anatomic pathology information the challenge of tracking and routing at mgh

1. Anatomic Pathology Information – The Challenge of Tracking and Routing at MGH Thomas M. Gudewicz, MD Massachusetts General Hospital Harvard Medical School

3. Outline Mission, Vision and Driving Forces From 1896 to 2010 - The Contrast The Challenge Tracking and Routing – Defined MGH Tracking and Routing – Today Building the Foundation

4. 1. Mission, Vision and Driving Forces 2. From 1896 to 2010 – The Contrast 3. The Challenge 4. Tracking and Routing – Defined 5. MGH Tracking and Routing – Today Building the Foundation

7. Healthcare - The Driving Forces

8. MGH Pathology Products and Services Pathology and clinical laboratory results and reports (clinicians, patients) Education and training (technologists, residents, fellows) Research materials (tissue, blocks, slides, data) Therapeutic modalities (blood and blood products, therapeutic phlebotomy, plasmapheresis, etc.)

9. MGH Pathology Products and Services Pathology and clinical laboratory reports (clinicians, patients) Education and training (technologists, residents, fellows) Research materials (tissue, blocks, slides, data) Therapeutic modalities (blood and blood products, therapeutic phlebotomy, plasmapheresis, etc.)

10. Mission, Vision, and Driving Forces From 1896 to 2010, the Contrast The Challenge Tracking and Routing – Defined MGH Tracking and Routing – Today Building the Foundation

14. 1. Mission, Vision, and Driving Forces 2. From 1896 to 2010 – The Contrast 3. The Challenge Tracking and Routing – Defined MGH Tracking and Routing – Today Building the Foundation

15. Sunquest CoPath / MGH Collaboration Software co-development: efficient, flexible work, specimen & information flow. Strengthen the informatics infrastructure: use advanced diagnostic & information management (IM) technologies. Provide a revenue stream: commercial distribution of the software.

16. Collaboration Project Requirements Retire PowerPath & Implement Sunquest CoPath 5.0 AP-LIS. Analyze, re-design, & optimize workflow top to bottom. Apply automation, advanced diagnostic & IM technologies, digital pathology, molecular tests, operational Business Intelligence (dashboards)

17. Mission, Vision, and Driving Forces From 1896 to 2010 – The Contrast The Challenge 4. Tracking and Routing – Defined MGH Tracking and Routing – Today Building the Foundation

18. Tracking and Routing

19. Assets - Defined Hard Assets: Any identified physical item assigned to a case Tissue, blocks, slides. Paper requisitions, documents and reports x-ray film. Soft Assets: Non-physical (electronic, virtual) information EMR, PACS Images CD’s (?)

20. Assets - Defined

21. Tracking – Where is the Asset?

22. Routing – Where Do Assets Go? Route: User defined criteria outlining the SPOTs that an asset must enter & exit for processing ..

23. Routing – Where Do Assets Go?

24. Mission, Vision, and Driving Forces From 1896 to 2010 – The Contrast The Challenge Tracking and Routing – Defined 5. MGH Tracking and Routing – Today Building the Foundation

25. MGH Tracking and Routing - Today Barcode technology. Limited SPOTs (7). Begins at accessioning. Ends in histology prior to delivery of slides to pathologist. After that – all bets are off. No existing software or automated rules.

26. MGH Barcoded Asset Tracking System System: MGH internally customized system. Implemented late 2004 and fine tuned through 2006. Linear barcodes. Scanners (Symbol, Orbit) single line and omnidirectional; keyboard wedge. Program Interfaces: PowerPath/AMP (Advanced Materials Processing) Transcription Service Server (SoftScript) MS Access Program Custom programs (Visual Basic, etc.)

27. MGH Barcoded Asset Tracking System

28. Barcode Use - Surgical Pathology

29. Barcode Use - Cytology and Autopsy

30. Existing System Strengths and Weaknesses Strengths Marginal Cost Asset IDs generated and distributed electronically Limited tracking possible (Who, What, When, Where) Automation of routine tasks Good reliability Reduced errors Weaknesses Limited SPOTs Customized programs LIS/equipment interface Succession planning difficult (programers) Linear barcode Manual action Not readable through objects Limited data capacity, ruggedness Orientation dependent

31. Mission, Vision, and Driving Forces From 1896 to 2010 – The Contrast The Challenge Tracking and Routing – Defined MGH Tracking and Routing – Today 6. Building the Foundation

32. Building the Foundation

33. Building the Foundation

34. LEAN principles: Just in time supply Right person – right job Work flow continuity; up-stream processes in direct proximity to down-stream processes LEAN - The Seven Wastes Overproduction Waiting Transportation Processing Inventory Motion Defects

35. Previous MGH LEAN Experience Results: Reduced average routine surgical TAT from 48 hr to 20 hr. Reduced average Biopsy TAT from 24 hr to 16 hr. Reduced overtime from 3.5 FTE’s in 2005 to 0.97 FTE’s in 2006 Improved morale.

36. Foundation Building – 1st Step

37. Foundation Building – 1st Step Present system – strengths, weaknesses, preferences. PowerPath LIS Analysis Exit interviews with users at all steps of production. Workflow Analysis Map workflow of existing production system. Future system – capabilities, requirements and desires. Sunquest CoPath 5.0 requirements and specifications Generate Gap analysis Workflow Idealized workflow design

38. Foundation Building – 2nd Step

39. Foundation Building – 2nd Step Methods: Work flow charts Failure Modes and Effects Analysis (FMEA) Time motion analysis Workflow simulation Fishbone (Ishikawa) diagrams Histograms Pareto charts

40. Analysis Methodology Map work flow analyses by functional areas identifying all decision points and hand-offs. Identify how the system falters or fails (failure modes). Confirm process by direct observations. Incorporate time-motion analysis, Spaghetti diagrams, etc. as necessary. Simulate alternative work flows with available data (iGrafx®).

41. Workflow Chart – Back Bench

42. Failure Mode and Effects Analysis (FMEA) Product development and operations management tool for analysis of failure modes (FM) in various phases of a product life cycle. FMs are errors or defects in a process, design, or item. Team approach used to identify failure modes (potential or actual) based on experience and risk analyses. Drives designs by prioritizing highest risk failures for early attention.

43. FMEA Cycle

44. FMEA – Small Gross Bench

45. FMEA – Failure Modes Summation

46. Initial Project Results 27 Functional Areas (FA) mapped for workflow Workflow confirmation by observation complete in 1 area and ongoing in 2nd but largest functional area 1 FMEA completed

47. Summary of 27 Functional Areas (FA) A preliminary analysis of our workflow includes 27 functional areas defined as separate physical locations or task specific areas within a physical location, representing nearly all areas of surgical, cyto and autopsy pathology, with the notable exception of immunohistochemistry. A preliminary analysis of our workflow includes 27 functional areas defined as separate physical locations or task specific areas within a physical location, representing nearly all areas of surgical, cyto and autopsy pathology, with the notable exception of immunohistochemistry.

48. Simple Sign-Out: 1 H&E slide The simple sign-out is for, example, a vas deferens, one H&E slide per part, no recuts, immunos, special stains, QA issues. The simple sign-out is for, example, a vas deferens, one H&E slide per part, no recuts, immunos, special stains, QA issues. 

49. Acknowledgments Carlos Alaya William Amin Denise Bland-Piontek Maya Daderling James Happel Chris Oberg David McClintock Michelle Schwab-Macdonald

50. Questions?