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Mark Routbort MD PhD 1 ; Erin Grimm, MD 2 ; Rodney Schmidt MD PhD 2 .

Optimized Document Management in Anatomic Pathology – Two Paths to a Common Workflow with Analysis of Benefits. Mark Routbort MD PhD 1 ; Erin Grimm, MD 2 ; Rodney Schmidt MD PhD 2 .

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Mark Routbort MD PhD 1 ; Erin Grimm, MD 2 ; Rodney Schmidt MD PhD 2 .

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  1. Optimized Document Management in Anatomic Pathology – Two Paths to a Common Workflow with Analysis of Benefits Mark Routbort MD PhD1; Erin Grimm, MD2; Rodney Schmidt MD PhD2. 1Department of Hematopathology, MD Anderson Cancer Center, Houston, TX; 2University of Washington, Seattle, WA.

  2. Imperatives • Operate more efficiently • Facilitate information flow • Preserve records Paper is cheap and records are stable but there are high indirect costs associated with using and managing paper.

  3. What are the benefits of document imaging? • Scan case paperwork • Instant availability of original paperwork Easily implemented • Permanent storage • Quick retrieval • No xeroxing!!! • No paper storage

  4. Inside Cases Consult Cases = Possible places to scan documents What are possible workflows for scanning?

  5. Baseline state • UWMC • Paper records only (no scanning) • MDACC • Paper sent to outside service for scanning after cases were signed out Both used PowerPath v8.3 (Impac) with Imaging licenses (engineered for gross and micro images). Scan via TWAIN interface, store, display with case.

  6. UWMC Approach • Scan paper using native PowerPath function • Consult cases at accessioning • Inside surgicals after signout • Cost-benefit analysis • Directly measurable benefits • User survey • Custom middleware to improve workflow

  7. Document accumulation - UWMC

  8. How does scanning help workflow? • Paperwork is instantly available • Pathologists/Residents don’t spend time searching for paperwork during: • Case signout • Conference preparation • Off-site coders have access to original paper during billing

  9. UWMC – Financial Analysis

  10. UWMC – User survey after implementation of document scanning system

  11. Documents – Benefits • Direct benefits low • Takes longer to scan than copy • Primarily due to system login, navigation • Indirect benefits high (35 hrs/wk) • Instant 24 x 7 availability • No paper retention • Easy conference preparation • Integration with PowerPath

  12. Custom Middleware - UW • Facilitates document scanning workflow • Avoids multiple logins • Bypasses navigation to cases in PowerPath • TWAIN interface to scanner • Single- and multi-sheet modes • Direct insertion of scanned images into PowerPath

  13. Post-middleware survey • Accessioners liked using it • Subjective average score 10.0/10 • Document scanning process is faster • Subjective average score 8.3/10 • Saved 0.25 min/case • Doing additional work (renaming images) • Scanning cases in batches (minimizes login and navigation benefits)

  14. MDACC Approach • Bring scanning in-house • Custom middleware to facilitate scanning • Motivated by anticipated workflow • Avoid multiple logins and PowerPath navigation • TWAIN driver for scanner • Direct insertion of images into PowerPath • Assess benefits

  15. Benefits - MDACC • Cost avoidance of >$50,000/yr • Timely archiving of paperwork • Eliminate scanning of unnecessary and redundant documents • Universal access to archived images through PowerPath • Indirect utilization benefits similar to UW

  16. Conclusions • UWMC and MDACC both achieved large direct and indirect benefits • Optimal workflow is key – both compelled to write middleware to improve scanning workflow • Integration with the AP-LIS (PowerPath) is enormously beneficial • Workflow is key • Digitization of data is beneficial

  17. Future Scan all paperwork at the time of accessioning • Real-time availability while case is in process • Concurrent availability (e.g. transcription, coding, resident, pathologist) • Immediate archiving (no lost paper) • Custom apps (e.g. gross room)

  18. Acknowledgements • UWMC • Kevin Fleming, Rosy Changchien, Kim Simmons, Paula Reeve, Phil Nguyen, Victor Tobias • MDACC • Mike Riben, Lori Heydon

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