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Surgical Pathology Quality Assurance Program Using Robotic Real-time Telepathology

Ronald S. Weinstein, M.D. Professor, Pathology Head, Pathology 1990 – 2007 Director, Arizona Telemedicine Program. Surgical Pathology Quality Assurance Program Using Robotic Real-time Telepathology. Disclosure. DMetrix – Tucson, AZ Medical Director Apollo Telemedicine – Falls Church, VA

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Surgical Pathology Quality Assurance Program Using Robotic Real-time Telepathology

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  1. Ronald S. Weinstein, M.D. Professor, Pathology Head, Pathology 1990 – 2007 Director, Arizona Telemedicine Program Surgical Pathology Quality Assurance Program Using Robotic Real-time Telepathology

  2. Disclosure • DMetrix – Tucson, AZ • Medical Director • Apollo Telemedicine – Falls Church, VA • Shareholder

  3. Telepathology • The use of telecommunications technology to facilitate the transfer of image-rich pathology data between remote locations for the purposes of diagnosis, education, and research.

  4. Telepathology systems are divided into three major types: static image-based systems, real-time systems, and virtual slide systems. • Static image systems have major benefits of being the most reasonably priced and usable in the widest range of settings, but have the significant drawback in only being able to capture a selected subset of microscopic fields. • Real-time systems and virtual slides allow a consultant pathologist the opportunity to evaluate the entire specimen. With real-time systems, the consultant actively operates a microscope located at a distant site -- changing focus, illumination, magnification, and field of view at will. • Virtual slide systems utilize an automated scanner that takes a visual image of the entire slide, which can then be forwarded to another location for diagnosis.

  5. *Hospital housing the telepathology workstation. The Hospital General del Estado in Hermosillo served as the hub for a network of regional hospitals whose pathologists brought cases to the referring site for transmission to Tucson and teleconsultation.

  6. a University of Arizona telepathology services, initial 4100 cases, 1993-2008. b Weinstein Classification of Telepathology Systems [2]. c For special studies, such as immunohistochemistry, or for glass slide review d Includes some second-opinion cases.

  7. TELEMEDICINE JOURNALVolume 1, Number 1, 1995Mary Ann Liebert, Inc., Publishers Case Triage Model for the Practice of Telepathology A.K. BHATTACHARYYA, M.D., JOHN R. DAVIS, M.D., BRADFORD E. HALLIDAY M.D., ANNA R. GRAHAM, M.D., S. ANNE LEAVITT, M.D., RALPH MARTINEZ, Ph.D., RICARDO A. RIVAS, and RONALD S. WEINSTEIN, M.D.

  8. Case Triage Model Referring Pathologist Triage Pathologist Subspecialty Pathologist Triage Pathologist Case Sign-out Case Sign-out PATHWAY A PATHWAY B

  9. AFIP Model Referring Pathologist Triage Clerk GYN Path Renal Path Derm Path Etc. GI Path Case Sign-out Case Sign-out Case Sign-out Case Sign-out Case Sign-out

  10. a University of Arizona telepathology services, initial 4100 cases, 1993-2008. b Weinstein Classification of Telepathology System [2]. c For special studies, such as immunohistochemistry, or for glass slide review

  11. Havasu Regional Medical Center University Medical Center Tucson, AZ 316 Miles

  12. Quality Assurance Program • HRMC processes approximately 3500 surgical pathology cases annually • One pathologist, on-site, between July 2005 and October 2009. • All new cancer cases and challenging non-malignant cases were selected by the HRMC pathologist for telepathology re-review.

  13. Deferral Rate

  14. Deferral Rate

  15. Deferral Rate

  16. Deferral Rate • The case deferral rates for individual telepathologists ranged from 4.79% to 21.26% • The deferral rates were not significantly changed by exclusion of cases within the individual pathologists’ subspecialty area. These deferral rates ranged from 4.94% to 21.81%

  17. The triage pathologist completed the telepathology consultation without any assistance of a subspecialty pathologist in 66% of the cases. • A review panel examined the original glass slides from 134 cases by light microscopy. • Concordance rates of the telepathologists’ provisional diagnosis or review panel’s diagnoses with the referring pathologists’ diagnoses were not statistically different ( P > 0.05).

  18. Conclusions: • Deferral rates were minimally impacted by pathologist subspecialty. • Overall diagnostic discordance rate, comparing on-site light microscopy and telepathology diagnoses, was 5.73%. • Deferrals for glass-slide review represented less than 10% of telepathology QA cases.

  19. Conclusions: • Deferral rates were minimally impacted by pathologist subspecialty. • Overall diagnostic discordance rate, comparing on-site light microscopy and telepathology diagnoses, was 5.73%. • Deferrals for glass-slide review represented less than 10% of telepathology QA cases.

  20. Telepathology Practice Models

  21. Thank you!

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