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Procedure Step Approaches for Pathology Lab Workflow

Procedure Step Approaches for Pathology Lab Workflow. Harry Solomon, GE Healthcare Co-chair, HL7/DICOM Imaging Integration WG. Path lab workflow. From Søren Skovsen, Dako. Managed Workflow Concepts. Conceptual Procedure Steps. Accessioning Gross imaging (VL Photographic)

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Procedure Step Approaches for Pathology Lab Workflow

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  1. Procedure Step Approachesfor Pathology Lab Workflow Harry Solomon, GE Healthcare Co-chair, HL7/DICOM Imaging Integration WG

  2. Path lab workflow From Søren Skovsen, Dako

  3. Managed Workflow Concepts

  4. Conceptual Procedure Steps • Accessioning • Gross imaging (VL Photographic) • Tissue Processing • Including embedding, sectioning • May be several separate processes / steps • Staining • Whole Slide Imaging • Analysis • Including automated and human • Reporting

  5. Management of Procedure Steps • A responsibility of Lab Info System • Needs an explicit information model of Procedure Steps • Scheduling / control of managed device or human processes • Receive status inputs • Track work products • Basic approaches • IHE-LAB Lab Device Automation (LDA) Profile using HL7v2 • IHE-AP Anatomic Pathology Workflow (APW) Profile using DICOM

  6. Integrating the Healthcare Enterprise • An international public-private initiative • 425 members: 60 healthcare professional organizations; 15 government agencies; 10 SDOs and trade associations; 30 provider, research and education organizations; 300 HIT and consulting companies • Goal to improve patient care and provider efficiency by harmonizing electronic health information exchange • Profiles approved standards to seamlessly pass health information among care providers on a local, regional and national level • Developed through ~10 specialty domains • Collaboration with regional and national deployment efforts (e.g., ONCHIT, Canada Health Infoway)

  7. IHE Lab Device Automation • Pre-analytical process (sorting, centrifugation, aliquoting, transportation, decapping) • Analytical process (run of the ordered tests on the specimen) • Post-analytical process (recapping, transportation, rerun, storage and retrieval).

  8. IHE LDA Profile uses HL7v2 • LAB-21 WOS download to automated device - OML/ORL • LAB-22 WOS queried by automated device - QBP/RSP • LAB-23 Status change of an analytical WOS, and upload of the results produced - OUL • LAB-26: Status change of a pre- or post-analytical WOS - SSU

  9. IHE Anatomic Path Workflow • Modeled on IHE Radiology Scheduled Workflow • Expected to leverage DICOM infrastructure for imaging workflow management and work products

  10. IHE APW Profile uses DICOM • PAT-5 Query Modality Worklist - MWL • PAT-6 Modality Procedure Status Notification - MPPS • RAD-8/-10/-43 Work Product Stored – Storage / Storage Commit

  11. Selection of a Workflow Approach • DICOM objects used for image work products (WSI and gross imaging) • Presumption of workflow management for imaging using DICOM MWL / MPPS • But not necessarily • Desired consistent, comprehensive lab workflow • Either HL7 or DICOM approach can work, or we could have a mixed environment • Which world is the AP lab in - Lab, or Imaging?

  12. Imaging as HL7 Lab Device • Permits either push or pull workflow management • Needs profiling of several HL7 segments and fields beyond requirements of IHE-LAB • Study identifiers (use IPC segment?) • Imaging parameters • Specimen preparation history • References to images produced • Images still stored / committed using DICOM

  13. Preparation history example

  14. Staining as DICOM Modality • Pull model only (device always queries for work step) • CP-1149 (Final Text Oct 2011) • MWL Protocol Codes, stain identifiers defined in DICOM Context Groups using SNOMED • May also use private code or text • Stain step results transcribed from MPPS into Specimen Preparation Sequence item • May need minor change to Specimen Preparation Sequence to simplify transcription • Complex protocol could be recorded in persistent object • Specimen Prep SR object

  15. Pros & Cons • LIS systems may already implement HL7v2 (although not to requirements of IHE LDA) • DICOM MWL/MPPS supported by variety of brokers / interface engines (but don’t support specimen-related attributes) • DICOM object management infrastructure has no HL7 counterpart • Don’t forget cytometry – processes more closely aligned with lab world

  16. Strawman Proposal • Use HL7v2 messages profiled in IHE LDA for device workflow management • Add features for needs of imaging management • Use value sets specified in DICOM • Use DICOM services profiled in IHE APW for persistent object management • WSI, photography, stain SR, cytometry (embedded FCS) • Work with IHE-AP to profile this new configuration • Change to APW? New profile?

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