the provider through the HL7 OBX segment. Initial validation studies for concordance between glass slides and WSI using the platform was greater than 95 percent. If the referring institution has the same LIS, HL7 messaging allows automatic transfer of patient metadata along with links to WSI for viewing in both centers.
Conclusion: APLIS-WSI integration improves workflow efficiencies, decreases chances of preanalytical errors, helps improve turnaround time and permits automation. Disadvantages include added steps that require additional planning and initial setup costs. The goal of this presentation is to showcase multiple perspectives of the implementation process and discuss the best path forward for integration of DP into mainstream pathology with the added value of using AI models. Perspectives from the AP Chairs, LIS vendors, workflow creators (DP vendors), and end users (pathologist) will be presented. How do we incorporate a multi-modality digital cockpit provided by vendors with the LIS and enhance case management, workflow, and reporting capabilities for pathologists? How do we integrate AI models and results generated by the models into the reports? Can we simulate consensus meetings/group discussions using the workflows? How does this link to education and research functionalities of the departments? This discussion will help build consensus for workflows that can provide better and faster diagnosis, better patient care and ultimately better reputation and increased business for the hospital systems that go digital.
Dr. Singh is the Director of Dermatopathology at Summit Health, New Jersey. He has held academic positions and worked as a Professor of Pathology at UPMC, Mt. Sinai and Northwell. He is the Founder of PathPresenter, an online digital platform with 50,000+ users in 170+ countries and is used by multiple academic departments, private pathology groups and organizations all over the world. He serves on the Sulzberger Grant Committee of the AAD and on the Editorial Board of JAAD. In 2013, he was awarded the Sulzberger Grant from the AAD for developing interactive tools for teaching of dermatology and dermatopathology. He is the Editor, creator and developer of the app, mydermpath+. He also serves as a member of the Editorial Board of the WHO for Classification of tumors, 5th Edition and the Board of the DPA. He was nominated to the Power List of Pathology in 2020,2021 and 2022.