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Telepathology as a Networking Tool in VISN 12

Telepathology as a Networking Tool in VISN 12. Bruce E. Dunn, M.D. Milwaukee VA Medical Center E-mail: Bruce.Dunn@med.va.gov. VISN 12 Hospitals. Iron Mt. (S). Chicago Metro VAs. Tomah. Legend. Milwaukee (M,R,S). Lakeside (M,R,S). M = Affiliated with medical school

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Telepathology as a Networking Tool in VISN 12

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  1. Telepathology as a Networking Tool in VISN 12 Bruce E. Dunn, M.D. Milwaukee VA Medical Center E-mail: Bruce.Dunn@med.va.gov

  2. VISN 12 Hospitals Iron Mt. (S) Chicago Metro VAs Tomah Legend Milwaukee (M,R,S) Lakeside (M,R,S) M = Affiliated with medical school R = Pathology residence training program S = Surgery program Madison (M,R,S) Westside(M,R,S) N. Chicago(M) Hines, (M,R,S) Chicago

  3. Iron Mountain VISN 12 Distance Schematic Tomah 220 mi 92 mi 78 mi Madison Milwaukee 60 mi North Chicago 35 mi Westside Lakeside Hines 9 mi 3 mi

  4. VISN 12 Telepathology Network NRM Tomah RM Iron Mtn DR GS POP POP DR NRM NRM Madison Milw Voice-Activated Dictation GS DR POP POP Interface to VistA* DR Scanner WAN Printer NRM NRM Lakeside Westside Multi-site Conferencing* DR DR POP POP NRM NRM Hines North Chicago GS GS POP POP DR Scanner POP Printer KEY GS - gross station DR - document reader RM - robotic microscope NRM - non-robotic microscope * New function ST Micro (Hines) VHA WAN Internet VHA WAN Internet NRM DR

  5. Applications of Telepathology • Surgical pathology • Primary diagnosis or consultation • Documentation of gross pathology • Consultation with clinicians • Autopsy pathology • Clinical pathology • Microbiology • Protein electrophoresis and immunofixation • Continuing education

  6. Clinical Need for Telepathology at Iron Mountain VAMC • Retirement of pathologist • Surgical pathology (~1,000 cases per year) • Frozen sections • Autopsies (~10 per year) • Diagnostic Nuclear Medicine studies • (Service chief, clinical pathology) • Component of comprehensive telemedicine program

  7. Dynamic Robotic Telepathology 4 5 WAN IRM Router IRM Router Pathologist views images in real time Slides examined using robotically-controlled microscope 3 7 Pathologist dictates report to PA Slides read in Milwaukee 6 2 H & E Sections made Tissue examined/ hub site pathologist 1 Report printed locally and signed 9 PA enters report into Iron Mt.. DHCP 8

  8. Surgical Pathology TAT for Iron Mountain VA Medical Center TP used only to cover on-site pathologist absence Histotech/PA both involved in TP PA only involved in TP PA begins on-line transcription and correction TP implemented completely; dictations streamlined Iron Mtn. Transcriptionist retires

  9. Technical Summary (first 2,200 cases) Deferral rate: ~2% Concordance on non-deferred cases: 99.7% Time per case: 11.6 min (cases 1-200), reduced to 3.58 min (cases 2001-2200) Time per slide: 4.25 min (cases 1-200), reduced to 1.13 min (cases 2001-2200) Case turn-around-time: < 1.5 days

  10. Telepathology and the Autopsy • Send key images electronically to attending along with PAD • Submit tissue sections from a distance • Documentation of sections • Autopsy conference presentations • VistA Imaging as permanent record

  11. Consolidation of Microbiology Functions • Plate, incubate and send (portable incubators) • Telepathology to view gram stains and early culture growth - primary lab • Telepathology to view gram stains and show cultures to clinicians - core lab

  12. Conclusions • Telepathology can be extended to all areas of anatomic and clinical pathology • Multiple capabilities available • Must balance access, diagnostic accuracy and cost • Users must be flexible, but do not have to be computer experts • Strong support of telecommunications network is essential

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