John H. Sinard, MD, PhD John H. Sinard, MD, PhD Neil Mutnick Neil Mutnick Peter Gershkovich, MD, MHA Peter Gershkovich, MD, MHA Pathology Informatics Pathology Informatics Yale University School of Medicine Yale University School of Medicine Histology Asset Tracking Histology Asset Tracking Dashboard: Dashboard: Real-time monitoring and dynamic work Real-time monitoring and dynamic work lists lists Pathology Informatics 2010 Pathology Informatics 2010
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John H. Sinard, MD, PhDJohn H. Sinard, MD, PhDNeil MutnickNeil Mutnick
Peter Gershkovich, MD, MHAPeter Gershkovich, MD, MHA
Pathology InformaticsPathology InformaticsYale University School of MedicineYale University School of Medicine
Histology Asset Tracking Dashboard:Histology Asset Tracking Dashboard:Real-time monitoring and dynamic work listsReal-time monitoring and dynamic work lists
• Level I: AuditingLevel I: Auditing• Post events for each asset (what, when, who)Post events for each asset (what, when, who)• Allows auditing and workflow analysisAllows auditing and workflow analysis
• Level II: Constrained Status ProgressionLevel II: Constrained Status Progression• Assures appropriate asset used at appropriate timeAssures appropriate asset used at appropriate time• Promotes patient safetyPromotes patient safety
• Level III: Drive WorkflowLevel III: Drive Workflow• Dynamic to-do listsDynamic to-do lists• Identify assets which are falling behind real-timeIdentify assets which are falling behind real-time
John H. Sinard, MD, PhD
Barcodes in Tracking SoftwareBarcodes in Tracking Software
• Barcodes are not magicalBarcodes are not magical• Simply allow easy and accurate entrySimply allow easy and accurate entry• Makes it feasible to “enter” asset location at many time pointsMakes it feasible to “enter” asset location at many time points• ““Entry” can be accompanied by checks / constraintsEntry” can be accompanied by checks / constraints
• Human readable ID vs an internal key?Human readable ID vs an internal key?• Usability outside of the system holding the keyUsability outside of the system holding the key• Resistance to damage of the barcodeResistance to damage of the barcode• Backward compatibility with unlabeled assetsBackward compatibility with unlabeled assets• Conversion from one LIS to anotherConversion from one LIS to another• Length of identifier (and thus size of the barcode) Length of identifier (and thus size of the barcode)
John H. Sinard, MD, PhD
Prerequisites for Successful TrackingPrerequisites for Successful Tracking
• Individually identify each assetIndividually identify each asset• Blocks already doneBlocks already done• Slides: block and stain not sufficientSlides: block and stain not sufficient
• Assure accurate asset labelingAssure accurate asset labeling• Just-in-time labeling: generate label at same time as assetJust-in-time labeling: generate label at same time as asset
• One piece workflow – no batchingOne piece workflow – no batching
• Validate labeling if asset and label generated asynchronouslyValidate labeling if asset and label generated asynchronously
• Compatibility with workflow and resourcesCompatibility with workflow and resources• Clever people will find a way to circumvent constraintsClever people will find a way to circumvent constraints
John H. Sinard, MD, PhD
Slide NumberSlide Number
• Sequentially number slides as they are cut Sequentially number slides as they are cut from the blockfrom the block
• Can follow lesions through successive levelsCan follow lesions through successive levels• When ordering a stain on an unstained slide, can When ordering a stain on an unstained slide, can specify the level to be usedspecify the level to be used
• Places additional constraints on tracking systemPlaces additional constraints on tracking system• Have to assign slide number at the time of slide cutting, not orderingHave to assign slide number at the time of slide cutting, not ordering• Using an existing slide (eg unstained) requires modifying the Using an existing slide (eg unstained) requires modifying the
information about that slide; can’t add a new stain with a comment of information about that slide; can’t add a new stain with a comment of “use level 5”“use level 5”
John H. Sinard, MD, PhD
Assuring Accuracy of Asset LabelingAssuring Accuracy of Asset Labeling
• Blocks:Blocks:• Pre-make cassettes with unique block numbersPre-make cassettes with unique block numbers• Enter blocks into LIS by scanningEnter blocks into LIS by scanning
• Assures correct case number (patient safety)Assures correct case number (patient safety)• Confirms uniqueness of block numberConfirms uniqueness of block number
• Slides:Slides:• Scan block at microtome: print labels for slidesScan block at microtome: print labels for slides• Tentative slide numbers locked in by scanning the Tentative slide numbers locked in by scanning the cut, labeled slide to confirm successful cuttingcut, labeled slide to confirm successful cutting
• Just because a label prints doesn’t mean there is a slide Just because a label prints doesn’t mean there is a slide
John H. Sinard, MD, PhD
Ordering Blocks in LIS after PreprintingOrdering Blocks in LIS after Preprinting
John H. Sinard, MD, PhD
Barcoded Block WizardBarcoded Block Wizard
John H. Sinard, MD, PhD
S10-5010 01-01
Asset Status ProgressionAsset Status Progression
• Control WorkflowControl Workflow• Only allow assets to progress to a new status from an Only allow assets to progress to a new status from an appropriate old status(es), and in the correct contextappropriate old status(es), and in the correct context
• Need additional statuses to accommodate alternative Need additional statuses to accommodate alternative workflow pathwaysworkflow pathways
• Drive WorkflowDrive Workflow• Use asset status to determine not where it has been Use asset status to determine not where it has been but rather where it is goingbut rather where it is going
• Status of asset (and perhaps associated assets) should Status of asset (and perhaps associated assets) should determine next process, independent of asset historydetermine next process, independent of asset history
• There are different degrees to which an There are different degrees to which an asset tracking system can be implementedasset tracking system can be implemented
• Know what it is you want to achieveKnow what it is you want to achieve
• Dashboards can be a useful tool for...Dashboards can be a useful tool for...
...monitoring and driving workflow...monitoring and driving workflow
