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Procedure Step Approaches for Pathology Lab Workflow

This document outlines approaches to streamline pathology lab workflows by integrating HL7 and DICOM standards. Key process steps include accessioning, gross imaging, tissue processing, staining, whole slide imaging, and reporting. The workflow management relies on explicit information models and effective scheduling of managed devices and human processes. Utilizing IHE-LAB and IHE-AP profiles, this initiative aims to enhance patient care and provider efficiency by harmonizing electronic health information exchange. Collaboration with diverse organizations ensures seamless information flow on various levels.

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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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