Anatomic pathology laboratories receive multiple specimen types including pathology, IHC, molecular, next-gen sequencing, FLOW, cytogenetics, FISH, clinical trials, and specialty testing. This is why anatomic pathology laboratories require a sophisticated laboratory information system (LIS) with enhanced capabilities that can manage everything from routine to highly complex cases.
The right system must be able to receive specimens coming in from various locations and process multi-part specimens quickly and efficiently from accessioning to reporting. It should also provide for easy capture of gross information, histology management, pathology review and reporting, test add-ons, tissue mapping, image management, integrated voice recognition/navigation, and digital pathology integration. Specimen management, tracking, and validation are of paramount importance to ensure patient safety.
Not all lab information systems are built to provide these solutions. Your choice is to:
- Replace the entire LIS by upgrading to a new system with enhanced capabilities, or
- Integrate your current system with a new, complementary LIS, where needed, that can provide these specialized features.
Let’s review some of the unique LIS capability requirements for a modern anatomic pathology laboratory.
Specimen Management and Tracking
While speed and efficiency are indeed important, nothing is more important than ensuring patient safety by effectively managing the specimen through a robust labeling and tracking program. A suitable LIS should provide for cassette and label printing at every step in the process. It should also let the user scan a specimen barcode (whether on a jar, block, or slide) to make sure that the specimen is the correct specimen for the case that is being worked. The LIS specimen management functionality should also provide for tracking of send-out cases and storage of specimens.
Grossing needs to provide an easy review of the patient and specimen data, the printing of cassette(s), and easy data entry of the gross description. It is important for the grosser to be able to be hands-free when needed, allowing the use of voice navigation and voice recognition to enter the gross description in the application.
Histotechs have specific needs when it comes to an LIS to manage their workflow. This can include defined steps for embedding, cutting (microtomy), and staining (histology). Additional workflow steps can be added for quality control (QC) or for digital pathology scanning. This highlights the importance of having a configurable workflow that fits the needs of the lab. As always, barcode scanning, positive specimen verification, and label printing are critical. The ability for a histotech to quickly add tests/slides to a block is also important. The LIS system should immediately notify the histotech, on the screen, when add-on tests have been ordered by the pathologist.
Complex Multi-Specimen Cases (Urology, GI, Breast)
Good reporting for any complex multi-specimen case type starts during the accession process. The accessioner should be able to identify the specimens and quickly accession them into the LIS. When applicable specimen accessioning should match the collection kits for optimal data entry. Multi-specimen cases should be simple to manage through the grossing and histology workflow. At reporting, the pathologist should have the option to review all specimens in an easy-to-use grid with minimal need to scroll. Reporting should be easy with the use of hotkeys for selecting macros by diagnostic categories. For cases with multiple specimens, this is critical. The screen should also allow for easy test add-ons and for requests for global reads in technical component/professional component (TC/PC) scenarios. Reporting options for tissue maps, images, special stain/IHC tables, and synoptic reporting, are also important. Integrated voice recognition and navigation are effective time savers for a pathologist. The LIS should be able to be configured for any specialized multi-specimen case type to make it easier for pathologists to review and report cases.
Often a pathologist will order additional medically necessary molecular test add-ons to provide additional information about the disease and how to treat it. A suitable LIS must integrate all kinds of molecular results including polymerase chain reaction (PCR), next-generation sequencing (NGS), and gene-micro array for further assessment by the pathology team and for reporting purposes.
Bone Marrow Morphology
Bone marrow morphology reporting needs to capture a variety of results including the complete blood count (CBC), special stain/IHC, and any other types of relevant information. This module is tied to a complete histology module with grossing and histology workflows.
In addition to general anatomic pathology, each subspeciality within pathology (such as hematopathology, GI pathology, genitourinary (GU) pathology, and Dermatopathology) have incredibly unique needs, that the LIS must be able to accommodate.
Case Summary Reporting
The report is in many ways a laboratory’s calling card, and the right LIS must provide customizable reports that enable pathologists to better support the ordering clinicians by providing informative and clear diagnostic guidance. Ordering clinicians need to be able to quickly digest time-sensitive information. Reports can include diagnostic images, transcripted narratives, current and previous test results, patient history, and calculated scores to show the probability of an outcome against a given population of patient data.
Comprehensive case summary reports can incorporate results from several modalities into a single report. Drilldown links enable physicians to easily review information in detail and share it with others as needed.
TC/PC – Revenue Sharing
Pathologists also need to separate technical and professional workflow components for revenue sharing business relationships, seamlessly managing complex TC/PC revenue splits for workflows such as flow cytometry, FISH, and histology/IHC with integrated digital pathology.
Successful integration of digital pathology in laboratories is dependent on workflow, including seamless integration with the LIS. The LIS must be fully integrated with histology automation such as the Leica Cerebro or the Ventana Vantage platform. It must also be able to pass case information to the digital pathology system, as well as prepare barcoded slide labels that can be read by the imaging device. Once slides are scanned and the whole slide images are ready for review, pathologists should be notified of their availability via the LIS. The ideal digital workflow includes access to all case-related whole slide images via an image viewer within the LIS. Pathologists can then capture regions of interest and include them in the LIS report if desired. If the pathologist is utilizing automated image analysis, then those results should be able to be seamlessly incorporated into the LIS and final report.
Supplement your existing LIS
Replacing lab information systems can be time-consuming and costly. At XIFIN we recommend that if you have an LIS that works well for your lab but has capability gaps, rather than ripping and replacing your LIS, you should consider integrating a new system with your existing system to provide a solution for those capability gaps and expand performance. Labs are not always able to change their entire LIS but that does not mean that they must live with systems that do not support their needs.
How can XIFIN LIS help you?
Laboratory diagnostics can be complicated and require a pathologist to provide a comprehensive assessment to aid in the treatment planning of the patient. Labs need specific solutions for each case type they manage and a means to review all the results and create a summary case report. The XIFIN team believes in configurable systems that allow labs to define case types and workflows, integrate the data via an interface, and create a report that represents those results. We believe in products that support the pathology team and further increase the value they provide to the care team.
Learn more about how XIFIN LIS can augment your existing LIS to fill any capability gaps you suffer with in your anatomic pathology and sub-specialty pathology practice.