Histology Asset Tracking Dashboard: Real-time monitoring and dynamic work lists

1. Histology Asset Tracking Dashboard:Real-time monitoring and dynamic work lists Pathology Informatics 2010

2. Tracking Software “Complexity” • Level I: Auditing • Post events for each asset (what, when, who) • Allows auditing and workflow analysis • Level II: Constrained Status Progression • Assures appropriate asset used at appropriate time • Promotes patient safety • Level III: Drive Workflow • Dynamic to-do lists • Identify assets which are falling behind real-time John H. Sinard, MD, PhD

3. Barcodes in Tracking Software • Barcodes are not magical • Simply allow easy and accurate entry • Makes it feasible to “enter” asset location at many time points • “Entry” can be accompanied by checks / constraints • Human readable ID vs an internal key? • Usability outside of the system holding the key • Resistance to damage of the barcode • Backward compatibility with unlabeled assets • Conversion from one LIS to another • Length of identifier (and thus size of the barcode) John H. Sinard, MD, PhD

4. Prerequisites for Successful Tracking • Individually identify each asset • Blocks already done • Slides: block and stain not sufficient • Assure accurate asset labeling • Just-in-time labeling: generate label at same time as asset • One piece workflow – no batching • Validate labeling if asset and label generated asynchronously • Compatibility with workflow and resources • Clever people will find a way to circumvent constraints John H. Sinard, MD, PhD

5. Slide Number • Sequentially number slides as they are cut from the block • Can follow lesions through successive levels • When ordering a stain on an unstained slide, can specify the level to be used • Places additional constraints on tracking system • Have to assign slide number at the time of slide cutting, not ordering • Using an existing slide (eg unstained) requires modifying the information about that slide; can’t add a new stain with a comment of “use level 5” John H. Sinard, MD, PhD

6. Assuring Accuracy of Asset Labeling • Blocks: • Pre-make cassettes with unique block numbers • Enter blocks into LIS by scanning • Assures correct case number (patient safety) • Confirms uniqueness of block number • Slides: • Scan block at microtome: print labels for slides • Tentative slide numbers locked in by scanning the cut, labeled slide to confirm successful cutting • Just because a label prints doesn’t mean there is a slide John H. Sinard, MD, PhD

7. Ordering Blocks in LIS after Preprinting John H. Sinard, MD, PhD

8. Barcoded Block Wizard S10-5010 01-01 John H. Sinard, MD, PhD

9. Asset Status Progression • Control Workflow • Only allow assets to progress to a new status from an appropriate old status(es), and in the correct context • Need additional statuses to accommodate alternative workflow pathways • Drive Workflow • Use asset status to determine not where it has been but rather where it is going • Status of asset (and perhaps associated assets) should determine next process, independent of asset history John H. Sinard, MD, PhD

10. Block Status Progression CheckedOut Cassette Block CheckedIn Printed Ordered Received OnBatch Embeded Filed Missing ReProcess ReEmbed Cancelled John H. Sinard, MD, PhD

11. Block Status Progression Ordered Received OnBatch Embeded Filed ReProcess ReEmbed CheckedIn CheckedOut No slide for this block has a status of “Ordered” Processor batch not yet started Processor batch marked finished Processor batch started; not marked finished At least one slide for this block has a status of “Ordered” John H. Sinard, MD, PhD

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14. Slide Status Progression for H&E Ordered Cut Collected Stained Verified For Unstained Slides Ordered On Unst. Relabeled John H. Sinard, MD, PhD

15. Slide Status Progression Ordered Cut Collected Stained Verified Ordered On Unst. Relabeled Block Embedded or Checked in Block not yet embedded Block Filed or Checked out John H. Sinard, MD, PhD

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17. Effect on Overtime in Histology John H. Sinard, MD, PhD

18. Block/Slide Tracking Errors John H. Sinard, MD, PhD

19. Block/Slide Tracking Errors John H. Sinard, MD, PhD

20. Take Home Messages • There are different degrees to which an asset tracking system can be implemented • Know what it is you want to achieve • Dashboards can be a useful tool for... ...monitoring and driving workflow ...generating real-time to-do lists John H. Sinard, MD, PhD